Another case of aortic valve disease reduced with vitamin D

I watched Seth's aortic valve deteriorate over a two year period.

I was first consulted in 2004 to offer an opinion on Seth's heart scan score of 779 and flagrantly abnormal cholesterol patterns, including triglycerides in the 400 mg/dl range. But I heard a murmur, as well, a murmur of a leaky aortic valve, "aortic valve insufficiency."

Over the next two years, I watched Seth's aortic valve worsen, going from mild leakiness to severe.

In 2006-2007, I tiptoed into vitamin D replacement and asked Seth to add some vitamin D. Time passed and Seth's aortic valve got progressively worse.

Over the past year, However, he's maintained a truly healthy level of vitamin D, with blood levels consistently in the 60-70 ng/ml range.

While Seth's last echocardiogram showed a severely leaky aortic valve, the most recent echo showed mild leakiness ("mild aortic insufficiency")--a dramatic reduction.

I continue to see this in many, though not all, patients with aortic valve disease. Though I've more frequently witnessed either stalled progression or reversal of aortic valve stenosis (stiffness), I've now seen a handful of people with aortic valve leakiness (insufficiency) also reverse.

I've posted about this peculiar phenomenon previously:

Aortic valve disease and vitamin D
More on aortic valve disease and vitamin D

Prior to vitamin D, I had NEVER witnessed any aortic valve disease stop or reverse.

A formal trial at some point would be invaluable.

Comments (8) -

  • Jenny

    12/12/2008 2:46:00 PM |

    Dr. Davis,

    I have a question to you. I am seeing a lot of research lately linking low Vitamin D blood levels in obese people to a multitude of conditions.

    However, someone whose research chops I respect told me that it is possible that factors associated with the obesity is suppressing the vitamin D level rather than the obesity resulting from it.  

    I understand how raising Vitamin D might be very effective in cardiovascular conditions where calcium metabolism is awry, extending the issue further, but I wonder if you have any thoughts on whether raising Vitamin D would have any impact on obesity and its associated maladies without other steps being taken like lowering carbohydrates and blood sugar.

    One study I found suggests, for example, it may be that something about having diabetes lowers Vitamin D levels, rather than that Vitamin D improves insulin sensitivity.

    A study in which people who were deficient in Vitamin D were given glucose tolerance tests and then given a massive dose of Vitamin D which raised their levels to normal after which they were given follow up glucose tolerance tests found no change in blood sugar or insulin sensitivity after Vitamin D was normalized.

    Glucose tolerance and vitamin D: Effects of treating vitamin D deficiency Kamilia Tai. Nutrition. Volume 24, Issue 10, Pages 950-956 (October 2008).

  • Bevy

    12/12/2008 10:28:00 PM |

    I take Vitamin D for SAD! ;) It's really helped. I take 1k iu 3X a day. Smile Along with alot of other supplements.

  • Anne

    12/13/2008 5:30:00 PM |

    That is awesome - hope Seth continues to heal. This info needs to get out to other physicians.

    I am seeing more and more patients who have been tested for vitamin D deficiency. That is good. But many of them are being told to stop the vitamin D once the level comes up to "normal" or stop after a month without further blood testing. One person had started and stopped vitamin D 3 times - she said her doctor told her he did not know why it kept dropping. It is sad that most physicians know so little about vitamins, supplements and nutrition.

  • Dr. William Davis

    12/14/2008 2:33:00 PM |

    Hi, Jenny--

    Perhaps it's both.

    I can tell you that, from my perspective in the "trenches," reduction of blood sugar and presumed sensitization to insulin is very real, obese or no.

    It is also true that the more fat present, the greater the need. This has been thought to be due to sequestration in fat tissue, but that is pure speculation.

    Also, I have never seen vitamin D go up more than minimally with weight loss. I believe there is a rise, but that says nothing about the path of causality.

  • Anonymous

    12/14/2008 5:59:00 PM |

    dr Davis,

    I understand calcification of the valves plays a role.

    Decalcification of bone is a result of high levels of 1,25D (calcitriol), which may play a major role in the calcification of these valves.

    Did you measure the levels of 1,25D in these patients and how high were those levels ?

    Sincerely, Frans

  • Anonymous

    12/15/2008 10:27:00 PM |

    My Georgia teacher's Blue-Cross charged me $225 for a LabCorp Vitamin D, 25-Hydroxy test.

    Life Extension's test for $62.67 may be a bargin:
    http://www.lef.org/Vitamins-Supplements/ItemLC081950/Vitamin-D-25-Hydroxy-Blood-Test.html

    Matt

  • Bill Ball

    11/2/2009 4:49:16 AM |

    You say a formal trial at some point would be invaluable.  Why not do it?  I consider it rather unethical for a physcian to post anecdotal case reports like this on the Web.  Why not at least submit a letter or case report collection to a peer-reviewed medical journal where it could get proper scrutiny?  Posting it in a blog puts this in the hands of lay people who could inappropriately apply this to their own situation and perhaps do more harm than good.

  • buy jeans

    11/3/2010 8:33:38 PM |

    While Seth's last echocardiogram showed a severely leaky aortic valve, the most recent echo showed mild leakiness ("mild aortic insufficiency")--a dramatic reduction.

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"Heart scans" are not always heart scans

"Heart scans" are not always heart scans

Beware of the media reports now being issued that warn that "CT heart scans" pose a risk for cancer.

One report can be viewed at
http://www.webmd.com/cancer/news/20070717/ct-heart-scan-radiation-cancer-risk.

