Watch your weight plummet:Be a super vegetarian

Here's a neat trick for losing weight: Become a strict vegetarian for 3 days.

Before you yawn or say "Yecchhhh!", let me elaborate.

Pick some time period. It doesn't have to be 3 days. It could be 2 days, or 5 days, or two weeks. But, for the period you choose, eat only vegetables. No meat, cereals, breads, milk, cookies, etc.

Vegetables alone could get monotonous, so make them interesting. Possibilities include:


--Hummus--add a little bit of olive-oil, chopped garlic, paprika, red pepper.

--Tabouleh--I get mine from Trader Joe's and it's delicious.

--Salsa--Low in calories, rich in lycopene and other flavonoids, with no nutritional downside. Also, pico de gallo--chopped tomatoes, onions, jalapeno chiles, cilantro, cucumbers.

--Mustards--hot, yellow, brown, spicy, gourmet, horseradish, etc.

--Cocktail sauce--i.e., ketchup and horseradish. Use the low-carb ketchup made without high fructose corn syrup.

--Tapenades--e.g., olive tapenade made with chopped olives, capers, and olive oil.
--Pesto-made with basil, garlic, and olive oil.

--Spices and herbs--basil, arugula, peppers, mustard powder, garlic, cilantro, ginger, etc.

--Vinegars--wine, Balsamic, rice, apple cider.

--Infused olive oils--infused with garlic is especially delicious,e.g., added to hummus.

--Bean dips--white bean dip, roasted bean dip, etc.





With the varieties of ways to jazz up your vegetables, you couldn't possibly be bored.

For example, for breakfast on day 1, eat sliced cucumbers and green peppers dipped in garlic-infused olive oil hummus and a handful of almonds. For a snack, some walnuts, sunflower seeds, sliced zucchini dipped in salsa. For lunch, a salad with an olive oil and balsamic vinegar dressing. For dinner, tablouleh, a cucumber and tomato salad, celery sticks dipped in pico de gallo.

All vegetables can be eaten without restricting portion size, since calorie content of vegetables are so low compared to other calorie-dense foods. (See The Heart Scan Blog from a few days back, "One bit or many mouthfuls?" at http://heartscanblog.blogspot.com/2007/01/one-bite-or-many-mouthfuls.html.)

This approach works nearly as well as fasting. A half-pound per day weight loss or more is common and painless. You'll also feel great living on low glycemic index foods.

(Photos courtesy Wikipedia.)

Dr. Agatston to the rescue


Dr. Arthur Agatston, author of wildly successful South Beach Diet, has just released a new book titled The South Beach Heart Program. Dr. Agatston has started on a media speaking circuit to promote his book and concepts.


A reporter from Time, who interviewed Dr. Agatston, commented:

". . .not enough doctors prescribe niacin for their heart patients, even though the medicine is a proven treatment for raising 'good' cholesterol. Physicians are reluctant, Agatston suggests, because niacin requires diligent follow-up to watch for side effects, taking time that most primary-care practices cannot afford. On the other hand, he says, too many doctors are performing heart operations that represent a financial windfall for hospitals. Bottom line: there isn't as much money to be made in prevention as in treatment."

Amen.

Dr. Agatston echoes many of the concepts that the Track Your Plaque program advocates. His notoriety is going to help disseminate the idea that 1) CT heart scans are the #1 method to identify hidden atherosclerotic coronary plaque, 2) taking control of your heart scan score is the best way to seize hold of your future, and 3) the present-day popularity of heart procedures like stents and bypass is intolerable, inexcusable, and needs to be reined back.

Agatston also brings great credibility and fairness to the conversation and his comments will gain tremendous attention in the press and with the public.

When is a vitamin not a vitamin?

When it's a hormone.

That's the stand that several researchers in vitamin D have taken and I think they're right. Dr. John Cannell has made a fuss over this in his www.vitamindcouncil.com website.

Structurally, vitamin D is most closely related to testosterone, estrogen, and cortisol. You wouldn't call testosterone vitamin T, would you?

Vitamins are also meant to be obtained from food. Yes, vitamin D is in milk but only because humans are required to put it there to prevent childhood rickets. Otherwise, the only substantial food source of vitamin D is in oily fish like salmon and then only a modest quantity.

Vitamin D is cholecalciferol, a hormone. Deficiencies of hormones can have catastrophic consequences. Imagine that every winter your thyroid gland shuts down and produced no thyroid hormone. You'd get very ill, gain 30 lbs, lose your hair, feel awful.

That's what happens when you're sun deprived and thereby deficient in cholecalciferol--you're deficient in a hormone. And it happens to most of us every year for many months.

