Low thyroid: What to do?

8. February 2009 William Davis (25)
I've gotten a number of requests for solutions on how to solve the low thyroid issue if either 1) your doctor refuses to discuss the issue or denies it is present, or 2) there are government mandates against thyroid correction unless certain (outdated) targets are met.

Oh, boy.

While I'm not encouraging anyone to break the laws or regulations of their country (and it's impossible to generalize, with readers of this blog originating from over 30 countries), here are some simple steps to consider that might help you in your quest to correct hypothyroidism:

--Measure your body temperature--First thing in the morning either while lying in bed or go to the bathroom and measure your oral temp. Record it and, if it is consistently lower than 97.0 degrees (Fahrenheit), show it to your doctor. This may help persuade him/her.(You can still be hypothyroid with higher temperatures, but if low temperatures are present, it is simply more persuasive evidence in favor of treatment).

--Supplement with iodine 150 mcg per day to be sure you are not iodine deficient. This is becoming more common in the U.S. as people avoid iodized salt. It is quite common outside the U.S. An easy, inexpensive preparation is kelp tablets.

--Show your doctor a recent crucial study: The HUNT Study that suggests that cardiovascular mortality begins to increase at a TSH of only 1.5 or greater, not the 5.5 mIU usually used by laboratories and doctors.

--Ask people around you whether they are aware of a health practitioner who might be willing to work with you, or at least have an open mind (sadly, an uncommon commodity).

Also, see thyroid advocate and prolific author, Mary Shomon's advice on how to find a doctor willing to work with you. Yes, they are out there, but you may have to ask a lot of friends and acquaintances, or meet and fire a lot of docs. It shouldn't be this way, but it is. It will change through public pressure and education, but not by next week.

Another helpful discussion from Mary Shomon: The TSH Normal Range: Why is there still controversy? You will read that even the endocrinologists (a peculiarly contentious group) seethingly debate what constitutes normal vs. low thyroid function.

Also, you might remind a resistant health practitioner that guidelines are guidelines--they are not laws that restrain anyone. They are simply meant to represent broad population guidelines that do not take your personal health situation into consideration.

Which statin drug is best?

8. February 2009 William Davis (7)
I re-post a Heart Scan Blog post from one year ago, answering the question: Which statin drug is best?

I still get this question from patients in the office and online, nearly always prompted by a TV commercial. So let me re-express my thoughts from a year ago, which have not changed on this issue.


The statin drugs can indeed play a role in a program of coronary plaque control and regression.

However, thanks to the overwhelming marketing (and lobbying and legislative) clout of the drug manufacturing industry, they play an undeserved, oversized role. I get reminded of this whenever I'm pressed to answer the question: "Which statin drug is best?"

In trying to answer this question, we encounter several difficulties:

1) The data nearly all use statins drugs by themselves, as so-called monotherapy. Other than the standard diet--you know, the American Heart Association diet, the one that causes heart disease--it is a statin drug alone that has been studied in the dozens of major trials "validating" statin drug use. The repeated failure of statin drugs to eliminate heart disease and associated events like heart attack keeps being answered by the "lower is better" argument, i.e., if 70% of heart attacks destined to occur still take place, then reduce LDL even further. This is an absurd argument that inevitably encounters a wall of limited effects.

2) The great bulk of clinical data examining both the incidence of cardiovascular events as well as plaque progression or regression have all been sponsored by the drug's manufacturer. It has been well-documnted that, when a drug manufacturer sponsors a trial, the outcome is highly likely to be in favor of that drug. Imagine Ford sponsors a $30 million study to prove that their cars are more reliable and safer. What is the likelihood that the outcome will be in favor of the competition? Very unlikely. Such is human nature.

If we were to accept the clinical trial data at face value and ignore the above issues, then I would come to the conclusion that we should be using Crestor at a dose of 40 mg per day, since that was the regimen used in the ASTEROID Trial that achieved modest reversal of coronary atherosclerotic plaque by intravascular ultrasound.

