All posts by william-davis

Why ATP-3 is B--- S---

20. August 2011 William Davis (8)

A Heart Scan Blog reader posted the link to this very excellent presentation by Dr. David Diamond, a neuroscientist at the University of South Florida.

ATP-3, or Adult Treatment Panel-3, is the set of cholesterol treatment guidelines as established by the National Cholesterol Education Panel, the guidelines used by practicing physicians nationwide. They are also the metric by which the "quality" of care is being judged by agencies like Medicare, health insurers, and other parties interested in policing healthcare. Dr. Diamond ably recounts how we ended up in this mess, the conflagration of "cut your fat, reduce cholesterol, and take a statin drug."

I was very impressed that, in his closing comments, he briefly discusses the pivotal role of glycation in heart disease causation. You will see in coming conversations how important an understanding of glycation is to create a healthy diet and lifestyle.

How far wrong can cholesterol be?

17. August 2011 William Davis (32)

Conventional thinking is that high LDL cholesterol causes heart disease. In this line of thinking, reducing cholesterol by cutting fat and taking statin drugs thereby reduces or eliminates risk for heart disease.

Here's an (extreme) example of just how far wrong this simpleminded way of thinking can take you. At age 63, Michael had been told for the last 20 years that he was in great health, including "perfect" cholesterol values of LDL 73 mg/dl, HDL 61 mg/dl, triglycerides 102 mg/dl, total cholesterol 144 mg/dl. "Your [total] cholesterol is way below 200. You're in great shape!" his doctor told him.

Being skeptical because of the heart disease in his family, had a CT heart scan. His coronary calcium score: 4390. Needless to say, this is high . . . extremely high.

Extremely high coronary calcium scores like this carry high likelihood of death and heart attack, as high as 15-20% per year. So Michael was on borrowed time. It was damn lucky he hadn't yet experienced any cardiovascular events.

That's when Michael found our Track Your Plaque program that showed him how to 1) identify the causes of the extensive coronary atherosclerosis signified by his high calcium score, then 2) correct the causes.

The solutions, Michael learned, are relatively simple:

--Omega-3 fatty acid supplementation at a dose sufficient to yield substantial reductions in heart attack.
--"Normalization" of vitamin D blood levels (We aim for a 25-hydroxy vitamin D level of 60-70 ng/ml)
--Iodine supplementation and thyroid normalization
--A diet in which all wheat products are eliminated--whole wheat, white, it makes no difference--followed by carbohydrate restriction.
--Identification and correction of all hidden causes of coronary plaque such as small LDL particles and lipoprotein(a)

Yes, indeed: The information and online tools for health can handily exceed the limited "wisdom" dispensed by John Q. Primary Care doctor.

The best artificial sweeteners

13. August 2011 William Davis (23)

Our new recipes, such as New York Style Cheesecake and Chocolate Coconut Bread, are wheat-free and low- or no-carbohydrate. They fit perfectly into the New Track Your Plaque Diet for gaining control over coronary atherosclerotic plaque, not to mention diabetes, pre-diabetes, hypertension, small LDL particles, high triglycerides, high inflammation (c-reactive protein) and other distortions of metabolism.

However, there's one compromise: We include use of non-nutritive sweeteners. It's therefore important to know that artificial sweeteners are not all created equal.

One common tripping point: maltodextrin.

Maltodextrin is composed of polymers (repeating subunits) of glucose, as few as 3 or as many as 20 or more glucose subunits. So maltodextrin is glucose sugar. While it lacks the especially destructive pentose sugar, fructose, maltodextrin is metabolized to glucose and thereby increases blood sugar substantially.

Many artificial sweeteners are bulked up with maltodextrin. For instance, granulated Splenda and Stevia in the Raw, two sweeteners billed as low-calorie and sugar-free that is used on a cup-for-cup basis like sugar, are primarily maltodextrin--with only a teensy bit of Splenda or stevia.

The best artificial sweeteners, i.e., the most benign without a load of maltodextrin, are:

Liquid stevia--Just the extract from stevia leaves and water. It can be a bit pricey, e.g., $10 for a 2 oz bottle, but a little goes a long way.

Truvia--While I'm not too fond of the manufacturer (Cargill), I believe that Truvia is among the better sweeteners around. It is a mixture of the natural sugar, erythritol, that generates little to no blood sugar effects and rebiana (rebaudioside), an isolate of stevia. Some people aren't too fond of the mild menthol-like cooling effect of the erythritol nor the slight aftertaste. I find it works pretty well in most recipes.

Be aware that, no matter which artificial sweetener you use, it has the potential to stimulate appetite. I therefore like to not eat foods sweetened with liquid stevia or Truvia in isolation but as part of a meal. That way, any appetite stimulation that results is substantially quelled by the proteins and fats ingested.

Sugar Nation

11. August 2011 William Davis (10)

Former Men's Health editor, Jeff O'Connell, has just released his new book, Sugar Nation.

Back in 2009, Jeff contacted me to obtain some background insights into diabetes and its relationship with diet. He recently sent me a copy of his new book that contains some brief quotes from me.

Jeff is a writer, not a physician nor scientist. But I think that you will find his grasp of diabetes and the nutritional and lifestyle events that led him there far exceed the insights held by most practicing physicians. Like many of us, Jeff discovered how to find his way back from pre-diabetes through lessons he had to learn on his own, but not from his doctor.

Jeff tells this story as reporter, son of an estranged diabetic father with whom he reconnects as he approaches the end of his life, and as fellow sufferer of the pre-diabetic/diabetic mess that modern habits and "official" dietary advice have given us. Jeff's book is worth a read to see yet another dimension of the human stories that are emerging from this incredible nutritional tangle we find ourselves in.

Here's a unique YouTube video about Jeff's story.

Track Your Plaque makes Consumer Reports!

8. August 2011 William Davis (27)

. . . but not in a good way.

The September, 2011 issue of Consumer Reports showcases their Protect Your Heart discussion. Third paragraph: "The website Track Your Plaque warns, 'The old tests for heart disease were wrong--dead wrong.' It says heart scans are 'the most important health test you can get.'"

They go on to expose the overuse of heart procedures like angioplasty and stent implantation and offer their advice on how to manage heart disease risk: lower BP, reduce LDL cholesterol, lose weight, stop smoking, take aspirin. They quote Dr. Paul Ridker who declares heart scans are not useful because the "deposits cardiologists worry about are the less stable plaques that CT scans routinely miss."

I thought I'd been transported back to 1995. Not only is it clear that the Consumer Report writers never looked beyond the homepage of Track Your Plaque, but somehow saw our heart disease prevention and reversal program as promoting heart procedures. Incredible.

Of course, the Track Your Plaque program does the exact opposite: Advocates an approach that virtually eliminates the need for procedures and returns control over heart disease to the participant. That's a critical difference.

And, as I've had to remind my colleagues time and time again, what we are really after is an index of total coronary atherosclerotic plaque. Even in 2011, that index remains the simple coronary calcium score, a gauge of total plaque, not just of "hard," stable plaque. Perhaps in 10 years we will be using a better tool to gauge progression and regression of all the components of coronary atherosclerotic plaque, but today it remains the simple, accessible, mammogram-like coronary calcium score.

Consumer Reports does for the idea of heart disease prevention what food manufacturers do for health and weight loss: Echo conventional wisdom of the sort that generally makes us fatter, more diabetic, leads us to more heart procedures and needless deaths. I might use Consumer Reports to rate MP-3 devices or toasters, but I certainly would not rely on them for insightful health advice.

Paging Dr. Basedow

6. August 2011 William Davis (8)

A 23-year old man came to my office having experienced weeks of extreme anxiety, palpitations, and 19 pounds of weight loss triggered by an overactive thyroid.

It all happened because of a large dose of iodine received during a CT scan using iodine-containing x-ray dye. (X-ray dyes are made visible on x-ray due to the iodine content.) This is a reaction first described in the 19th century by German physician, Karl Adolph von Basedow. (Jod is German for iodine.)[caption id="attachment_4313" align="alignleft" width="217" caption="Dr. von Basedow. Image courtesy Wikipedia"]

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Now, here's the kicker: Jod-Basedow only occurs when there is pre-existing iodine deficiency. Indeed, this young man had an enlarged thyroid, signaling longstanding iodine deficiency (a goiter).

This example is among the more flagrant examples of something I have been witnessing: the return of iodine deficiency. As Americans cut back on their intake of iodized salt and fail to obtain iodine in sufficient quantities from seafood, seaweed, or supplementation, goiters and iodine deficiency are making a return in all its glory, reminiscent of the early 20th century, pre-iodized salt.

This young man's frightening experience is yet another way iodine deficiency can show itself, by the overenthusiastic thyroid response to a large dose of iodine when iodine deficiency has been present for a prolonged period.

Iodine deficiency and goiters have been lost to memory for most people. Even the FDA, in its advice for Americans to reduce salt and sodium intake, have forgotten to remind everyone to obtain iodine from an alternative source. "Those who cannot remember the past are condemned to repeat it."

Get your iodine.