I continue to witness spectacular effects by bringing 25-OH-vitamin D3 blood levels to 50 ng/ml with supplementation, including an apparent surge in success dropping heart scan scores.

An epidemic of heart disease reversal

Heart disease reversal is nothing new in my office. However, I have to admit that it's not something that generally happens each and every day.

As our approach is refined, we are witnessing an unprecedented frequency of plaque reversal. Since Monday (today is Tuesday), I've seen four people who have regressed their coronary plaque and dropped their heart scan score.

Pat was the most recent addition to this list. At age 53, I was honestly surprised at the ease of dropping her heart scan score from 128 to 42 in the space of a year. I was surprised because among her lipoprotein patterns was the dreaded combination of lipoprotein(a) and small LDL, probably the most aggressive risk for heart disease I know of and also among the most difficult to gain control over. She also suffered a deep personal tragedy in her family, an emotional convulsion that can sometimes wipe out any hope of plaque reversal.

I'm hopeful that this virtual epidemic of heart disease reversal continues. And I hope that you participate in it.

Second heart scan and heart attack risk

At first, Joe felt disappointed, defeated, and frightened. After his heart scan, a radiologist at the center told him that his score of 264 was moderately high. He told Joe that he was at moderate risk for heart attack and that a nuclear stress test was going to be required.

This left Joe feeling confused. After all he'd had a heart scan 18 months earlier and his score was 278, 5% higher.

I reassured Joe that the radiologist had not been aware that Joe had a prior heart scan. The radiologist didn't know that Joe's heart scan score had actually been reduced.

In fact, Joe's risk for heart attack was not moderate--it is now very low, since his score was 5% lower. While growing plaque is active plaque, shrinking plaque is inactive plaque and thereby at far less risk for heart attack.

I wrote about this phemonenon in a previous Blog: When is a heart scan score of 400 better than 200? at http://heartscanblog.blogspot.com/2006_09_01_archive.html. When you've had more than one scan, the risk for heart attack suggested by the score takes a back seat to the rate of change of your score. In other words, even though Joe's score of 264 represented a moderate risk (of approximately 3% per year, roughly 30% over 10 years), this no longer held true, since it actually represented a 5% decrease over a previous score.

Joe's risk for heart attack is probably close to zero. ALWAYS view your second (or any subsequent) heart scan score in the context of your previous score, not in isolation.

Track Your Plaque newsletter subscribers: We will detail more of Joe's story in the coming January 2007 newsletter. If you'd like to read or subscribe to the newsletter, go to http://www.cureality.com/f_scanshow.asp.

Heart scan curiosities #5

Despite the controversy over drug-coated stents, I maintain that the best stent is no stent at all.

Yes, there are indeed times when such things are necessary, but not with the frequency that they are implanted nowadays.

Another reason why stents are an undesirable phenemenon is that they muck up your heart scan. Take a look:





The long white object in the center is a stent in the left anterior descending artery of this 60 year old man. Just beyond the stent (at about 1 o'clock from the stent) is a plaque that could be scored. However, you can see that, with the presence of the stent, the bulk of this artery is no longer "scorable". If this man wishes to "track his plaque", he will have to be content with tracking only the circumflex and right coronary arteries, the other two arteries without stents.

The stainless steel or similar metallic materials of current stents simply prevent us from seeing through them for plaque scoring purposes. It's best if you can simply avoid getting one for this and other reasons.

Track Your Plaque Members: Watch for the upcoming editorial by our Heart Hawk on drug-eluting stents.

One bite or many mouthfuls

A reader brought this beautiful series of food photos to my attention:

http://www.wisegeek.com/what-does-200-calories-look-like.htm

It's simply a graphic display of what 200 calories of various foods look like. You'll note that vegetables and fruits permit large servings to yield 200 calories. Processed foods, on the other hand, require very little to tally up the same calorie load. In particularly, look how little in the way of wheat products are required to match that amount.

Heart scan curiosities #4

Here's an interesting example of a 63-year old man with a heart scan score of 112. However, his aortic valve was also severely calcified (loaded with calcium). In other words, the normally flexible and mobile "leaflets" of the aortic valve were coated with calcium and other tissues that interfere with its free motion. The aortic valve is the starburst white in the center of the heart.








This is what the aortic valve should look like on a CT heart scan--you shouldn't see it at all.

The first man with the calcified valve will unfortunately require a new prosthetic aortic valve sometime in his future. This is usually determined with the help of an ultrasound, or echocardiogram, a better test for assessment of the aortic valve (though useless for detection of coronary plaque).

