Don't overdo the vitamin D

As time passes and I advise more and more people to supplement vitamin D, I gain increasing respect for this powerful "vitamin". I am convinced that vitamin D replacement is the reason for a recent surge in our success rates in dropping CT heart scan scores. I believe it is also explains the larger drops we've been witnessing lately--20-30%.

But vitamin D can be overdone, too. Too much of a good thing . . .

Despite being labeled a "vitamin", cholecalciferol is actually a hormone. Vitamins are obtained from food and you can thereby develop deficiencies because of poor intake. Deficiency of vitamin C, for instance, arises from a lack of vegetables and fruits.

Vitamin D, on the other hand, is nearly absent from food. The only naturally-occuring source is oily fish like salmon and sardines. Milk usually has a little (100 units per 8 oz) because milk producers have been required by law to put it there to reduce the incidence of childhood rickets.

A woman came to me with a heart scan score of nearly 3800, the highest score I've every seen in a woman. (Record for a male >8,000!) She was taking vitamin D by prescription from her family doctor but at a dose of 150,000 units per week, or approximately 21,000 units per day. This had gone on for about 3-4 years. This may explain her excessive coronary calcium score. Interestingly, she had virtually no lipoprotein abnormalities identified, which by itself is curious, since most people have some degree of abnormality like small LDL. Obviously, I asked her to stop the vitamin D.

Should you be afraid of vitamin D? Of course not. If your neighbor is an alcoholic and has advanced cirrhosis, does that mean you shouldn't have a glass or two of Merlot for health and enjoyment? It's a matter of quantity. Too little vitamin D and you encourage coronary plaque growth. Too much vitamin D and you trigger "pathologic calcification", or the deposition of calcium in inappropriate places and sometimes to extreme degrees, as in this unfortunate woman.

Ideally, you should have your doctor check your 25-OH-vitamin D3 blood levels twice a year in summar and in winter. We aim for a level of 50 ng/ml, the level at which the phenemena of deficiency dissipate.

Comments (1) -

  • curious

    11/5/2007 9:06:00 PM |

    Don't forget Vitamine K's role! MK4 should be taken along such high D3 doses. Actually, i recomend some anyway.

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It's the score, stupid

It's the score, stupid

Sal has had 3 heart scans. (He was not on the Track Your Plaque program.) His scores:

March, 2006: 439

April, 2007: 573

October, 2009: 799

Presented with the 39% increase from April, 2007 to October, 2009, Sal's doctor responded, "I don't understand. Your LDL cholesterol is fine."

This is the sort of drug-driven, cholesterol-minded thinking that characterizes 90% of primary care and cardiologists' practices: "Cholesterol is fine; therefore, you must be fine, too."

No. Absolutely not.

The data are clear: Heart scan scores that continue to increase at this rate predict high risk for cardiovascular events. Unfortunately, when my colleagues hear this, they respond by scheduling a heart catheterization to prevent heart attack--a practice that has never been shown to be effective and, in my view, constitutes malpractice (i.e., performing heart procedures in people with no symptoms and with either no stress test or a normal stress test).

It's the score, stupid! It's not the LDL cholesterol. Pay attention to the increasing heart scan score and you will know that the disease is progressing at an alarming rate. Accepting this fact will set you and your doctor on the track to ask "Why?"

That's when you start to uncover all the dozens of other reasons that plaque can grow that have nothing to do with LDL cholesterol or statin drugs.

Comments (4) -

  • Dexter

    11/15/2009 5:43:29 PM |

    Even more evidence that CVD confusion reigns supreme among PCPs.

    http://www.theheart.org/article/1020935.do

  • Roger

    11/15/2009 5:52:16 PM |

    Dr. Davis,

    In June you kindly profiled my "near-miss" CT angiogram, where I had to take charge and make sure I was getting only a CT calcium score scan.

    The good news was that my score was a zero.  I can't really explain that; while I was a vegetarian for many years, I also ate too many refined carbs and until recently was carrying a few too many pounds. There is heart disease in my family.  I am 54 years old.

    Is it genes, luck, or inadvertantly prudent lifestyle?   How often should folks with low scores be re-tested?  I know you probably cover this at TYP but I'm sure the blog readers would also find it informative.  Thanks again for reporting my story.