Carb counting

5. August 2011 William Davis (20)

In the recent Heart Scan Blog post, Can I eat quinoa, I discussed how non-wheat carbohydrate sources like quinoa, amaranth, black beans, brown rice, fruit, etc. do not exert the inflammation-provoking, appetite-increasing effects of wheat (since gliadin and gluten are not present), nor do they increase blood glucose as enthusiastically as the amylopectin A of wheat--but non-wheat grains can still increase blood sugar quite substantially.

Of course, any food that triggers blood sugar also trigger hepatic de novo lipogenesis, thereby increasing triglyceride levels and postprandial particles (e.g., chylomicron remnants), which, in turn, triggers formation of small LDL particles.

So these non-wheat carbohydrates, or what I call "intermediate carbohydrates" (for lack of a better term; low-glycemic index is falsely reassuring) still trigger all the carbohydrate phenomena of table sugar. Is it possible to obtain the fiber, B-vitamin, flavonoid benefits of these intermediate carbohydrates without triggering the undesirable carbohydrate consequences?

Yes, by using small portions. Small portions are tolerated by most people without triggering all these phenomena. Problem: Individual sensitivity varies widely. One person's perfectly safe portion size is another person's deadly dose. For instance, I've witnessed many extreme differences, such as 1-hour blood sugar after 6 oz unsweetened yogurt of 250 mg/dl in one person, 105 mg/dl in another. So checking 1-hour blood sugars is a confident means of assessing individual sensitivity to carbs.

Some people don't like the idea of checking blood sugars, however. Or, there might be times when it's inconvenient or unavailable. A useful alternative: Count carbohydrate grams. (Count "net" carbohydrate grams, of course, i.e., carbohydrates minus indigestible fiber grams to yield "net" carbs.) Most people can tolerate around 40-50 grams carbohydrates per day and deal with them effectively, provided they are spaced out throughout the day and not all at once. Only the most sensitive, e.g., diabetics, apo E2 people, those with familial hypertriglyceridemia, are intolerant to even this amount and do better with less than 30 grams per day. Then there are the genetically gifted from a carbohydrate perspective, people who can tolerate 50-60 grams, occasionally somewhat more.

People will sometimes say things like "You don't know what the hell you're talking about because I eat 200 grams carbohydrate per day and I'm normal weight and have perfect blood sugar and lipids." As in many things, the crude measures made are falsely reassuring. Glycation, for instance, from postprandial blood sugars of "only" 140 mg/dl--typical after, say, unsweetened oatmeal--still works its unhealthy magic and will lead long-term to cataracts, arthritis, and other conditions.

Humans were not meant to consume an endless supply of readily-digestible carbohydrates. Counting carbohydrates is another way to "tighten up" a carbohydrate restriction.

One hour blood sugar: Key to carbohydrate control and reversing diabetes

2. August 2011 William Davis (27)

Diabetics are instructed to monitor blood glucose first thing in the morning and two hours after eating. This helps determine whether blood sugar is controlled with medications like metformin, Januvia, Byetta injections, or insulin.

But that's not how you use blood sugar to use to prevent or reverse diabetes. Two-hour blood sugars are also of no help in deciding whether you have halted glycation, or glucose modification of proteins the process that leads to cataracts, brittle cartilage and arthritis, oxidation of small LDL particles, atherosclerosis, kidney disease, etc.

So the key is to check one-hour after-eating (postprandial) blood sugars, a time when blood glucose peaks after consumption of carbohydrates. (It may peak somewhat sooner or later, depending on factors such as how much fluid was in the meal; protein, fat, and fiber content; presence of foods like vinegar that slow gastric emptying; the form of carbohydrate such as amylopectin A vs. amylopectin B, amylose, fructose, along with other factors. Once in a while, you might consider constructing your own postprandial glucose curve by doing fingersticks every 15 minutes to determine when your peak occurs.)

I reject the insane notion that after-eating blood sugars of less than 200 mg/dl are acceptable, the value accepted widely as the cutoff for health. Blood sugars this high occurring with any regularity ensure cataracts, arthritis, and all the other consequences of cumulative glycation. I therefore aim to keep one-hour after-eating glucoses 100 mg/dl or less. If you start in a pre-diabetic or diabetic range of, say, 120 mg/dl, then I advise people to not allow blood glucose to go any higher. A pre-meal blood glucose of 120 mg/dl would therefore be followed by an after-eating blood glucose of no higher than 120 mg/dl.

No doubt: This is strict. But people who do this:

--Lose weight from visceral fat
--Heighten insulin sensitivity
--Drop blood pressure
--Drop HbA1c and fasting glucose over time
--Reduce small LDL and other carbohydrate-sensitive measures

By the way, if you inadvertently trigger a high blood sugar like I did when I took my kids to the all-you-can-eat Indian buffet, go for a walk, bike, or burn the sugar off with a 30-minute or longer physical effort. Check your blood sugar again and it should be back in desirable range. But then learn from your lesson: Eliminate or reduce portion size of the culprit carbohydrate food.

Wheat Belly coming to bookstores!

31. July 2011 William Davis (18)

Anyone following the conversations on these pages know that I have some very serious concerns about this thing being sold to us called "wheat"--cause it ain't wheat! It is the result of incredible genetics shenanigans inflicted on this plant, mostly in the name of increased yield per acre.

I now classify wheat as "Public Enemy #1," the prime nutritional culprit underlying obesity, heart disease, "cholesterol" abnormalities, hypertension, arthritis, psychiatric illness, and on and on. Once you read the full story, I believe that you will agree: Modern Triticum aestivum, the plant that now serves as the source for virtually all the wheat flour products now consumed--organic, whole grain, multigrain, sprouted . . . it makes no difference--does not belong in the human diet. So many people, searching for solutions for their fatigue, weight gain, leg edema, incurable rashes, joint pain, etc., will find their answers here.

Wheat Belly: Lose the wheat, lose the weight and find your path back to health will be on bookstore shelves including Barnes and Noble August 30, 2011 or is available for preorder here at Amazon. Wheat Belly will also be available as a downloadable Kindle book and as unabridged audio CDs.

You can also follow the Wheat Belly conversations on my Wheat Belly Blog. One of my recent posts discusses the herbicide-resistant semi-dwarf wheat strain, Clearfield, that is now making its way to more and more supermarket shelves.

You'll also find more conversation on the Wheat Belly Facebook pages.

The exception to low-carb

31. July 2011 William Davis (60)

I witness spectacular results restricting carbohydrates, both in the office as well as in my online experiences, such as those in Track Your Plaque. Of course, the diet I advocate is not just low-carb; it starts with elimination of wheat (for a long list of reasons). So the diet is wheat-free in the setting of low-carbohydrate.

What does this accomplish? Here's a partial list:

--Weight loss-Specifically, loss of visceral fat, the kind hinted at on the surface as "love handles" or what I call "wheat belly."
--Reduced blood sugar and HbA1c (reflecting prior 60-90 days glucose)
--Marked reduction in small LDL and triglycerides, increased HDL
--Reduced inflammatory measures like c-reactive protein
--Reduced leptin and leptin resistance, increased adiponectin
--Reduced estrogen and prolactin in men, accompanied by shrinkage or loss of enlarged breasts ("man boobs"); reduced estrogen in females accompanied by reduced risk for breast cancer

Pretty impressive. But there's one group of people who can experience unexpected effects with this diet: The 25% of people with apoprotein E4.

Everybody has two genes for apo E; the most common type is apo E 3/3. Around 1 in 4 people have 1, less commonly 2, genes for apo E4.

I hate apo E4. I hate apo E4 because it means I've got to dust off the nonsense I used to tell patients about cutting their fat, cutting their saturated fat. But that's what apo E4 people have to do. But it doesn't end there.

Apo E4 people also typically have plenty of small LDL particles triggered by carbohydrates. Put fats and carbohydrates together and you get an explosion of small LDL particles. Remove fats, small LDL goes down a little bit, if at all. Remove carbohydrates, small LDL goes down but total LDL (mostly large) goes up. The large LDL in apo E4 does seem to be atherogenic (plaque-causing), though the data are fairly skimpy.

So apo E4 creates a nutritional rock and a hard place: To extract full advantage from diet, people with apo E4 have to 1) go wheat-free, low-carb, then 2) not overdo fats, especially saturated fat.

It still gives me the creeps to tell an apo E4 person that they've got to watch their fats, worse than watching Starsky and Hutch reruns.

Blast triglycerides

15. May 2009 William Davis (0)

The conventional answers to high triglycerides levels are generally: low-fat diet, a fibrate drug (Tricor, Lopid), a statin drug, and--most recently--prescription fish oil.

This is the regimen to take if you want the drug industry to get even richer and more powerful than they already are. After all, what CEO of a pharmaceutical company can stand to have his salary and benefits slashed to below $200 million this year? It's outrageous!

If you really want to blast the heck out of your triglycerides and achieve numbers like 50 mg/dl, then the regimen to consider consists of:

--Elimination of sugars, wheat, and cornstarch
--Fish oil--Sam's Club would do fine at $8 for 350 capsules, or the high-potency at $14.99 for 180 capsules (at 680 mg EPA +DHA, nearly the same potency as prescription Lovaza at 842 mg)
--Vitamin D supplementation sufficient to achieve normal blood levels (60-70 ng/ml)

Those three strategies alone can reduce triglycerides far more than any drug combination. In fact, it is rare for someone with triglycerides as high as 900 mg/dl to not reduce them to the <100 mg/dl range.

