Let's gamble with your health

5. September 2008 William Davis (4)
Let's play a game.

I'm going to list some lipid patterns and you tell me whether or not the person with these values has heart disease.

Patient 1

Total cholesterol 150 mg/dl
LDL cholesterol 75 mg/dl
HDL 50 mg/dl
Triglycerides 125 mg/dl


Patient 2

Total cholesterol 300 mg/dl
LDL cholesterol 200 mg/dl
HDL cholesterol 35 mg/dl
Triglycerides 325


Patient 3

Total cholesterol 300 mg/dl
LDL cholesterol 100 mg/dl
HDL cholesterol 25 mg/dl
Triglycerides 875 mg/dl



Let's say that any one of these profiles is yours. Should you be getting your affairs in order, preparing for your cardiac catastrophe? Should you demand a stress test from your doctor, hoping that it will shed some light on your dilemma? Should you go ahead and go to the all-you-can-eat rib restaurant, content that you will be attending your granddaughger's wedding in 2020 in full health?

If you can tell, you're a lot better at this than I am.

I provide consultation to other physicians and patients on complex hyperlipidemias in my area. In other words, if someone has a difficulty to manage lipid disorder, the doctor sends the patient to me.

Managing these wildly variable values is the easy part. Deciding whether or not heart disease is concealed within the patient . . . well, that's the hard part.

Let's take it a step further: Suppose all three profiles also have 50% of all LDL particles as the abnormal small particles. And they all have a lipoprotein(a) level of 50 mg/dl, an abnormally high level.

How about now: Can you tell whether any or all of these people have hidden heart disease?

What if they are 20 years old? Does that make a difference?

What if they are all females over 65 years--how about now?

If the only tool you have to divine the presence of hidden heart disease is a lipid panel, or even a lipoprotein panel, then the best you can manage is to hazard a guess based on statistical probability. You also assume that this "snapshot" represents the sorts of values someone has had for their entire lives. You cannot factor in the fact that the first person gained 60 lbs in the last three years since completing menopause. You can't factor in that patient 2 smoked two packs of cigarettes a day for 25 years, but quit 10 years ago.

It's also foolhardy to believe that every known cause of heart disease is currently identifiable and revealed by modern-day blood testing.

A heart scan is simply a means to quantify the sum-total of risk factors--causes--that have exerted an effect up until the moment of your scan. It will reveal the quantity of coronary atherosclerotic plaque present, regardless of whether you stopped smoking 20 years ago or lost 30 lbs last year.

For these reasons, nothing can replace the value of quantifying plaque: not cholesterol, not the Framingham risk calculation, not measures of small LDL or lipoprotein(a), not the presence or absence of symptoms. In 2008, the method of choice for measuring plaque remains a CT heart scan. Perhaps in 10 years it will be some other method.

As always, let me remind Heart Scan Blog viewers that I make this point NOT to sell heart scans, which I have no reason whatsoever to do. I say this because we require a tool to track this potentially fatal disease. We require a yardstick for tracking progression or regression. The only tool that suits these purposes in 2008 is a CT heart scan.
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Comments (4) -

  • Anonymous

    9/5/2008 4:31:00 PM |

    An EBT heart scan is also acceptabte, or equivalent to a CT scan?

  • lizzi

    9/6/2008 2:31:00 PM |

    So, Dr. Davis. Do you ever use carotid intimal medial thickness measurements in your practice? If so, how?  If not, why not?

  • Steve

    9/6/2008 8:43:00 PM |

    instead of having to be exposed to radiation of a heart scan why wouln't a carotid IMT study be enought to indicate CAD since a narrowing of the carotid would preesent a high probability of CAD?

  • Anonymous

    9/10/2008 3:37:00 AM |

    Well we are going to do the heart scan in Feb - thanks to your blog.
    Check this out, our local place that does it is offering a two for one price! So me and the hubby can both get it done. I am nervous a bit but ready to do it.

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Are you addicted to fructose?

Are you addicted to fructose?

13. August 2007 William Davis (1)
Try a little experiment:

Side by side, try a yogurt made with fructose or high fructose corn syrup as one of the first ingredients on the label along with a yogurt made without fructose.