It's my suspicion that chronic and longstanding deficiency of vitamin D is among the factors that contribute to the abnormal deposition of calcium on the aortic valve. We desperately need more data on this. Nonetheless, perhaps this adds yet another reason to 1)get a CT heart scan, and 2) bring your vitamin D blood level to normal. (We aim for 50 ng/ml year round.)

Fish oil and the perverse logic of hospitals

Hospitals are now starting to carry prescription fish oil, known as Omacor, on their formularies. It's used by some thoracic surgeons after bypass surgery, since fish oil has been shown to reduce the likelihood of atrial fibrillation (a common rhythm after heart surgery).

Why now? The data confirming the benefits of fish oil on atrial fibrillation has been available for several years.

It's now available in hospitals because it's FDA-approved. In other words, when fish oil was just a supplement, it was not available in most hospitals. Whenever I've tried to get fish oil for my patients while in hospital, you'd think I was trying to smuggle Osama Bin Laden into the place. The resistance was incredible.

Now that FDA-approved Omacor is available, costing $130 dollars per month for two capsules, $195 for the three capsule per day dose for after surgery, all of a sudden it becomes available. Why would this irrational state of affairs occur in hospitals?

Several reasons, most of which revolve around the great suspicion my colleagues have towards nutritional supplements. In addition, there's the litigation risk: If something has been approved by the FDA, their stamp of endorsement provides some layer of legal protection.

However, I regard those as pretty weak reasons. I am, indeed, grateful that fish oil is gaining a wider audience. But I think it's absurd that it requires a prescription to get it in many hospitals. Imagine, as the drug companies would love, vitamin C became a prescription agent. Instead of $3, it would cost far more. Does that make it better, safer, more effective?

Of course, no drug sales representative is promoting the nutritional supplement fish oil to physicians nor to hospitals. I now see people adding the extraordinary expense of prescription fish oil to their presription bills.

In my view, it's unnecessary, irrational, and driven more by politics and greed than actual need. Take a look at the website for Omacor (www.omacorrx.com). Among the claims:

"OMACOR is the only omega-3 that, along with diet, has been proven and approved to dramatically reduce very high triglycerides..."

This is a bald lie. Dozens of studies have used nutritional supplement fish oil and shown spectacular triglyceride-reducing effects.

Their argument against fish oil supplements:

"Dietary supplements are not FDA-approved for the treatment of any specific disease or medical condition. Get the Facts: nonprescription, dietary supplement omega-3 is not a substitute for prescription OMACOR."

Does that make any sense to you? Should you buy a GM car because only GM makes genuine GM cars? This is the silly logic being offered by these people to justify their ridiculous pricing.

How about: "The unique manufacturing process for OMACOR helps to eliminate worries about mercury and other pollution from the environment."

Funny...mercury in fish tends to be sequestered in the meat, not the oil. Independent reports by both Consumer Reports and Consumer Lab found no mercury, nor PCB's, in nutritional supplement fish oil. But just suggesting a difference without proving it may be enough to scare some people.

Just because something is used by a hospital does not make it better. The adoption of fish oil is hospitals is a good thing. Too bad it has to add to already bloated health care costs to enrich some drug manufacturer.

Repent for past sins

If the food temptations of the holidays got the best of you, and you're now 5, 10, 15 lbs or more over your pre-holiday weight (our record is 18lbs!), then it's time for serious action.

One easy method to regain the control you may have lost is to pick some period, say, 3 days. During those three days, eat nothing but vegetables--no breads, meats, dairy products, certainly no cookies, cakes, pasta, etc., not even fruit. Follow this routine and weight drops rapidly. Vegetables are wonderful but sometimes boring, so use healthy condiments to spice them up: mustards (hot, brown, yellow, horseradish); healthy salad dressings, which are olive or canola oil-based; salsas, a fabulous garnish with no nutritional downside whatsoever; pesto; tapenades; horseradish added to other condiments or even by itself (wasabi).

Of course, fasting in one of its several variations is another rapid method to regain control. My favorite is to use soy milk in a modified fast, usually 4-6 glasses of a low-fat, low-sugar soy milk per day, along with plenty of water. (Please refer to the precautions detailed in the recent Track Your Plaque Special Report, Fasting: Fast Track to Control Plaque , particularly if you fast 5 days or longer or take blood pressure or diabetic medication.)

Of course, yo-yoing your weight--up during the holidays, down after their conclusion--is not good for you. It does raise the likelihood of diabetes, not to mention cultivate the patterns that contribute to coronary plaque growth, especially small LDL. But if temptation got out of control and you need to regain lost ground, these two strategies work fabulously well for most people.