Cheerios: Prescription required?

13. May 2009 William Davis (15)

Followers of The Heart Scan Blog know my feelings about Cheerios:

Can you say "sugar"?

Cheerios and heart health

There's an interesting tussle going on between the makers of Cheerios, General Mills, and the FDA.

The FDA says that the Cheerios' package claims of:

• "you can Lower Your Cholesterol 4% in 6 weeks"
• "Did you know that in just 6 weeks Cheerios can reduce bad cholesterol by an average of 4 percent? Cheerios is ... clinically proven to lower cholesterol. A clinical study showed that eating two 1 1/2 cup servings daily of Cheerios cereal reduced bad cholesterol when eaten as part of a diet low in saturated fat and cholesterol."

constitute a medical claim, i.e., trying to promote Cheerios as a drug.

I'm glad that the FDA has come down on General Mills. But I find this entire episode laughable: The debate is over the purported health benefits of what I would regard as pure junk food, no better in my view than claiming that a cupcake has health benefits, or a carton of ice cream.

In my experience, Cheerios does not 1) reduce risk for heart disease, nor 2) reduce cholesterol.

It does, however, cause blood sugar to skyrocket and increase the small type of LDL--you know, the type that causes heart disease.

"Placebos are frequently of value"

12. May 2009 William Davis (1)

The treatment of angina pectoris, generally speaking, is unsatisfactory.

Any procedure that relieves mental tension is valuable. Since patients suffer particularly during the winter, I encourage winter vacations in a southern climate.

I insist that obese patients lose weight, and have found small doses of benzedrine, 10 to 20 mg. daily, helpful in curbing the appetite.

I generally forbid smoking. This is a particularly disturbing task for many patients to carry out. In such cases, I suggest that 3 or 4 cigarettes be smoked daily, knowing full well that regardless of what I say or recommend, the patients is going to continue to smoke.

Innumerable drugs, most of which are of questionable value, have been used to prevent attacks of angina pectoris. In fact, placebos are frequently of value.

Testosterone--The male sex hormone has been effective in my experience. Whether it acts as a vasodilator or merely by promoting a sense of well-being is not known.

Alcohol--Alcohol (whiskey, brandy, rum) has been used for many years in the treatment of angina pectoris. I have prescribed it in moderate quantity--an ounce several times a day--and while I have not made alcoholics of any of my patients, I also have not cured any of them with it. Preparations, such as creme de menthe, are of value in relieving "gas" of which so many patients complain.

From Heart Disease Diagnosis and Treatment

Emanuel Goldberger, MD

1951

Iodine is not salt

12. May 2009 William Davis (3)

I've noticed a point of confusion recently, something I hadn't noticed in my patients before: Because of the public health advice from the FDA, American Heart Association, and Surgeon General's office to reduce sodium/salt intake, people have thought this meant reducing iodine, too.

I believe that people have drawn an equation in their minds:

Sodium = iodine

Of course, they are two entirely unrelated things.

Recall that the only reason iodine is added to many (not all) salt products is because it was a public health solution to solve the substantial nationwide iodine deficiency prevalent during the 20th century. But it was a solution conceived in 1924, when the FDA thought this was the best way to get iodine into Americans. And it worked.

Unfortunately, sodium does indeed present adverse effects in some people. As a result, "get your iodine from salt" has evolved into "reduce your sodium intake." Everyone forgot about the iodine: They forgot about the large disfiguring goiters, the poor school performance in iodine-deficient schoolchildren, the mentally-impaired offspring of iodine-deficient mothers.

So don't confuse sodium with iodine. You may need less of the former, but more of the latter.

For more on this, see "Help keep your family goiter free."

"You can't reduce coronary plaque"

10. May 2009 William Davis (9)

"I told my cardiologst that I stumbled on a program called 'Track Your Plaque' that claims to be able to help reduce your coronary calcium score.

"My cardiologist said, 'That's impossible. You cannot reduce coronary plaque. I've never seen anyone reduce a heart scan score."

Who's right here?

The commenter is right; the cardiologist is wrong.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Quantify and work to reduce the atherosclerotic plaque? No way! That's work, requires thinking, some sophisticated testing (like lipoprotein testing), even some new ideas like vitamin D. "They didn't teach that to me in medical school (back in 1980)!"

Welcome to the new age.

Atherosclerotic plaque is 1) measurable, 2) trackable, and 3) can be reduced.

We do it all the time. (Amy still holds our record: 63% reduction in plaque/heart scan score.)

Though I pooh-pooh the value of statin drug studies, there's even data from the conventional statin world documenting coronary plaque reversal. The ASTEROID Trial of rosuvastatin (Crestor), 40 mg per day for one year, demonstrated 7% reduction of atherosclerotic plaque using intracoronary ultrasound.

I have NEVER seen a heart attack or appearance of heart symptoms (angina, unstable angina) in a person who has reversed coronary plaque (unless, of course, they pitched the whole effort and returned to bad habits--that has happened). Stick to the program and coronary risk, for all practical purposes, been eliminated.

A heart scan score is not a death sentence. It is simply a tool to empower your prevention program, a measuring stick to gauge plaque progression, stabilization, or regression. Don't accept anything less.

Lethal lipids

8. May 2009 William Davis (15)

There's a specific combination of lipids/lipoproteins that confers especially high risk for heart disease. That combination is:

Low HDL--generally less than 50 mg/dl

Small LDL--especially if 50% or more of total LDL

Lipoprotein(a)--an aggressive risk factor by itself

This combination is a virtual guarantee for heart disease, often at a young age. It's not clear whether each risk factor exerts its own brand of undesirable effect, or whether the combined presence of each cause some adverse interaction.

For instance, lipoprotein(a), or Lp(a), by itself is the most aggressive risk factor known (that nobody's heard about--there's no blockbuster revenue-generating drug for it). Each Lp(a) molecule is a combination of an LDL cholesterol molecule with a specific genetically-determined protein, apoprotein(a). If the LDL component of Lp(a) is small, then the combination of Lp(a) with small LDL is somehow much worse, kind of like the two neighborhood kids who are naughty on their own, but really bad when they're together.

Interestingly, the evil trio responds as a whole to many of the same corrective treatments:

Niacin--increases HDL, reduces small LDL, and reduces Lp(a)

Elimination of wheat, cornstarch, and sugars--Best for reducing small LDL; less potent for Lp(a) reduction.

High-fat intake--Like niacin, effective for all three.

High-dose fish oil--Higher doses of EPA + DHA north of 3000 mg per day also can positively affect all three, especially Lp(a).

If you have this combination, it ought to be taken very seriously. Don't let anybody tell you that it is uncorrectable--just because there may be no big revenue-generating drug to treat it on TV does not mean that there aren't effective treatments for it. In fact, some of our biggest successes in reducing heart scan scores have had this precise combination.

"Get regressive"

6. May 2009 William Davis (0)

This caught my eye:

Niaspan, prescription niacin, now sold by Abbott Laboratories, is now promoting its advantages in regressing coronary plaque:

In patients with a history of coronary artery disease (CAD) and hypercholesetgerolemia, Niaspan (niacin), in combination with a bile acid-binding resin, is indicated to slow progression or promote regression of atherosclerotic disease.

And the new slogan: "Get regressive."

Interestingly, the new marketing campaign is based on relatively old data. They base this new claim on 3 studies:

1) Cholesterol-Lowering Atherosclerosis Study (CLAS)--a 1987

CRP House of Cards

4. May 2009 William Davis (15)

Lew has coronary plaque with a heart scan score of 393. At age 53, that's in the 90th percentile (higher score than 90% of men in his age group).

On our search for causes of his coronary plaque, we identify low HDL of 41 mg/dl, high triglycerides of 202 mg/dl, small LDL (83% of total), calculated LDL of 133 mg/dl, and severe vitamin D deficiency with a starting blood level of 25-hydroxy vitamin D of 19 ng/ml.

His c-reactive protein: 4.1 mg/dl--above the cut-off of 2.0 mg/dl that the pharmaceutical industry is targeting as a mandate for statin therapy, particularly given the JUPITER data.

Lew instead eliminates wheat and other small LDL-provoking foods and, as a result, loses 28 lbs in 3 months; adds omega-3 fatty acids from fish oil; supplements vitamin D sufficient to increase his blood level to 70 ng/ml.

Along with dramatic correction of his starting abnormalities, his c-reactive protein: 0.4 mg/dl--no statin drug.

In my view, increased CRP is nothing more than a surrogate for the inflammatory phenomena that arise from high-carbohydrate diets, overweight, and small LDL. Correct those and CRP drops off a cliff. In fact, it is exceptionally rare for CRP to not drop to very low levels following this formula.

I believe that CRP is one more item on the list of reasons--the house of cards--the pharmaceutical industry is building to persuade us to take more and more statin drugs. LDL not low enough? Take more statin. Diabetic with low cholesterol? Take a statin. Inflammation? Take a statin.

Enough already.

At-home blood tests

2. May 2009 William Davis (6)

Our at-home blood tests are proving a hit.