Yoplait and Dannon brands, for instance, fit the bill for fructose. Several brands do not use fructose products. Many of these are the unflavored or unsweetened versions. You may therefore have to add some blueberries, strawberries, or some other fruit for some flavor. ( I doubt that you would add high fructose corn syrup.) Add nuts, seeds, flaxseed, or oat bran to either.

Many people who do this will notice a peculiar effect: The fructose or high fructose corn syrup containing product is, to most, delicious. It also triggers a desire for more. You can't have just one--you've got to have another, or you've got to eat something else.

The non-fructose containing product is more likely to generate satiety, a feeling that you've had enough.

If you experience this effect, the solution is simple: avoid fructose and high fructose corn syrup. I believe that the most worrisome health effect of fructose is this hunger-increasing aspect, difficult to document, perhaps impossible to measure, but a great boon to the food industry who practice an "eat more" philosophy to increase revenues year after year.

Perhaps you will also see weight drop (since you will be more satisfied), see triglycerides drop (since fructose raises triglycerides), and maybe obtain all the downstream benefits of reduced triglycerides (higher HDL, less small LDL, less VLDL, more rapid clearance of post-prandial lipoproteins).

Most people who follow this idea gain better control over appetite, lose weight, and do better in health, including in their Track Your Plaque program.
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    8/14/2007 9:33:00 PM |

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Niacin and hydration

Niacin and hydration

27. February 2008 William Davis (12)
Many people know about niacin's curious effect of the "hot flush," a feeling of warmth that covers the chest and neck, occasionally the entire body.

However, many people are unaware of the fact that hydration can block this effect. In fact, many people who were not advised of this will come to the office describing miserable experiences with niacin--hot flushes that last for hours, intolerable itching, etc.--only to experience little or none of these effects with generous hydration.

The vast majority of the time, two 8-12 oz glasses of water when the hot flush occurs will eliminate the flush within a few minutes.

Sometimes, the hot flush will occur many hours after taking niacin. Nine times out of ten, this delayed effect is also due to poor hydration. For instance, you might be engrossed in your work and forget to keep up with fluid demands. Or, it may be warm and you've lost fluids through sweating. That's when you begin to feel the hot flush creep up on you.

The cure: Lots of water. In this situation, in which you have allowed dehydration to develop, it may require more than two big glasses. Relief from the flush may also take more time, but it still works nearly every time.

On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief.

Why go to some much bother? Well, niacin remains the best agent we have for reduction of small LDL, raising HDL (although vitamin D is proving to be a powerful competitor in this arena), and reducing lipoprotein(a). How much do statin drugs contribute to these effects? Very little, if at all.

Several drug manufacturers are also working on "antidotes" to the hot flush effect of niacin that will be packaged within the niacin tablet. Naturally, it will also boost the cost up many times higher.

In the meantime, if or when you experience the niacin hot flush, just think: Put out the "fire" with plenty of water.
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Comments (12) -

  • Michael

    2/27/2008 12:43:00 AM |

    Any particular types of snacks helpful when taking niacin? I sometimes eat a handful of nuts, or an apple,  when taking niacin, hoping it will reduce the possibilty of flush -- just curious if some foods are better than others.

    Also, since niacin can raise histamine, has any studies been done on taking an anti-histamine along with high dose niacin? Or how about some vitamin C (natural histamine reducer) at the same time as niacin?

    And finally, any real differences between Niaspan, Slo-Niacin and Enduracin (besides cost)? The only difference I can find is that Slo-Niacin might tax the liver a bit more, since it takes longer to fully absorb. The others are absorbed within 6-8 hrs, I believe.