If you've gained, say, 10 lbs during the holidays, but simply resume your usual habits, chances are you won't lose the weight. Year after year, this can add up to an enormous weight gain. The time to act is now. It's easier to lose the 10 lbs of weight you gained recently, rather than the 50 lbs you've stacked up over the past 5 years.
Mini-dose CTA?

Mini-dose CTA?

I caught this little news report in the online edition of Canyon News , an LA paper, under the title Cedars-Sinai Develops Test to Prevent Heart Attacks .

They report that Dr. Daniel S. Berman M.D., chief of Cardiac Imaging and Nuclear Cardiology at Cedars-Sinai, reports that a new method of performing CT coronary angiography, "mini-dose CTA," has been developed that allows both coronary calcium scoring as well as CT coronary angiography (CTA) at a dose as low as 10% of standard dose. No technical details were provided.

Now, that may be worth knowing more about. If this is true, then CTA may indeed be useful as a "screening" procedure. However, we are going to need to know more: What devices are capable of doing this, what settings on the devices were used, etc. It does indeed come from a reputable source in Dr. Dan Berman, who is well known in nuclear cardiology circles.

We will try and dig for info. Stay tuned.

Comments (11) -

  • wccaguy

    10/15/2007 5:57:00 PM |

    Very interesting.

    The article also contains this potential nugget:

    Dr. Daniel S. Berman M.D., chief of Cardiac Imaging and Nuclear Cardiology at Cedars-Sinai reports that the danger in not testing for non-calcified blockages is great. These plaques, he says, are “more prone to rupture than calcified plaques. The new procedure, which does test for these, provides “better risk assessment.”

    Any thought about these "non-calcified blockages"?  This is somewhat related to a question I asked a while back about "reducing plaque as measured by calcium score" and reducing risk by reducing risk of rupture in the artery.  You had a good answer to the question but it seems like there is more to explore here.

    Thanks for the info.

  • Anonymous

    10/15/2007 8:54:00 PM |

    Here is a similar study using ct to diagnose degree of stenosis:

    Dual-source CT non-invasively detects coronary stenoses

    15 October 2007

    MedWire News: Dual-source multi-slice computed tomography (DSCT) angiography can accurately detect coronary stenoses in patients with an intermediate likelihood of coronary artery disease (CAD), even in the presence of arrhythmias and raised heart rates (HRs), researchers say.

    Alexander Leber (University of Munich, Germany) and team explain in the European Heart Journal that using multi-slice CT to detect coronary stenoses can be limited by the appearance of motion artefacts.

    The researchers tested the newly-developed DSCT technique in 90 patients with an intermediate pretest likelihood of CAD referred for invasive coronary angiography. They obtained data sets providing image quality sufficient for analysis in 88 patients.

    The image quality was diagnostic in six of seven patients with atrial fibrillation, and in 46 out of 48 patients with HR >65 beats per minute (bpm).

    In 1165 of 1174 segments, significant (>50% stenosis) disease was correctly ruled out using DSCT.

    All patients (n=9) with at least one stenosis >75% (sensitivity 100%) and 11 of 12 (sensitivity 88%) patients with at least one stenosis ranging from 50-75% were correctly identified by DSCT.

    Meanwhile DSCT-angiography correctly excluded a lesion >50% in 60 of 67 patients (specificity 90%, positive predictive value 74%).

    The accuracy to detect coronary stenoses >50% was similar in patients with HR >65 bpm and those with HR =65 bpm (sensitivity 92 and 100%, specificity 88 and 91%, respectively).

    The researchers conclude: "DSCT is a non-invasive tool that allows to accurately rule out coronary stenoses in patients with an intermediate pretet likelihood for CAD, independent of the HR."

    Eur Heart J 2007; 28: 2354-2360

  • wccaguy

    10/16/2007 4:10:00 AM |

    I thought I'd take another shot at stating the question I have about the relationship of a declining calcium score and plaque rupture risk.

    If the calcium within plaque is reduced at greater rate than the plaque it had calcified, hence leaving that plaque non-calcified, then, does that recently non-calcified plaque qualify as being a type of plaque that, as Berman puts it, is "more prone to rupture than calcified plaques"?

    There are a lot of different ways to state the question I guess.  Here's another try.

    Does the process of calcium/plaque reduction per se result a type of instability that is "more prone to rupture"?

    Perhaps it does not.  But if it does, then, it seems as if it would be important to understand how to increase stability per se.

    In that case, aren't BOTH plaque reduction and plaque stability important?

    How is plaque stability promoted?

    Hope all this make sense.

    Thanks.

  • Dr. Davis

    10/16/2007 11:44:00 AM |

    Great questions. Not all answers are available.