So far, vitamin D is the number one most popular test, no surprise.

Second--to my surprise--is DHEA. I would have predicted it would have been thyroid testing.

Our male and female hormone panels are also proving popular.

I've personally been using the thyroid and vitamin D testing to monitor my levels. I increased my Armour thyroid based on a low free T3 value, while my vitamin D was perfect at 77 ng/ml on 8000 units vitamin D3 (cholecalciferol) per day.

The process of performing the blood spots is straightforward. The finger pricks are virtually painless using the automatic spring-loaded finger stick devices:

The number of blots to make depends on how many tests you'd like. Just a vitamin D test requires 2 blots. If 6 or more tests are ordered at a time, then all 12 blots should be made. (Two spring-loaded lancets are provided in each kit.)

If you are interested in any of our at-home blood tests, go here.

Our own Heart Hawk has posted an editorial on about blood spot testing on Health Central:

Simple, affordable home blood testing is a real game-changer in the arena of informed, self-directed healthcare. For the first time broad access to home blood testing, on a scale similar to that enjoyed by persons who routinely test their blood sugar, is available to virtually everyone and it removes doctors as the gatekeepers of these tests. Even private insurance companies and Medicare are beginning to understand the potential for improving healthcare and decreasing costs and are slowly beginning to expand coverage of home blood testing much as they do for diabetics or persons taking anti-coagulants.

"Help keep your family goiter free"

1. May 2009 William Davis (10)

People ask, "If I need iodine, should I go back to iodized salt?"

First of all, how did this notion of iodized salt originate?

In 1924, J. Edgar Hoover was appointed head of the FBI, Marlon Brando and Doris Day were born, and Calvin Coolidge was elected President of the United States. Half of American households had a car, while 1 in 4 Americans were illiterate.

In the 1920s, cities were a fraction of their current size and a third of the U.S. population, or 36 million people, lived in small rural communities.

Goiters were also wildly prevalent in 1924. Up to a third of the population in some areas of the country, particularly the Midwest, suffered from goiters, thyroid glands that enlarged due to lack of iodine.

Goiters were not only unsightly, but sometimes grotesque, causing a visible bulge in the front of the neck. Occasionally, they would grow so big that it compressed adjacent structures, like the trachea, and would have to be surgically removed. Goiters were commonly associated with thyroid dysfunction, especially low thyoid or hypothyroidism, that resulted in low IQ's in schoolchildren, debilitation in adults. Women of childbearing age delivered retarded children.

So iodine deficiency in early 20th century America was a big problem. How to solve this enormous public health problem in a large nation without television, few radios, no internet, with a largely rural and often illiterate population?

Thus was iodized salt born, a simple, technologically available solution that could be implemented on a large scale nationwide at low cost. The FDA chose this route in 1924, figuring that it was the best way to ensure that most Americans could obtain sufficient iodine through liberal use of iodized salt. Public health officials urged Americans to use salt. Morton's salt label proudly bore the slogan "Help keep your family goiter free!"

It worked. Goiters largely became a thing of the past.

How about today? The American Heart Association recommends limiting salt, recently announcing that they would like to limit intake to 1500 mg per day. The American Medical Association has been lobbying the FDA to set lower salt limit guidelines. The FDA has been clamping down on food manufacturers to reduce the quantity of salt in processed foods.

Why limit salt? The concern is that there are segments of the population (not all) that are salt sensitive, particularly African Americans, people with certain genetic forms of high blood pressure, conditions that cause water retention, and any degree of heart or kidney failure. Salt in these peoplem, in fact, can be disastrous.

So adding iodine to salt was the solution to epidemic goiter. And it worked.

But salt is not a perfect solution, just one that served its purpose back in 1924. What we need is a 21st century solution.
You will find that in the various iodine supplements at your health food store. My favorite is kelp--inexpensive, available, and a form that mimics the way Japanese people obtain iodine (though by eating seaweed, rather than with tablets).

Image of kelp courtesy Wikipedia

All posts by william-davis

Wheat "debate" on CBC

11. October 2011 William Davis (29)

"Many Canadians plan warm buns, stuffing and pie for their Thanksgiving meals tonight. But I'll speak with a cardiologist who thinks we have no reason to be thankful for any food that contains wheat. William Davis says our daily bread is making us fat and sick."

That's the introduction to my recent interview and debate on CBC, the Canadian public radio system, aired on the Canadian Thanksgiving. Arguing the other side was Dr. Susan Whiting, an academic nutritionist. (I use the word "arguing" loosely, since she hardly argued the issues, certainly hadn't read the book, but was content to echo the conventional line that whole grains are healthy and cutting out a food group is unhealthy.)

I do have to give credit to the Canadian media, including the CBC, who have been hosting some rough-and-tumble discussions about the entire wheat question despite Canada being a world exporter of wheat. I recently participated in another debate with a PhD nutrition expert from Montreal who, in response to my assertion that the genetically-altered high-yield, semi-dwarf strains have changed the basic composition of wheat, argued that the creation of the 2-foot tall semi-dwarf strain was a convenience created so that farmers could see above their fields--no kidding. I stifled my laugh. (The semi-dwarf variants were actually created to compensate for the heavy seed head that develops with vigorous nitrate fertilization that buckles 4 1/2-foot tall wheat stalk, making harvesting and threshing impossible, a process farmers call "lodging." The 2-foot tall semi-dwarf thick, stocky stalk is strong enough to resist lodging.)

In short, debating the nutrition "experts" on this question has been tantamount to arguing with a school age child on the finer points of quantum physics. There has not yet been any real objection raised on the basic arguments against modern genetically-altered wheat. Modern semi-dwarf wheat is, and remains, an incredibly bad creation of the genetics laboratories of the 1970s. It has no business on the shelves of your grocery store nor on the cupboards in your home.

Carrot Cake

5. October 2011 William Davis (14)

This is among my favorite recipes from the Wheat Belly book. I reproduce it here for those of you who read the Kindle or audio version and therefore didn't get the recipes.

I made this most recently this past weekend. It was gone very quickly, as even the 13-year old gobbled it up.

(I reduced the sour cream in this version from 8 to 6 oz to reduce cooking time. Also, note that anyone trying to avoid dairy can substitute more coconut milk, i.e., the thicker variety, in equivalent quantities.)

Makes 8-10 servings

Ingredients:
Cake:
2 cups carrots, finely grated
1 cup chopped pecans
1 cup coconut flour
1 tablespoon ground flaxseed
2 teaspoons ground cinnamon
1 teaspoon allspice
1 teaspoon nutmeg
1 teaspoon baking powder
2 tablespoons freshly grated orange peel
Sweetener equivalent to ½ cup sugar (e.g., 4 tablespoons Truvia)
½ teaspoon sea salt
4 eggs
1/2 cup butter or coconut oil, melted
2 teaspoons vanilla extract
½ cup coconut milk
6 ounces sour cream

Icing:
8 ounces cream cheese or Neufchâtel cheese, softened
1 teaspoon lemon juice
1 tablespoon Truvía or 1/8 teaspoon stevia extract powder or ¼ cup Splenda

Preheat oven to 325° degrees F. Grate carrots and set aside.

Combine coconut flour, flaxseed, cinnamon, nutmeg, baking powder, orange peel, sweetener, and salt in large bowl and mix by hand.

Put eggs, butter or coconut oil, vanilla coconut milk, and sour cream in mixing bowl; mix by hand. Pour liquid mixture into dry pecan/coconut flour mixture and blend with power mixer until thoroughly mixed. Stir carrots and pecans in by hand with spoon. Pour mixture into greased 9- or 10-inch square cake pan.

Bake for 60 minutes or until toothpick withdraws dry. Allow to cool 30 minutes.

Place Neufchâtel cheese in bowl. Add lemon juice and sweetener and mix thoroughly. Spread on cake.

Why wheat makes you fat

1. October 2011 William Davis (32)

How is it that a blueberry muffin or onion bagel can trigger weight gain? Why do people who exercise, soccer Moms, and other everyday people who cut their fat and eat more "healthy whole grains" get fatter and fatter? And why weight gain specifically in the abdomen, the deep visceral fat that I call a "wheat belly"?

There are several fairly straightforward ways that wheat in all its varied forms--whole wheat bread, white bread, multigrain bread, sprouted bread, sourdough bread, pasta, noodles, bagels, ciabatta, pizza, etc. etc.--lead to substantial weight gain:

High glucose and high insulin--This effect is not unique to wheat, but shared with other high-glycemic index foods (yes: whole wheat has a very high-glycemic index) like cornstarch and rice starch (yes, the stuff used to make gluten-free foods). The high-glycemic index means high blood glucose triggers high blood insulin. This occurs in 90- to 120-minute cycles. The high insulin that inevitably accompanies high blood sugar, over time and occurring repeatedly, induces insulin resistance in the tissues of the body. Insulin resistance causes fat accumulation, specifically in abdominal visceral fat, as well as diabetes and pre-diabetes. The more visceral fat you accumulate, the worse insulin resistance becomes; thus the vicious cycle ensues.