  • Anne

    2/27/2008 3:37:00 AM |

    What about the use of Quercetin. There is a recent article showing it may inhibit the niacin flush. At least that was the result in rats. The study was published in the British Journal of Pharmocology Jan 2008
    Anne

  • Anonymous

    2/27/2008 5:48:00 PM |

    Dr Davis, the flush of Niacin has been of little bother to me. However each winter when I go to Florida from my cold north home, the Niacin itchy rash appears on my chest. This year I finaly found that Benadryl extra strength eliminated it after three applications. It has to be the increased sunshine that kicks it in. I hope others may find this helpful...Niacin is a life saver and still vastly under rated. Thanks for your informative blogs. Over&Out

  • Darin T

    2/27/2008 10:29:00 PM |

    I've noticed what seems to be a correlation between flushing and eating spicy foods -- foods that contain peppers containing capsaicin.  Has anyone else noticed this?

    It seems that I can pretty much count on getting a flush response 30-60 minutes after eating spicy food.  

    Dr. Davis, any thoughts?

  • Anonymous

    2/28/2008 12:14:00 AM |

    Nice post - and I swear I don't know how doctors do it, repeating your self over and over.  I forward your blog wittings to family and friends.  And because of that I'm the one they naturally come to when looking for TYP advice.  

    For what ever reason, no matter how many times I repeat myself, people forget two items with niacin:  1)hydrate to limit flush 2) avoid time release niacin as that can dangerously poison your liver - along with telling your doctor you are taking niacin. Grrrrr.........

  • Anonymous

    3/14/2008 2:59:00 PM |

    Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces.  It won't.

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    11/2/2010 8:31:02 PM |

    On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief.

  • Anonymous

    1/27/2011 7:58:52 AM |

    "Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces. It won't."

    Okay. And as a long-term niacain user, myself, who just read this earlier tonight and who just tried drinking water when experiencing a flush, I will say that it does work. For me, at least.

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The many faces of LDL

The many faces of LDL

29. January 2008 William Davis (0)
Pam has an LDL cholesterol of 144 mg/dl.

To most people, this means that she has a mildly elevated LDL value. Many people would respond by cutting the saturated fat in their diet. Most physicians would concur and talk about prescribing a statin drug.

Let me tell you what an LDL cholesterol of 144 mg/dl means to me:

1) It could mean an LDL of all large particles (which is good) or an LDL of all small particles (which is very bad). Or, perhaps it's some combination of big and small. I can't tell which just by knowing that LDL is 144.

Small LDL responds to a diet reduced in processed carbohydrates and wheat flour; large LDL does not. Small LDL responds in an exagerrated way to niacin; large LDL does not. It makes a difference.

2) It could mean that, hidden within LDL, is lipoprotein(a), or Lp(a). Recall that Lp(a) is a high-risk genetic pattern that can provide the false appearance of high LDL cholesterol. If Pam were prescribed a statin drug, it would have little effect and little benefit. (See Red flags for Lipoprotein(a).)

Knowing that Pam has Lp(a) can point us in an entirely different direction than just LDL cholesterol. It might mean high-dose fish oil, a more serious approach to niacin, hormonal treatments like DHEA or testosterone. It might mean more attention to warning your children about the possibility that they, too, might share this genetic trait.

3) It could mean both small LDL and Lp(a) are present simultaneously, an especially dangerous combined pattern that is among the highest risks for heart disease known.

4) Because Pam's LDL of 144 mg/dl was not measured, but calculated, it means that it is subject to tremendous inaccuracy.

In my office, calculated LDL cholesterols can be inaccurate by 50 or 100 mg/dl--commonly. So Pam's LDL of 144 mg/dl could really be 70 mg/dl, or it could be 244 mg/dl. Once again, it's a big difference.


Just like The Three Faces of Eve, the 1957 film in which Joanne Woodward played the three wildly different sides of Eve's personality--the daytime Eve White, the fun-loving and daring Eve Black, and Jane--so can LDL assume several different faces, all with different personalities, different implications.

Accepting LDL cholesterol as LDL cholesterol is a fool's game. It is only a starting point, nothing more. Accepting a statin drug based on LDL is, likewise, a trap fraught with uncertainty, the potential for limited or ineffective results, the price being your heart and health.
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Break the addiction

Break the addiction

28. July 2007 William Davis (8)
"But, doc, I can't lose my cereal! Pretzels--you've got to be kidding me! I eat 'em every night! I can't do it. I'll be hungry all the time!"