    However, there are several things we do know, mostly from intracoronary ultrasound studies, autopsy studies, and extrapolations from animal studies. (Real, live human data is not generally available, since few people would allow us to remove plaque.)

    We know that:

    --The lipid components of atherosclerotic plaque are fairly readily regressible, e.g., LDL cholesterol reduction. Lipid resorption precedes calcium extraction.

    --Plaque instability is determined less than calcium presence or absence than by the presence of high-rupture risk markers, like collections of lipid near the surface, so called "lipid pools" and think fibrous "caps" at the surface-to-lumen interface, as well as inflammatory cell collections and enzymatic activity, e.g., matrix metalloproteinase.

    --Calcium is probably the least resorbable factor in plaque. If you resorb calcium by x percent, you've probably resorbed the lipid and inflammatory elements hugely. However, given the rarity of profound regression in studies, these observations are scant.

    --The trend towards substantial reductions in cardiovascular events in people who have not progressed heart scan score (or other measures of coronary atherosclerotic burden) vs. those who progress confirm that progressively increasing scores are accompanied by increasing risk of events, "plaque rupture."

    --There are not enough data on event rates in people who drop their score substantially because: 1) Nobody except our program has achieved this, and 2) Events in people who reduce their score are, for all practical purpose, non-existent. We are collecting our data for publication in the coming year, as well as assembling the pieces for subsequent studies for full validation of these concepts.

  • wccaguy

    10/16/2007 12:16:00 PM |

    Dr. Davis,

    Thanks for an answer right on point.

    You continue to amaze with your knowledge that speaks to an issue and makes common sense while at the same time you acknowledge that sometimes "we just don't know".

  • wccaguy

    10/16/2007 1:16:00 PM |

    I know I've already said thanks for the answer but I thought I'd make one last point here.

    There is a clear distinction between plaque reduction and plaque rupture risk reduction.

    I think your last comment contained solid evidence, to the extent we now have it, that plaque reduction doesn't increase plaque rupture risk but in fact decreases it.

    This has settled my mind on the issue (until there is more evidence to evaluate).

    I understand that this is a needling kind of point but it seems to me an important one and I think the answer you gave is a great start on a new TYP Program Special Report.

    You probably have a long list of these kinds of reports to write.  I'd recommend adding this topic to that queue.

    Thanks again for everything you do.

  • Dr. Davis

    10/16/2007 4:47:00 PM |

    Eventually, I'd like to see a two armed study comparing the Track Your Plaque appraoch to a control group using statins and an American Heart Association diet. My prediction is that there will be no comparison. However, I doubt a drug company would sponsor such a study that likely would cost several million dollars, given the large numbers of people required for conclusive outcome (i.e., cardiovascular events) data.

    A more practical approach would be to do side-by-side serial heart scans with intracoronary ultrasound. I think this may be more achievable in the foreseeable future, but will require a great deal of planning. Believe it or not, I tried such a study nearly 12 years ago but encountered tremendous resistance, since such a study needs to be performed in a hospital setting.

    Another thought: With the tremendous experience we are developing on line, this could be construed as a "virtual clinical trial" that allows us to quantify events among a growing number of people. Not as "clean" but still persuasive.

  • Anonymous

    10/16/2007 8:26:00 PM |

    A pdf file with a more detailed description of how they do the mini-dose CCTA is at the cedars-sinai website here.

    They reduce the radiation dose by using x-rays produced during only 1/10th of the cardiac cycle.

  • Dr. Davis

    10/16/2007 10:43:00 PM |

    Thanks for the lead.

    I looked at the press release but it leaves me puzzled. Many scan centers "gate" to the EKG. I'm not sure what they are doing differently. I'll do some digging.

  • G

    11/13/2007 2:49:00 AM |

    No smart drug company will do a drug trial versus the TYP plan. (if they're smart!!) In the PROVE-IT trial, Bristol Myers conclusively demonstrated that their drug (pravastatin) sucked...  maybe you can use your favorite colleague's patients for the control-arm? *wink wink*

    You definitely need to publish a 'metabolic' arm, including any T2DM patients. I think by distinguishing the difference, you may demonstrate even more accelerated plaque regression compared with non-metabolic.  Perhaps most pts are 'metabolic?'.  

    remember if you have Asians or Indo-Asian patients, the BMI >= 27.5 is considered 'obese' and waist circumference > 35.5 inches for men is 'metabolic'...  hope that helps!

  • Dr. Davis

    11/13/2007 2:56:00 AM |

    I agree.

    Our first release of the data this coming spring will lump together people with metabolic syndrome and diabetes along with everybody else. As the experience grows, I believe that a subset analysis will be possible.

Loading