But I do not advocate such an ASTEROID-like approach for several reasons:

1) In my experience, nobody can tolerate 40 mg of Crestor for more than few weeks, a few months at most. Show me someone who can survive and tolerate Crestor 40 mg per day and I'll show you somebody who survived a 40 foot fall off his roof--sure, it happens, but it's a fluke.

2) The notion that only one drug is necessary to regress this disease is, in my view, absurd. It ignores issues like hypertension, metabolic syndrome, inflammatory phenomena, lipoprotein(a), post-prandial (after-eating) phenomena, LDL particle size, triglycerides, etc. You mean that Crestor 40 mg per day, or other high-intensity statin monotherapy should be enough to overcome all of these patterns and provide maximal potential for coronary plaque reversal? No way.

3) Plaque reversal can occur without a statin agent. While statin drugs may provide some advantage in the reduction of LDL, much of the benefit ends there. All of the other dozens of causes of coronary atherosclerotic plaque need to be addressed.

So which statin is best? This question is evidence of the brainwashing that has seized the public and my colleagues. The question is not which statin is best. The question should be: What steps do I take to maximize my chances of reversing coronary atherosclerotic plaque?

The answer may or may not involve a statin drug, regardless of the subtle differences among them.

Dr. Nancy Sniderman, heart scans on Today Show

5. February 2009 William Davis (6)
While shaving this morning, I caught the report by NBC medical expert, Dr. Nancy Sniderman, about her coronary plaque and CT coronary angiogram.

Visit msnbc.com for Breaking News, World News, and News about the Economy




Those of you in the Track Your Plaque program or who follow The Heart Scan Blog know that we should tell Dr. Sniderman and her doctor that:

She has done virtually nothing that will stop an increasing heart scan score! In fact, Dr. Sniderman is now following the "prevention program" that is eerily reminiscent of Tim Russert's program! We all know how that turned out.

It is pure folly to believe that a combination of Lipitor, exercise, and a "healthy diet" (usually meaning a low-fat diet--yes, the diet that promotes heart disease) will stop the otherwise relentless increase in heart scan score.

Dr. Sniderman, please consider:

1) Having the real causes of your coronary plaque identified. (It is highly unlikely to be just LDL cholesterol, though the drug industry is thrilled that you believe this.)

2) Ask yourself (or, if your doctor knew what she was doing, ask her): Why do I have heart disease? LDL cholesterol is insufficient reason--virtually nobody I know has high LDL cholesterol as the sole cause. LDL cholesterol is, at most, one reason among many others, but is insufficient as a sole cause.

3) What is your vitamin D status? Crucial!

4) What is your thyroid status?

5) Fish oil--a must!

6) Do you have lipoprotein(a)? Small LDL?

Just addressing the items on the above checklist would put you on a far more confident path to stop your heart scan score from increasing.

If you were to repeat your heart scan score, my prediction: Your score will be higher by 18-24% per year.

My personal experience with low thyroid

3. February 2009 William Davis (31)
Something happened to me around October-November of last year.

I usually feel great. Ordinarily, my struggles are sleeping and relaxing. As with most people, I have too many projects on my schedule, though I find my activities stimulating and fascinating.

I blasted through a very demanding November, trying to meet the needs of a book publisher. This involved sleeping only a few hours a night for several days on end, all after a full day of office practice and hospital duties.

But it was getting tougher. My concentration was becoming more fragmented. Getting things done was proving an elusive goal. Exercise became a real chore.

Although I usually force myself to go to sleep, I was starting to fall asleep before my usual bedtime, and I was sleeping longer than usual.

It's been a tough winter in Wisconsin. Let's face it: It's Wisconsin. But it's been tough even for this region, with weeks of temperatures consistently below 10 degrees. Even so, I was having a heck of a time keeping warm. Extra shirts, socks, soaking my hands in hot water--none of it worked and I was freezing.

So I had my thyroid values checked:

Free T3: 2.6 pg/ml (Ref 2.3-4.2)
Free T4: 1.20 ng/dl (Ref 0.89-1.76)
TSH: 1.528 uUI/ml (Ref 0.350-5.500)

Normal by virtually all standards. I measured my first morning oral temperature: 96.1, 96.3, 95.9. Hmmmm.