Cycles of satiety and hunger--The 90- to 120-minute glucose/insulin cycle is concluded with a precipitous drop in blood sugar. This is the foggy, irritable, hungry hypoglycemia that occurs 2 hours after your breakfast cereal or English muffin. The hypoglyemia is remedied with another dose of carbohydrate, starting the cycle over again . . . and again, and again, and again.

Gliadin proteins--The gliadin proteins unique to wheat, now increased in quantity and altered in amino acid structure from their non-genetically-altered predecessors, act as appetite stimulants. This is because gliadins are degraded to exorphins, morphine-like polypeptides that enter the brain. Exorphins can be blocked by opiate-blocking drugs like naltrexone. A drug company has filed an application with the FDA for a weight loss indication for naltrexone based on their clinical studies demonstrating 22 pounds weight loss after 6 months treatment. Overweight people given an opiate blocker reduce calorie intake 400 calories per day. But why? There's only one food that yields substantial quantities of opiate-like compounds in the bloodstream and brain: wheat gliadin.

Leptin resistance--Though the data are preliminary, the lectin in wheat, wheat germ agglutinin, has the potential to block the leptin receptor. Leptin resistance is increasingly looking like a fundamental reason why people struggle to lose weight. This might explain why eliminating, say, 500 calories of wheat consumption per day yields 3500 calories of weight loss.

And, as in many things wheat, the whole is greater than the sum of the parts. Despite all we know about this re-engineered thing called wheat, eliminating it yields health benefits, including weight loss, that seem to be larger than what you'd predict with knowledge of all its nasty little individual pieces.

Just who is "Real Facts 2000"?

29. September 2011 William Davis (38)

This is an example of what seems to be developing over at Amazon.com, posted as a "book review":

The author has no credentials, no credibility, just a small cult of terribly misinformed followers. Don't be fooled by the high volume screech against wheat and grains. Allegations of "secret ingredients in wheat" to make you eat more, or comparisons to cigerettes. Seriously?! For over 8000 years wheat has sustained and grown human kind, oh and it tastes good when mixed with a little water and yeast. Every nutritionist and serious medical professional will tell you that bread is the most economical and safe source of essential nutrients. In fact, bread is handed out in natural disasters because it sustains life without food safety issues or requiring refrigeration. And now, suddenly it will kill you. Comical! This book is such a bone headed, misinformed way to just scare people into not eating.

As for secret ingredients, humm, apparently the author is ignorant of the food laws that regulate everything that goes into food and on food labels. Unlike some enforcement agencies, the FDA has some serious teeth behind its enforcement. As for frankenwheat, again seriously?! Wheat, due to its ubiquitous presence in the world is treated as sacrosant from any GMO research or development.

If you need real, science based information on healthy eating, check out [...] and leave this book and its cult in the compound.

If you recognize the wording and tone, you will readily recognize the footprints of the Wheat Lobby here. "Terribly misinformed followers"? . . . Hmmm. "Food laws"? I didn't realize that eating more "healthy whole grains" was a . . . law?

Make no mistake: There are people and organizations who have a heavy stake in your continued consumption of the equivalent of 300 loaves of bread per year. There are people and organizations (read: pharmaceutical industry) who have a big stake on the "payoff" of your continued consumption of "healthy whole grains."

This is not a book review; this is part of a concerted, organized campaign to discredit a message that needs to be heard.

Anybody from the media listening?

Almonds are the new wheat

29. September 2011 William Davis (31)

Once you eliminate this genetically-altered Frankengrain called modern wheat, the diet should center around vegetables, nuts, healthy oils like olive and coconut, fish, meats, cheese, olives, avocados and other real whole foods. This is, in fact, the diet that I have advocated in my heart disease prevention practice, as well as my online program for prevention and reversal of heart disease.

But what if you'd like a piece of cheesecake or a nice slice of dessert bread---but you don't want to gain two pounds, spend 48 hours in the bathroom suffering with diarrhea and cramps, 3 weeks of joint pains and leg swelling, wade through mental "fog," anxiety, and rage just because you had that momentary indulgence---as you would with wheat?

That's why I've been focusing on recipes that allow you to have something familiar, e.g., chocolate coconut bread or biscotti, but using ingredients that will not generate the metabolic contortions triggered by wheat.

On perusing these recipes, you will notice that there are recurring ingredient themes. Many of the same ingredients pop up time and again. Among the most frequent, versatile, user-friendly, and tasty: Almonds.

You can use almonds as ground whole almonds, ground blanched almonds for a finer texture, ground roasted almonds, almond butter (though, for maximum health benefits, I prefer the ground whole almonds). Ground almonds allow you to recreate muffins, breads, scones, pizza crust, pie crust, biscotti, and cookies with health benefits that exceed that of whole wheat---but with none of the downside: no weight gain, no high blood sugar, no triggering of small LDL particles (#1 cause of heart disease in the U.S.), no accumulation of visceral fat, no appetite stimulation.

In short, you just have your chocolate almond biscotti or mocha cupcake and enjoy it, no health price to pay. So I call almonds the new wheat, except better.

Being regular is dangerous to your health

25. September 2011 William Davis (21)

No, I'm not referring to your daily morning ritual in the bathroom. I'm talking about heart rate.

Counterintuitively, a perfectly regular heart rate is a marker of poor health. People with perfect regularity of heart rate have more heart attacks, for instance.

Regularity of heart rate occurs more commonly in people with hypertension and other metabolic derangements, and it signals increased risk for both heart attack and death. A perfectly regular heart rate, i.e., no variation in the time interval from beat to beat, suggests that the parasympathetic nervous system, the component of automatic ("autonomic") nervous system control that is associated with the relaxation response, feelings of well-being, quiet, and relaxation, is weak. It also means that the opposing sympathetic nervous sytem that regulates the "fight or flight," adrenaline-like response is allowed to be dominant. Dominance of the sympathetic over the parasympathetic system generates regularity of heart rate. Heart rate also tends to be faster, e.g., 85 beats per minutes rather than 55 or 60 beats per minute. So perfect regularity, as well as increased rate, is undesirable.

What we want is irregularity of heart rate. But not irregularity that occurs chaotically with no rhyme or reason. More precisely, we want variability in heart rate. And we want variability to occur in synchrony with breathing, i.e., the respiratory cycle.

The ideal response is:

1) increase in heart rate with inspiration

2) decrease in heart rate with expiration.

Heart rate in healthy people typically varies 15-20 beats per minute within the respiratory cycle, e.g., 60 bpm at end-exhalation, 80 bpm at end-inspiration.

Restoration of increased heart rate variability is associated with reduced blood pressure, reduced blood sugars (HbA1c), reduced inflammatory markers and cortisol (associated with stress), even an increase in DHEA levels. Feelings of well-being and calm also develop.

Among the strategies to consider to restore heightened heart rate variability and slowed heart rate include:

--Omega-3 fatty acid supplementation
--Exercise
--Weight loss
--Deep breathing exercises
--Meditation, prayer, and biofeedback

For our Track Your Plaque purposes, we are folding in the HeartMath strategies, i.e., use of a heart rate monitor that calculates heart rate variability in the context of respiratory cycle. If you've not already done so, take a look at the two Special Reports devoted to this topic on the Track Your Plaque website.

You mean weight loss is hazardous to your health?

23. September 2011 William Davis (11)

In my last Heart Scan Blog post, What is this wacky thing called weight loss?, I discussed how weight loss is associated with distortions in cholesterol and blood sugar values that can be very confusing, often leading your doctor to wrongly and unnecessarily prescribe drugs--since he/she likely rarely sees weight loss.

Blog reader, Donald K., posted his enlightening story:

I experienced this very thing.

After losing serious weight from the eliminating wheat, processed, and sugary foods (1 year in total) I lost 130 pounds. When I was nearly finished I went to see my doctor. He wanted to put me on statins. I explained to him how the data does not support application to me (no evidence of heart disease) and I got the mantra about standards of practice, etc, etc. I held my ground and decided I am much happier eating dairy, eggs, grass fed beef, wild caught fish, and as much raw foods (nuts, veggies, fruits) as my body desires to treat my health parameters.

Maintaining weight, it is easy. My BMI (23 down from 40) has remained constant for a few months now. You are right: metabolic processes definitely change. I no longer have sensations of glucose fluctuations or an uncontrolled appetite. I can only imagine the improved hormone regulation and metabolic communication going on inside my body.

The symptoms from obesity, all gone. Goodbye sleep apnea, hypertension, hemorrhoids, arrhythmias, gastroinestinal disruptions, smelly body, chaffing thighs, and others not mentioned. The positive effects are just as dramatic, but I don’t want to ramble on.

Weight loss? What is it? Getting your life back!

Brace yourself: If you are following the nutrition advice posted here and in the Track Your Plaque program, or the discussion I've initiated in Wheat Belly, then you may find yourself in the very same health predicament as Donald. Arm yourself to protect yourself against the drug-wielding ways of doctors. No, weight loss to achieve ideal weight is definitely not bad for health. But your doctor's misinterpretation of its effects can be!

What is this wacky thing called "weight loss"?

20. September 2011 William Davis (41)

I've discussed this before, but it has proven such an (encouragingly!) frequent issue that I thought it was worth discussing once again.

What happens when you lose weight?