    Roger

  • Dr. William Davis

    11/15/2009 11:31:13 PM |

    Hi, Roger--

    Genes enter into the equation in a big way. Lifestyle is important, but it is not everything.

    For people starting with a score of zero, I generally suggest waiting 3-5 years before thinking about another scan.

  • Jenny Light

    11/16/2009 5:00:14 PM |

    I'll second the motion about catherizations being malpractice!

    My mom died three years ago in a cath lab!  After having chest pains after a chemical stress test, she was hospitalized overnight and the next day had a catherization with two stents implanted.  

    Something went wrong during the procedure, and an artery was torn. She became unconscious, she stopped breathing, and they were unable to insert a breathing tube.  They did an emergency tracheotomy but it was too late.  No cardiac surgeon was in the facility at the time.

    The cardiologists explination to us was that "she had very small arteries".

    I would think it would be reasonable for a patient to request that a cardiac surgeon be "in the house" during this procedure.

    My dad about hit the roof when he saw the cause of death listed on her death certificate as "myocardial infraction". He requested that the coroner check the circumstances, after which he changed the cause to "cardio-pulmenary arrest due to long term heart disease".  Sorry, but it should have read: "Due to complications during catherization procedure".  

    Not a benign procedure folks!  Ask whether drugs can perhaps be used in lieu of this invasive (and very lucritive for the hospital) action.

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Mammogram of the heart

Mammogram of the heart

Some people have called CT heart scans the "mammogram of the heart." The analogy contains a lot of wisdom.

First of all, both--mammograms and CT heart scans--are screening tests, one for cancer, of course, the other for coronary atherosclerotic plaque. Both are performed in specific age groups, mammograms in women 40 years and over (generally), heart scans in women 50 years and over (generally).


















Mammograms: Left, normal; right, a small mass. (Courtesy Nat'l Institutes of Health and Wikipedia.)



Both are also meant to be repeated periodically when normal as a surveillance process.

Both use low quantities of radiation of about 0.3-0.4 mSv (the most real-life measure of total body exposure), a modest quantity of radiation.

Both are good for their purposes, though not perfect. Can a mammogram performed properly miss a small cancerous mass? Sure it can, but it's still unusual. Can a CT heart scan miss the non-calcified plaque prone to rupture? Sure it can, but this is also unlikely (<5% probability).

Given the exorbitant costs of medical tests, both are quite inexpensive. On the flip side, they are both also quite unprofitable for the centers providing the tests. Unfortunately, this means that mammography centers and heart scan centers come and go because of the difficulties of the profit-side of these services.

Both tests initially struggled to gain acceptance among the medical community. In 1960, for instance, mammograms were performed on standard x-ray devices, the same as that used to perform chest x-rays--low precision, high radiation back then. In 1969, dedicated mammography devices made the scene. However, it took over 10 years for even these new dedicated devices to become widely used. Use of mammograms has gradually increased over the ensuing 20 years. In other words, 47 years have passed since the introduction of mammography.

CT heart scans, of course, have had a shorter history of approximately 20 years, since engineer, Dr. Douglas Boyd, first invented the "ultra-fast" EBT devices, the first devices with sufficient scanning speed to scan the heart and coronary arteries.

One interesting difference between the two: In a woman between the age of 50 and 60, the likelihood of detecting cancer is 1 in 237. The likelihood of detecting coronary atherosclerotic plaque? About 1 in 4. Coronary disease eventually kills 1 in 3 females, hugely overshadowing breast cancer in frequency.


Progress on both fronts, one in cancer detection, the other in atherosclerotic coronary plaque detection. But still lots more progress to go.

Comments (3) -

  • Anonymous

    10/7/2007 12:05:00 PM |

    Great blog on the comparison between the histories of the two tests - thanks for writing it.    

    Curious, have you heard if progress has been made with MRIs being able to perform heart scans?

  • Dr. Davis

    10/7/2007 12:20:00 PM |

    Not to my knowledge. I believe they are still bogged down by the slow data acquisition. It will be a fabulous tool if the speed is accelerated and the price can be lowered.

  • buy jeans

    11/2/2010 8:07:00 PM |

    CT heart scans, of course, have had a shorter history of approximately 20 years, since engineer, Dr. Douglas Boyd, first invented the "ultra-fast" EBT devices, the first devices with sufficient scanning speed to scan the heart and coronary arteries.

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