This was triggered by a Columbia University study of risk for cancer based on the dose of radiation used in CT coronary angiograms. Theoretically, exposure to the radiation dose of CT coronary angiography can raise risk for cancer by 1 in 143 women if radiated in their 20s just from that single exposure.

If you've been following the Track Your Plaque discussion, as well as my diatribes in the Heart Scan Blog, you know that the media got it all wrong. The "heart scans" they are referring to are not the same as the heart scans that we discuss for the Track Your Plaque program.

A conventional heart scan (of the sort we refer to) exposes the recipient to 4 chest x-rays of radiation if an EBT device is used, around 8-10 chest x-rays of radiation if a 64-slice CT scanner is used. For the quality of information we obtain from these screening heart scans, we feel that it's an acceptable exposure.

The "heart scan" this study and subsequent reports refer to is not truly a screening heart scan, but a CT coronary angiogram, or CTA. CTAs are performed on the same CT or EBT devices, but involve far more radiation. CTA exposes the recipient to about 100 chest x-rays of radiation on a 64-slice device (more or less, depending on the way it is performed.) Just a couple of years ago, some centers were performing CTA on 16-slice devices, a practice I and the Track Your Plaque program vocally opposed, since up to 400 chest-rays of radiation were required! I even called a number of centers advising them that they were putting the public in jeopardy. CTAs also require injection of x-ray dye, just like any conventional angiogram.

CTA on 64-slice CT scanners require the same radiation exposure as a conventional heart catheterization, an issue glossed over in most conversations. In other words, the test that many of my colleageus so casually recommend poses a similar risk.

The message: the test I advocate for screening for coronary heart disease is a CT or EBT heart scan, not a CT coronary angiogram. CTA is a useful test and will get better and better as the engineers discover ways to reduce radiation exposure. But, in 2007, CTA is a diagnostic device, not a screening device. If you require an abdominal CT scan because your doctor suspects pancreatic cancer, or a CT scan of the brain because you might have a life-threatening aneurysm causing double-vision or seizures, it would be silly to not undergo the scan because of long-term and theoretical cancer risk.

But undergoing a CT coronary angiogram for screening purposes is ridiculous with present technology. I've said it before and I will say it--shout it--again:

CT coronary angiograms are not screening procedures; they are diagnostic procedures that should be taken seriously and do indeed pose measurable risk for cancer, a risk that is presently unacceptable for a screening test.

You wouldn't undergo a mammogram to screen for breast cancer if it exposed you to 100 chest x-rays of radiation, would you? Screening tests should be safe, reliable, accurate, and inexpensive. CT coronary angiography is none of these things. Genuine heart scans--the kind the Track Your Plaque program talks about and relies on--is all of those things.

Comments (6) -

  • Anonymous

    7/19/2007 12:16:00 AM |

    Dr. Davis, would you please specify the millisievert values you are assuming for chest x-ray, EBCT Ca score, MSCT Ca score, and CT angiogram? I just got a 64-slice Ca score and they told me I received an effective dose of 2 mSv. Would a CT angiography typically result in 20 mSv?

  • Dr. Davis

    7/19/2007 12:59:00 AM |

    Hi,

    Please see my Blog post, CT scans and radiation exposure at http://heartscanblog.blogspot.com/2007/06/ct-scans-and-radiation-exposure.html

    You may notice some differences. There's enormous variation in exposure, depending on how it's measured, how the scan is performed, type and manufacturer of scanner. However, you can get a good idea of ballpark figures from the table in the blog post.

  • Dr. Davis

    7/19/2007 1:02:00 AM |

    Let me try that URL again:

    http://heartscanblog.blogspot.com/
    search/label/CT%20scans%20and%
    20radiation%20exposure

    Or, go to the left sidebar of Blog contents and see "CT scans and radiation"

  • JT

    7/22/2007 1:55:00 AM |

    I watch Fox news.  And with that statement I'm sure some are rolling their eyes.  Never before in the history of America has declaring what news channel one watches apparently pigeonholed one on their political views.  

    Like many I get my news from different locations: internet blogs, TV, radio, magazines, newspapers, etc, but in the morning I often watch Fox and Friends.  I do so for two reasons I suppose, the first being that I enjoy the joking around / humor on the set.  The second reason why I watch Fox is because it goes out of its way to present two sides of a debate.  It seems revolutionary what Fox has done to TV news - present two sides of a story.  Some people become terribly wound up over this.  On a personal note, I have an "ultra liberal" uncle, by his own definition, that in all honesty is so upset over Fox news and me watching it that he no longer communicates with me.  Uncle Gordon probably has never watched Fox News.  He only knows what he has heard.  And knowing him if he did watch he would only see the conservatives and not notice the liberal view point.  I hope one of these days he calms down and we can find ourselves on friendly terms again.  Change is hard for some to come to terms with.          

    When reading this blog, it disturbed me.  I wish that all news reporters tried harder to present two sides to a story. These high radiation reports would be easy to demonstrate as being only half true.  But instead, because of poorly researched, unprofessional reporting, there undoubtedly will be Americans that will decide to not have a life saving CT heart scan for fear of radiation poisoning.  And that is sad.

  • Dr. Davis

    7/22/2007 3:09:00 AM |

    Hi, JT--

    I couldn't agree more.

    If there's one theme that presents itself over and over lately, it is the struggle to discern the truth in the sea of information we're all presented with every day. I can only hope that we all zig-zag towards a real truth over time.

  • Darwin

    7/24/2007 6:34:00 PM |

    Re the CTCA - new study out concerning radiation exposure for young women.

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