The process of weight loss is characterized by multiple shifts in metabolic patterns that can be confusing. To the uninitiated eye, weight loss can look like a disastrous distortion in metabolism. The naive doctor on seeing your lab values, for instance, might insist you take a statin drug, a fibrate like Tricor (to reduce triglycerides or increase HDL), or simply berate you for your bad health habits--when it's actually a good thing you've accomplished.

So when you lose weight, say, 30 pounds in 3 months, what have you accomplished?

Energy stored as fat, especially from visceral fat stores, is mobilized into the bloodstream. It floods the bloodstream as fatty acids and triglycerides. These fatty acids and triglycerides don't occur in isolation, but interact with other particles and metabolic patterns. The resulting blood patterns include:

--Increased triglycerides--An increase in triglycerides, for instance, from 90 mg/dl to 200 mg/dl in the midst of weight loss is common.

--Reduced HDL--The flood of triglycerides leads to increased degradation of HDL, thus a drop. A drop in HDL from, say, 40 mg/dl to 27 mg/dl--very frightening to people--is exceptionally common.

--Increased blood sugar--The flood of fatty acids and triglycerides results in insulin resistance, leading to higher blood sugars. It is not uncommon for someone with pre-diabetes to develop diabetic-range blood sugars, or a non-diabetic to show pre-diabetic blood sugars.

--Increased small LDL particles--Though small LDL is highly variable during weight loss. When it does happen, it's probably from the interaction of VLDL (triglycerides) with LDL particles and the reaction that overloads LDL particles with triglycerides and conversion to small LDL particles.

So why don't doctors often recognize these patterns when a patient loses weight? Because they rarely see it. Most of my colleagues are accustomed to having patients come back with weight gain, getting heavier and heavier each time. Lose weight? Impossible! So they just don't recognize weight loss effects when they see it. As followers of The Heart Scan Blog know, a frequent conversation around here is "Am I too skinny?" or "How do I stop losing weight?"

The solution: Be patient. Be patient and wait about two months after a weight plateau has been achieved. That's when the numbers "settle down" and you see marked drops in triglycerides, increases in HDL, drops in blood sugar, reductions in small LDL.

As with many things, it's all about timing.

Why small LDL particles are the #1 cause of heart disease in the US

15. September 2011 William Davis (77)

Ask your doctor: What is the #1 cause of heart disease in the US?

Let's put aside smoking, since it is an eminently modifiable risk and none of those crazies read this blog anyway. What will your doctor say? Most like he or she will respond:

High cholesterol or high LDL cholesterol

Too much saturated fat

Obesity

Pfizer, Merck, AstraZeneca and their kind would be overjoyed to know that they can add your doctor to their eager following.

I'd tell you something different. I would tell you that small LDL particles are, by far and away, the #1 cause for heart disease. I base this claim on several observations:

--Having run over 10,000 lipoprotein panels (mostly NMR) over the past 15 years, it is a rare person who does not have a moderate, if not severe, excess of small LDL particles. 50%, 70%, even 90% or more small LDL particles are not rare. Over the course of a year, the only people who show no small LDL particles are slender, athletic, pre-menopausal females.

--In studies in which lipoproteins have been quantified in people with coronary disease, small LDL particles dominate, just as they do in my office. Here's a 2006 review.

--Small LDL is largely the province of people who consume carbohydrates, such as the American population instructed to "cut fat and eat more healthy whole grains." Conventional diet advice has therefore triggered an expllosion in small LDL particles.

--When fasting triglycerides exceed 60 mg/dl, small LDL particles increase as a proportion of total LDL particles. This includes the majority of the US population. (This ignores postprandial, or after-eating, triglycerides, which also contribute to small LDL formation.)

If you were to read the data, however, you might conclude that small LDL affects a minority of people. This is because in most studies small LDL categorize it as either "pattern B," meaning exceeding some arbitrary threshold of percentage of small LDL particles, versus "pattern A," meaning falling below that same arbitrary threshold.

Problem: There is no consensus on what percentage of small LDL particles should mark the cutoff between pattern A vs. pattern B. In many studies, for instance, people with 50% small LDL particles are called "pattern A."

If, instead, we were to set the bar lower to identify this highly atherogenic (atherosclerotic plaque-causing) particle at, say, 20-30% of total, then the number or percentage of people with "pattern B" small LDL particles would go much higher.

I see this play out in my office and in the online program, Track Your Plaque, every day: At the start eating a low-fat, grain-filled diet with lots of visceral fat ("wheat belly") to start, they add back fat and cut out all wheat and limit carbohydrates. Small LDL particles plummet

Even moore from Jimmy Moore

14. September 2011 William Davis (8)

The ubiquitous and irrepressible Jimmy Moore posted even more commentary about the Wheat Belly phenomenon here, what he calls "The Wheat Belly Bonanza."

Is low-carb really, at its core, little more than elimination of wheat? Sure, corn, rice, and sugar exert deleterious effects. But the dominant effect--by far--is the elimination of wheat. So is the low-carb movement really, at its core, a wheat-elimination movement?

Food (non-wheat-containing, of course) for thought.

Stents, defibrillators, and other profit-making opportunities

16. April 2006 William Davis (2)

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

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

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

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

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

Will radiation kill you?

16. April 2006 William Davis (4)

Several people have asked me lately if radiation is truly dangerous. These conversations were sparked by an editorial comment made on a column I wrote for Life Extension Magazine's April, 2006 issue on "Three ways to detect hidden heart disease".

Among the methods that were discussed in this piece was, of course, CT heart scanning. Anyone who is involved with CT heart scans Quickly recognizes the spectacular power of this test to uncover hidden, unsuspected heart disease, literally within seconds. In 2006, there's really nothing like it for the every day person to have hidden heart disease detected and precisely quantified.

Yet, the "rebuttal" to my article claimed that the broad use of heart scans was only my personal view and that, in truth, radiation kills people.

NONSENSE! If an ovarian cancer is discovered by a CT scan of the abdomen, is that unwise use of radiation? If pneumonia or lung cancer is discovered on a chest x-ray with minimal radiation exposure, have we performed a disservice. Of course not. In fact, these are often lifesaving applications of radiation.

Can radiation be used unwisely with excessive exposure? Of course. The 64 slice CT angiograms are just an example of this. Dr. Mehmet Oz announced on Oprah recently that this was a test to be used for broad screening of women for heart disease. This is wrong. The radiation required for a full 64 slice CT angiogram test is truly excessive for a screening application. You wouln't want to get breast cancer from your mammogram, would you? The radiation from a 64-slice CT angiogram is similar to that of a heart catheterization in the hospital--too much for screening. This is not to be confused with a CT heart scan for a calcium score performed on a 64 slice device. I think this can be performed with acceptable radiation exposure.

Think about what would happen, for instance, if you had your heart disease undetected, had a heart attack, and went to the hospital? During your hospitalization, you'd likely get five chest x-rays, a heart catheterization, perhaps one or more nuclear imaging tests, maybe even a full CT scan (with far more radiation than a screening heart scan). The amount of radiation of a heart scan is trivial compared to what you obtain in a hospital.

So take it all in perspective. The low level of radiation required for a simple heart scan (not an angiogram) does not by itself substantially add to your lifetime risk of radiation exposure. It may, in fact, save your life or reduce your life long exposure to radiation.

Are you using bogus supplements?

16. April 2006 William Davis (0)

I consider nutritional supplements an important, many times a critical,part of a coronary plaque control program.

But use the wrong brand or use it in the wrong way, and you can obtain no benefit. Occasionally, you can even suffer adverse effects.

Take coenzyme Q10, for instance. (Track Your Plaque Members: A full, in-depth Special Report on coenzyme Q10 will be on the website in the next couple of weeks.) Take the wrong brand to minimize the likelihood of statin-related muscle aches, and you may find taking Lipitor, Zocor, Crestor, etc. intolerable or impossible. However, take a 100 mg preparation from a trusted manufacturer in an oil-based capsule, and you are far more likely to avoid the inevitable muscle aches. (Though, of course, consult with your doctor, for all it's worth, if you develop muscle aches on any of these prescription agents.)

Unfortunately, you and I often don't truly know for a fact if a bottle from the shelf of a health food store or drugstore is accurately labeled, pure, free of contaminants, and efficacious.

One really great service for people serious about supplements is the www.consumerlab.com website. They are a membership website (with dues very reasonable) started by a physician interested in ensuring supplement quality. Consumer Lab tests nutritional supplements to determine whether it 1) contains what the label claims, and 2) is free of contamination. (I have no reason to pitch this or any other site; it's just a great service.) They recently found a supplement with Dr. Andrew Weil's name on it to have excess quantities of lead!

What Consumer Lab does not do is determine efficacy. In other words, they do a responsible job of reporting on what clinical studies have been performed to support the use of a specific supplement. However, true claims of efficacy of supplement X to treat symptom or disease Y can only come with FDA approval. Supplements rarely will be put through the financial rigors of this process.