My experience coincided with the Track Your Plaque and Heart Scan Blog conversations about low thyroid being enormously underappreciated, with the newest data on thyroid disease suggesting that a TSH for ideal health is probably 1.5 mIU or less. (More about that: Is normal TSH too high? and Thyroid perspective update .

Could this simply be a case of medical student-oma in which every beginning medical student believes he has every disease he learns about?

Despite the apparently "normal" thyroid blood tests, I took the leap and started taking Armour thyroid, beginning at 1/2 grain (30 mg), increasing to 1 grain (60 mg) after the first week.

Within 10 days, I experienced:

--Dramatic restoration of the ability to concentrate
--A boost in mood. (In fact, the last few blog posts before I replaced thyroid reflect my deepening crabbiness.)
--Large increase in energy, now restored to old levels
--Need for less sleep
--I'm warm again! (It's still <20 degrees, but I get easily stay warm while indoors.)

I am absolutely, positively convinced of the power of thyroid. I am further convinced from the clinical data, patient experiences, and now my own personal experience, that low levels of hypothyroidism are being dramatically underappreciated and underdiagnosed.

I shudder to think of what my life would have been like 6 months or a year from now without correction of thyroid hormone.

Now, the tough question: Why the heck is this happening to so many people?

Speaking availability

3. February 2009 William Davis (5)
Just a quick announcement:

If you would like to hear more about the concepts articulated in The Heart Scan Blog or in the Track Your Plaque program, I am available to speak to your group.

Among the possible topics:

Return to the Wild: Natural Nutritional Supplements That Supercharge Health
Why this apparent "need" for fish oil and other heart-healthy supplements? I discuss why some nutritional supplements make perfect sense when we are viewed in the context of primitive humans living modern lives, while other supplements do little.


Shrink Your Tummy . . .or, Why Your Dietitian is Fat!
Weight loss doesn't have to involve calorie counting, deprivation, or hunger pangs. But the conventional "rules" for weight loss and health have to be broken.

The Politically Incorrect Guide to Extraordinary Heart Health
Heart health is something that you can seize control over, something identifiable, correctable, and . . . reversible. Much of this can be achieved with little or no medication, nor procedures. I detail all the enormously empowering lessons learned through the Track Your Plaque program.


I can also present in-depth yet entertaining discussions on the power of vitamin D, natural cholesterol control, screening for heart disease, and similar topics covered in the blog.

To learn more, just e-mail us at contact@trackyourplaque, or call my office at 414-456-1123.

Learn how to eat from Survivorman

31. January 2009 William Davis (22)

Look no farther than Discovery Channel to learn how humans were meant to eat.

The Survivorman show documents the (self-filmed) 7-day adventures of Les Stroud, who is dropped into various remote corners of the world to survive on little but ingenuity and will to live. Starting without food or water, the Survivorman scrapes and scrambles in the wilderness for essentials to survive in habitats as far ranging as the Ecuadorian rainforest to sub-arctic Labrador.

What does Survivorman have to do with your nutrition habits?

Everything. The lessons we can learn by watching this TV show are plenty.

Survivorman plays out the life we are supposed to be living: slaughtering wild game with simple handmade tools and his bare hands, identifying plants and berries that are safe to eat, trapping fish, scavenging the kill of other predators. He's even resorted to eating bugs and caterpillars, particularly following several days of unsuccessful hunting and scavenging.

What is notable from the Survivorman experience is what is absent: In the steppe, desert, tundra, or jungle, you will not find bread, fruit drinks, or Cheerios. You won't find farm-fattened, corn-fed livestock with meat marbled with fat.

Imagine the result of such an experience for us, drawn out over 6 months. Even an obese, diabetic, gluttonous, XXX dress size 350-lb woman would return a lean 105 lbs, size 0, non-diabetic, fully able to run miles in the wild tracking game.