This is a discussion I have every day. The usual suspect: A 50-some year old with HDL in the 30s or 40s, small LDL, borderline high blood sugar approaching the pre-diabetic cut-off, highish blood pressure, excess tummy. They usually struggle with energy, feelings of sleepiness, use lots of caffeine to stay alert even in the middle of the day after a sufficient night's sleep.

Not as obvious as the tremulous, pinopint-pupil drug addict, but I recognize it nonetheless: The processed food addict.

Breaking this addiction can be as difficult for some people as breaking a smoking addiction. Instead of nicotine cravings, they get insatiable hunger. Just 3 or 4 hours without their processed food "fix," and they are ravenous to satiate their impulse. Most give in and go right back to the vicious cycle.

But break the cycle--eliminate processed foods like breakfast cereals, whole wheat crackers, pretzels, cookies, granola bars, fruit drinks, low-fat salad dressings, bran muffins . . .70+% of the foods in your supermarket---and you will make an interesting discovery:

You no longer crave these foods.

Just think about it: The addictive properties of processed foods are a food manufacturer's dream. What other product besides cigarettes has an addictive quality that ensures you come back for more... and more and more.

It it just too creepy that much of the processed food industry is, in reality, owned by the tobacco industry (Altria, previously known as Phillip Morris) and RJ Reynolds. Perhaps that is the modus operandi of these corporations: Identify products that have an edge, foods or other products that possess an addictive quality. This is not true of cucumbers, for instance. What a lousy investment a cucumber grower would make!

Be smarter than Phillip Morris. Outsmart the people looking to empty your pocket and corrupt your health. Break the addiction.

Hang around the produce aisle of your grocery and use the farmer's market or your local equivalent. Look for locally grown foods. Try to keep your food as unprocessed as possible.

You will be impressed with the results.
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Comments (8) -

  • BarbaraW

    7/28/2007 2:32:00 PM |

    You no longer crave these foods.

    It's true!  We've done it.  My husband and I stopped eating all grains and sugar in February.  At this point, we really don't miss them any more.  It was a huge change, but it's worth the effort.  I've lost over 20 pounds (10 to go)and my husband has lost 45 pounds (20 to go).  On top of it, our body shapes have changed drastically. It is really amazing.   I've got my waist back (and a whole wardrobe of clothes) - I'm thrilled.

    I'm also very happy to be eating foods that I always loved like eggs, avocados, and meats - without feeling guilty that they're not good for me.

    With the extremely hot weather this week in our area, we thought we'd "treat" ourselves to small ice cream cones.  To our surprise, it wasn't  that much of a treat. Didn't even taste as good as we'd anticipated. I know I would have been much more satisfied with a snack of smoked salmon with fresh dill, capers, chopped onion and drizzled with lemon juice.

    Aside from weight changes, we both feel so much better in general - feel much more alert and move around with much greater flexibility, sleep well, never have any indigestion.  We're really enjoying this.  It's like feeling younger.  

    It's not a diet for us.  This will be the way we eat from now on.  Actually, we think our food has become more interesting and varied since giving up all the "white stuff". I guess we felt compelled to get a little more creative.  

    Eating out (or at other peoples' places) has probably been the hardest part of this adjustment.  But now we're getting pretty comfortable saying what we won't eat.  I'm starting to enjoy the reactions it produces.

    Just wanted to share our experience with your readers.

    BTW, Dr. Davis, we got the Carlson Vitamin D3 softgel caps and are each taking 4000 units a day.

  • Dr. Davis

    7/28/2007 2:57:00 PM |

    That's fabulous!

    Your post was so interesting that I read it to my two teenagers, who are both encountering great skepticism from their friends and grandparents and other relatives when they bring up this topic.

  • BarbaraW

    7/28/2007 3:49:00 PM |

    I hope it helps give them some perspective!  

    One of my husband's favorite comments to people is "Grains are for birds". That slows them down a bit.  

    I also just remembered a conversation I had a few months ago  with a neighbor who had invited us to dinner.  She asked if we had any food allergies or things we couldn't eat. She knew we were on some kind of diet.  I told her no food allergies to worry about and the diet is really simple: no grains, no potatoes and no sugars.  She was quiet for a minute and then replied "My goodness, that's just about our whole diet!"  It was hilarious.