If you're not a serious supplement user, but just need a reliable source, we've had good experiences with:

--GNC--the national chain
--Vitamin Shoppe--also a national chain
--www.lifeextension.com or www.lef.org--A great and low-priced source, but they do charge a $75 annual membership that comes with a subscription to their magazine, Life Extension (which I frequently write for) and several free supplements that you may or may not need. Again, I'm not pitching them; they are simply a good source.
--Solgar--a major manufacturer
--Vitamin World
--Nature's Bounty
--Sundown

There are many others, as well. Unfortunately, it's only the occasional manufacturer or distributor that permits unnacceptable contamination with lead or other poisons, or inaccurately labels their supplement (e.g., contains 1000 mg of glucosamine when it really contains 200 mg). I have not come across any manufacturer/distributor who has systemtically marketed uniformly bad products.

It really helps to have someone to lean on

16. April 2006 William Davis (0)

Among my patients are several husband and wife teams, both of whom have heart disease by some measure. Several couples, for instance, consist of a huband who's received a stent, survived a heart attack, or has some other scar of the conventional approach. The wives generally have a substantial heart scan score in the several hundred range.

There are a few couples for which the roles are reversed: wife with bypass, heart attack, etc. and husband with a substantial quantity of coronary plaque by CT heart scan.

From them all, however, I've learned the power of teamwork. When both wife and husband (or even "significant other") are committed to the effort of controlling or reversing heart disease risk, the likelihood of success is magnified many-fold. Everything is easier: shopping for and choosing foods, incorporating supplements in the budget, taking vacations with a healthy focus, following through and sticking with your program.

Several of the couples have succeeded in obtaining regression of plaque for both man and woman. Both have reduced their heart scan scores and, as a result, dramatically reduced the potential for future heart attack and procedures.

Unfortunately, I will also see the opposite situation: One spouse committed to the program but the other indifferent. They may say such things as "You can't control what happens in the future." Or, "There's no way you can get rid of risk for heart disease. My doctor says it's hereditary." Or, "I've eaten this way since I was a kid. I'm not changing now for you or for anybody else."

Such negative commentary can't help but erode your commitment to health. Most of us recognize these sorts of comments as self-fulfulling and self-defeating.

What should you do if you have an unsupportive partner? Not easy. But it really can help to seek out a supportive partner, whether it's a friend, relative, or other significant person in your life. Of course, not everybody can find such a person. Perhaps that's another way our program can help.

I'd like to hear from anyone who does obtain substantial support of someone close, or if you are struggling to do so.

Five foods that can booby trap your heart disease prevention program

14. April 2006 William Davis (0)

There are several foods that commonly come up on people's lists of habitual foods that are truly undesirable for a heart disease prevention program. Curiously, people choose these foods because of the mis-perception that they are healthy. My patients are often shocked when I tell them that they are not healthy and are, in fact, detrimental to their program.

I'm not talking about foods that are obviously unhealthy. You know these: fried foods, greasy cheeseburgers, French fries, bacon, sausage, etc. Nearly everyone knows that the high saturated fat content, low fiber, and low nutritional value of these foods are behind heart disease, hypertension, and a variety of cancers.

I'm talking about foods that people say they eat because they view them as healthy--but they're not.

Here's the list:

1) Low-fat or non-fat salad dressings--Virtually all brands we've examined have high-fructose corn syrup as one the main ingredients. What does high fructose corn syrup do? Triggers sugar cravings, makes your triglycerides skyrocket (causing formation of abnormal lipoproteins like small LDL), and causes diabetes. The average American now ingests nearly 80 lbs of this evil sweetener per year. You're far better off with olive, canol, grapeseed, or flaxseed based salad dressings.

2) Breakfast cereals--If you've been following these discussions, you know that the majority of breakfast cereals are sugar. They may not actually contain sugar, but they contain ingredients that are converted to sugar in your body. They may be cleverly disguised as healthy--Raisin Bran, Shredded Wheat, etc.

3) Pretzels--"A low-fat snack". That's right. A low-fat snack that raises blood sugar like eating table sugar from the bowl.

4) Margarine--Forget this silly argument about which is worse, butter or margarine. Which is worse, strychnine or lead? Both are poisons to the human body. Who cares which is worse? Fortunately, there are now healthy "margarines" like Smart Balance and Benecol that lack the saturated fat or hydrogenated fat of either.

4) Bananas--Bananas are not all that intrinsically unhealthy. The problem is that people will say to me, "Oh sure, I eat fruit. Two bananas a day." What I hear is "I don't really eat fruit with high nutrient value, fiber, and reduced sugar release. I reach for only bananas which yield extreme sugar rises in my blood and are low fiber." Aren't they high in potassium? Yes, but there are better sources. Cut back if you are a banana freak.

Why the mis-perceptions? A holdover from the low-fat diet days and marketing from food manufacturers are the principal reasons. Of course, foods are meant to be enjoyed, but be informed about it. Choose foods for the right reasons, not because of some cleverly-crafted marketing campaign.

Breakfast of champions?

12. April 2006 William Davis (1)

I spend time every day educating or reminding patients that breakfast cereals are not health foods.

I see jaws drop in shock when I tell them that, in my opinion and despite the marketing claims, Cheerios, Raisin Bran, Shredded Wheat, and the like do not yield health benefits. In fact, they do the the opposite: dramatically raise blood sugar and trigger an adverse cascade of events that eventually leads to diabetes and heart disease.

Why the health claims in advertising? Because these products contain insoluble fiber, the sort that makes your bowels regular. Yes, your bowels are important to health, too. But the benefits end there.

Breakfast cereals are a highly refined, processed food that are not good for your plaque control program. What they are is a highly profitable, multi-billion dollar business, deeply entrenched in American culture ("They'rrrre grrrrrreat!"--Tony the Tiger; "There's a whole scoop of raisins in every box of Post Raisin Bran!" Bet you remember them all.)

I find it particularly upsetting when I see the stamp of approval from the American Heart Association on some products. Gee, if the Heart Association says it's good for you, it must be true! Don't you believe it. The American Heart Association relies on corporate donations, just like any other charity.

If you must eat breakfast cereals, refer to www.glycemicindex.com for a full database of glycemic indexes. You can look up a specific product and it will list its glycemic index, or sugar-releasing properties. You should try to keep glycemic index of the foods you choose below 50.

For a revealing discussion of the influence of food marketers on our perceptions of food, see Track Your Plaque nutrition expert, Gay Riley's discussion The Marketing of Food and Diets in America at her website, www.netnutritionist.com.

In heart disease prevention, shoot for perfection

12. April 2006 William Davis (0)

It really struck me today that it's the people who've chosen to compromise their prevention program who end up with trouble--heart procedures, heart attack, even heart failure.

Take Bob, for example. Bob is 73 years old and had a bypass operation in 2000. The procedure went well and Bob enjoyed 6 years of seemingly trouble-free life. Bob had a seriously low HDL cholesterol for which he as taken a modest dose of niacin, but was unwilling to do much more. His HDL cholesterol was thererefore "stalled" at around 40 mg. (We aim for 60 mg or greater.) We talked repeatedly about the options for increasing HDL but Bob was content with his results. After all, since his bypass operation, he'd felt well and could do all he wanted without physical limitation.

But Bob underwent a stress test for surveillance purposes (which we routinely do 5 or more years after bypass surgery). The test was markedly abnormal with two major areas of poor blood flow to his heart (signalling potential heart attack in future). Bob ended up getting 5 stents to salvage two bypass grafts, both of which showed signs of substantial degeneration.

I've seen this scenario repeatedly: A person is unwilling to go the extra mile to obtain perfection in lipid/lipoprotein patterns, lifestyle changes, and taking the basic, required supplements. Compromises eventually catch up to you in the form of another heart attack, more procedures, heart failure, physical disability, even death.

The message: Don't draw compromises in heart disease prevention. Coronary plaque is a chronic process. It will take advantage of you if you ever let your guard down.

The epidemic of small LDL

11. April 2006 William Davis (0)

Of the patients I saw in my office yesterday, virtually EVERYONE had small LDL.

Small LDL is emerging as an extraordinarily prevalent lipoprotein pattern that drives coronary plaque growth. Previous estimates have put small LDL as affecting only 20-30% of people with coronary disease. However, in my experience in the last few years, I would estimate that greater than 80% of people with measurable coronary plaque have small LDL.

If you have a heart scan score >zero, chances are you have it, too.

I call small LDL a "modern" disease because it has skyrocketed in prevalence recently because of the great surge in inactivity in Americans.

When's the last time you walked to the grocery store and back, lugging two bags of groceries? How many years has it been since you've push-mowed your lawn? All the small conveniences of life have permeated further and further into our activities. Most of us spend the great majority of our day right where you are now--on your duff.

On the bright side, small LDL in most people is reducable by simply getting up and going. But the old teaching of 30 minutes of activity per day is now outdated. This was true when the other hours of your life included physical activities, like housework or a moderately active job. However, if the other 23 1/2 hours of your day are sedentary, then 30 minutes a day won't do it. An hour or more of activity, whether exercise or physical labor of some variety will get you better small LDL-suppressing results.

For most people with small LDL, fish oil and niacin are also necessary to fully suppress small LDL to the Track Your Plaque goal of <10 mg/dl.

A great discussion on vitamin D

10. April 2006 William Davis (0)

If you need better convincing that vitamin D is among the most underappreciated but crucial vitamins for health, see Russell Martin's review of vitamin D and its role in cancer prevention. You'll find it in March, 2006 Life Extension Magazine or their www.LEF.org website at:

http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1308&query=vitamin%20d&hiword=VITAM%20VITAMER%20VITAMERS%20VITAMI%20VITAMINA%20VITAMINAS%20VITAMINC%20VITAMIND%20VITAMINE%20VITAMINEN%20VITAMINES%20VITAMINIC%20VITAMINK%20VITAMINS%20d%20vitamin%20

Our preliminary experience over the past year suggests that vitamin D may be the crucial missing link in many people's plaque control program. We've had a handful of people who, despite an otherwise perfect program (LDL<60, HDL>60, etc.; vigorous exercise, healthy food selection, etc.--I mean perfect)continued to show plaque growth. The rate of growth was slower than the natural expected rate of 30% per year, but still frightening rates of 14-18% per year--until we added vitamin D. All of a sudden, we saw dramatic regression of 7-25% in 6 months to a year.

This does not mean that vitamin D all by itself regresses plaque. I believe it means that vitamin D exerts a "permissive" effect, allowing all the other treatments (fish oil, LDL reduction, HDL raising, correction of small LDL, etc.) to exert their full benefit. So please don't stop everything and just take D. This will not work. However, adding vitamin D to your program on top of the basic Track Your Plaque approach--that's the best way I know of.

MSNBC Report: We need more heart procedures!

10. April 2006 William Davis (0)

A recent headline from MSNBC by Robert Bazell reads:

NEW YORK - Angioplasty, bypass surgery and cholesterol-lowering medications are among the many interventions that have brought a sharp decrease in heart disease deaths in recent years. But, as Dr. Sharon Hayes of the Mayo Clinic points out, there is one big problem.

“The death rates in women have not declined as much as they have in men,” she says.

The piece goes on to suggest that women are getting short-ended in the diagnosis of heart symptoms and heart attack. The solution: More testing to assess the need for procedures like bypass.

This is typical of the device and medication-dominated media consciousness: More procedures, more medication, more devices. Who's paying for advertising, after all? The money at stake is huge. But is this what you want?

Don't be swayed by media reporters with limited understanding of the real issues (at best), consciousness of who's paying for advertising (at worst). Yes, heart disese is often underestimated or misdiagnosed in women. The answer is better detection earlier in life followed by efforts to halt the process--effective, safe treatments for people's benefit, not just profit.

Death of a $7 billion industry

28. June 2007 William Davis (8)

Vitamin D has taken its place as a crucial ingredient for coronary plaque control and control of CT heart scan scores.

Vitamin D replacement is also crucial for bone health, particularly the prevention of osteoporosis. But conversations about vitamin D replacement to true healthy levels is notably absent from the conversation on treatment and prevention of osteoporosis. Yes, you will find a small dose of vitamin D in calcium tablets and in multivitamins. Those of us who check blood levels of 25-OH-vitamin D3 in patients will tell you: They don't work. These are unabsorbable forms of vitamin D and at trivial doses. There was an attempt to give this issue a little cursory attention when a small dose of vitamin D was added to Fosamax (Fosamax D).

There are an estimated 50 million Americans with various degrees of osteoporosis. It's numbers like this that make the drug manufacturers salivate. Osteoporosis treatment is also chronic. This is among the holy grails of the drug industry: developing agents for widespread ailments that require long-term treatment that extends over years. That's a lot more profitable than 10 days of antibiotics that are over and done with in one treament course.

The osteoporosis market now stands at $7 billion per year and is expected to grow 6-7% per year, according to industry analysts. Drugs like Fosamax, Evista, and Actonel will eventually be replaced by Boniva, Eclasta, and bazedoxifene, and later by AMG-172 and balicatib. Monthly costs for these drugs can be $70 or more per month, sometimes several hundred dollars. (Experience has shown that the introduction of new drugs does not necessarily mean that other drugs will drop in price.)

Here's a clinical trial I'd like to see performed: Vitamin D restored to healthy levels of 50-100 ng/ml over an extended period and compared to a group treated with placebo. My prediction is that there will be dramatic differences in bone density. (Small studies have been performed, but no large, long-term trials of the sort that would yield real firepower.) Or, how about vitamin D to true therapeutic levels over 5 years compared head-to-head with one of the drugs. My prediction: little difference.

Vitamin D also provides an enormous panel of health benefits beyond restoration of bone density, like rise in HDL, drop in triglycerides, facilitation of control over CT heart scan scores, drop in fracture risk, drop in blood pressure and C-reactive protein, reduction in risk for colon, prostate, and breast cancer. None of the drugs can hope to provide any of these effects, except a drop in fracture risk.

Vitamin D usually costs around $2 per month. I doubt that such trials will be performed. If I were a manufacturer of osteoporosis drugs and my career success was dependent on the increasing revenues of these drugs, I would be quaking in my shoes, hoping that the public does not learn what a powerful tool good old vitamin D is. But if you are an individual just looking for health tools, vitamin D is, in my view, amongst the most powerful natural, nutritional tools you have available with outsized health benefits.

Comments (8) -

Anonymous
6/28/2007 2:17:00 AM |

I asked my doctor to include 25-OH-vitamin D3 in my cholesterol blood test. The nurse put down Vitamin D 25-Hydroxy (code 19893E)on the test requisition form without mentioning D3. Is this correct?

Anne
6/28/2007 3:18:00 AM |

Interesting about CRP and Vit D. Do you have a reference I can take to my doctor? I have had bypass and my hs-CRP has been high for years. I finally got my 25(OH)D up to 47ug/mL last summer but have not been able to get my PCP to recheck either CRP or D.

Great blog.
Anne

pomeropd
6/28/2007 4:59:00 AM |

A news article supports Vitamin D
June 20, 2007 By Martha Kerr

NEW YORK (Reuters Health) - A new study shows an association between low vitamin D levels and risk factors for cardiovascular disease "in a nationally representative sample."

Dr. Keith Norris, at Drew University School of Medicine in Los Angeles, and colleagues analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994.

They evaluated blood levels of vitamin D and the risk of heart-related disease in 7,186 men and 7,902 women.

Average vitamin D levels were lower in women, older individuals, racial and ethnic minorities, obese people and those with hypertension or diabetes, the researcher report in the Archives of Internal Medicine.

Compared to people with the highest vitamin D levels, those with the lowest levels were more likely to have high blood pressure, diabetes, and obesity -- all risk factors for heart disease.

Norris said that this evidence of the link between heart disease and vitamin D "reinforces the emerging evidence that suggests higher levels of vitamin D may be helpful to reduce the risk of cardiovascular disease."

In terms of taking a vitamin D supplement, "present dose recommendations range from 800 IU to 1,200 IU daily," he noted. However, he thinks 2000 IU per day is more likely to achieve adequate blood levels of vitamin D for prevention of cardiovascular disease. "There appears to be good safety at doses of 2000-3000 IU per day."

He pointed out that it has been known for a long time that vitamin D helps to make strong bones, but there is now "convincing evidence" that it has several beneficial effects on cardiovascular health.

"The potential implications from a public health and healthcare cost perspective are tremendous, even if vitamin D only impacts 5 percent to10 percent of heart health," Norris concluded.

SOURCE: Archives of Internal Medicine, June 11, 2007; Reuters Health

Dr. Davis
6/28/2007 12:18:00 PM |

See the study Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? Quarterly J. Medicine 2002 Dec;95(12):787-96, online at http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12454321&ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
You will note that a dark-skinned population was chosen, simply because they tend to be so severely deficient in vitamin D. But it is a genuine effect. I've witnessed it hundreds of times.

Dr. Davis
6/28/2007 12:19:00 PM |

I'm not sure about the code, but that's appears to be it.

JT
6/28/2007 5:27:00 PM |

It truly is amazing how over looked this simple nutrient is to our health.  And the benefits Americans could reap economically from increasing our vitamin D3 are fantastic to see.  Our health care system is reported to be heading for a collapse in the future due to run away hospital costs.  And every little bit to lower those costs would have to help I believe.

This argument reminds me of ethanol.  I fill my jeep up with ethanol.  I'm lucky in that there is a station just a few miles from my place.  As manufactured from corn, the fuel is not perfect, I know.  Plenty of smart people have let me know that ethanol is driving up the price of corn, which in turn drives up the price of milk, beef, pork, and in general all live stock prices.  Increased prices in these American staple foods immediately hurt the average American in the wallet.

After find out I have heart disease, I do not feel guilty about reports of price raises anymore.  I think how bad would it be if Americans ate less corn, beef, pork, and milk?  If less Americans ate those staple foods and instead made cheaper vegetables a mainstay in their diet, wouldn't we as a nation be healthier?  Wouldn't we see lower medical costs then?  Is it bad to want energy independence and also a healthier America?

Anonymous
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Vitamin D also provides an enormous panel of health benefits beyond restoration of bone density, like rise in HDL, drop in triglycerides, facilitation of control over CT heart scan scores, drop in fracture risk, drop in blood pressure and C-reactive protein, reduction in risk for colon, prostate, and breast cancer. None of the drugs can hope to provide any of these effects, except a drop in fracture risk.

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