  • JT

    7/28/2007 4:40:00 PM |

    It really is interesting that tobacco companies Phillip Morris & RJ Reynolds also sell processed foods that are responsible for so many life style disease problems effecting western society. My grandfather passed away undoubtedly by his life time of smoking.  Even after he had a heart attack he couldn't stop smoking for any length of time.  As soon as a stressful situation occurred, he was back using his pacifier, as we called his pipe.  I'm guessing the same reaction occurs with high glycemic, processed food.  

    Another addiction that is worth mentioning is convenience.  In sales there is a saying that simply says "people are lazy."  It means, the more work a salesman does for a customer the less likely he/she will say no.  Fast, processed, food sellers are master salesmen at promoting their products such that it is hard to say no.  

    I'm doing my part to promote healthy eating when outside the house.  A relative owns an award winning restaurant in St. Louis.  Talking to him about my new heart healthy diet, he mentioned that next time I'm in town he would like me to meet the chef.  The two of us will then create a couple heart healthy, TYP inspired, meals to be placed onto the menu.  I’m looking forward to this.  It will not only be fun to work in the kitchen with an accomplished chef but to also  have an easy place to visit for a healthy meal.

  • Dr. Davis

    7/28/2007 6:12:00 PM |

    I agree.

    Howeever, I do believe that we can maintain the convenience factor to some degree without too much sacrifice of health.

    My kids and I were in a hurry recently to make a movie time. There wasn't enough time to squeeze in a healthy lunch, so we ended up at Trader Joe's and bought a bag of unsalted, dry roasted pistachios and mixed nuts (not roasted in oils). Not a perfectly well rounded meal, but lacking many of the negative effects of the overly processed, addictive foods.

    Keep us posted on how your St. Louis menu turns out!

  • Stan

    7/29/2007 2:55:00 AM |

    BarbaraW,

    Keep it up, it's worth it and you won't look back!  I and my wife   went low carb high animal fat  (the "Optimal Diet") 8 years ago and we never felt better!

      Many things will improve, not just weight reduction:  you will think clearer, your reflexes will improve, your breathing rate will go down, your blood pressure will normalize.  You will never or rarely have a fever or viral infections like cold or flu.  You will become more resistant to cold temperature and you will rarely feel tired, ever!

  • Dr. Davis

    7/29/2007 12:35:00 PM |

    Great results, Stan.

    But let me make clear that I do NOT advocate high animal fat.

    In my view, despite the results you've enjoyed, there are adverse health--and social--consequences of high intake of animal fat, including dramatic escalation of cancer risk.

    There is no doubt that carbohydrate reduction alone achieves dramatic improvement in health and weight reduction. We've witnessed that on the Atkins' diet, for instance, a diet that is eminently effective for weight loss but is without question an unhealthy approach if followed for any more than a few weeks. (Bladder infections, constipation, higher colon cancer and other cancer risk, etc.)

    So, in my view, please do not follow an unlimited animal fat approach.

  • BarbaraW

    7/29/2007 3:48:00 PM |

    Hi Stan and Dr. Davis,

    We've been following the Eades' Protein Power plan for the most part and I don't think they advocate high fat. But we're not trying to go low fat, either. In any case, we've gravitated lately to eating more poultry and fish instead of red meats.  I think that has helped our weight loss a bit, along with cutting down on nuts and cheese.  We love red meat and do have it a couple of times a week, since we're fortunate to be in an area where we can easily get locally raised (grass-fed) beef and lamb, as well as free-range chickens and wonderful eggs. Quite different from what's typically sold in the grocery stores. Tastes much better.

    On another note, over the last 6 months, we've noticed our meal portions have become somewhat smaller.  We're not consciously trying to cut them down, it's just happened.  I think because we're eating more satisfying food we don't need quite as much. We find a less frequent urge to snack in between meals, too.

    We've already experienced a number of changes you mention, Stan, like blood pressure magically settling into perfect range and no colds/flu this past winter.

    It's all quite amazing, isn't it!

    Barbara

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