Survivorman's quiet desperation of living in the wild, preoccupied with worries over where his next meal might be found, is a stark contrast to the bloated, shelves stacked floor-to-ceiling supermarkets, and our modern society's all-you-can-eat several times per day lifestyle.

Am I advocating selling the car and house and chucking modern society for the "safety" of the jungles of Borneo?

No, of course not. I am advocating taking a lesson from the clever experiment conducted by Mr. Stroud, a return-to-the-wild experience that should teach us something about how perverse our modern nutritional lives have become.

CIS: Carbohydrate intolerance syndrome

28. January 2009 William Davis (28)
Carbohydrate intolerance comes in many shades and colors, shapes and sizes.

I call all of its varieties the Carbohydrate Intolerance Syndrome, or CIS. (Not to be confused with CSI, or Crime Scene Investigation . . . though, come to think of it, perhaps there are some interesting parallels!)

At its extreme, it is called type II diabetes, in which any carbohydrate generates an extravant increase in blood sugar, followed by the domino effect of increased triglycerides, reduction in HDL, creation of small LDL, heightened inflammation, etc. and eventually to kidney disease, coronary atherosclerosis, neuropathies, etc.

An intermediate form of carbohydrate intolerance is called metabolic syndrome, or pre-diabetes. These people, for the most part, look and act like diabetics, though their reaction to carbohydrate intake is not as bad. Blood sugar, for instance, might be 125 mg/dl fasting, 160 mg/dl after eating. The semi-arbitrary definition of metabolic syndrome includes at least three of the following: HDL <40 mg/dl in men, <50 mg/dl in women; triglycerides 150 mg/dl or greater; BP 135/80 or greater; waist circumference >40 inches in men, >35 inches in women; fasting glucose >100 mg/dl.

This is where the conventional definitions stop: Either you are diabetic or have metabolic syndrome, or you have nothing at all.

Unfortunately, this means that the millions of people with patterns not severe enough to match the standard definition of metabolic syndrome are often neglected.

How about Kevin?

Kevin, a 56 year old financial planner, is 5 ft 7 inches, 180 lbs (BMI 28.2). His basic measures:

HDL 36 mg/dl
Triglycerides 333 mg/dl
BP 132/78
Waist circumference 34 inches
Blood sugar 98 mg/dl

Kevin meets the criteria for metabolic syndrome on only two of the five criteria and therefore does not "qualify" for the diagnosis.

Kevin's basic lipids showed LDL 170 mg/dl, HDL 36 mg/dl, triglycerides 333 mg/dl.

But take a look at his underlying lipoprotein patterns (NMR):

LDL particle number 2231 nmol/L (equivalent to a "true" LDL of 223 mg/dl)
Small LDL 1811 nmol/l
Large HDL 0.0 mg/dl


In other words, small LDL constitutes 81% of all LDL particles (1811/2231), a severe pattern. Large HDL is the healthy, protective fraction and Kevin has none. These are high-risk patterns for heart disease. These, too, are patterns of carbohydrate intolerance.

Foods that trigger small LDL and reduction in healthy, large HDL include sugars, wheat, and cornstarch. Kevin is carbohydrate-intolerant, although he lacks the (fasting) blood sugar aspect of carbohydrate intolerance. But he shows all the underlying lipoprotein and other metabolic phenomena associated with carbohydrate intolerance.

We could also cast all three conditions under the umbrella of "insulin resistance." But I prefer Carbohydrate Intolerance Syndrome, or CIS, since it immediately suggests the basic underlying cause: eating carbohydrates, especially those that trigger rapid and substantial surges in blood sugar.

CIS is the Disease of the Century, judging by the figures (both numbers and humans) we are seeing. It will dominate healthcare in its various forms for many years to come.

The first treatment for the Carbohydrate Intolerance Syndrome? Some would say the TZD class of drugs like Avandia. Others would say a DASH or TLC (American Heart Association) diet. How about liposuction, twice-daily Byetta injections, or even the emerging class of drugs to manipulate leptin and adiponectin? How do "heart healthy" foods like Cheerios and Cocoa Puffs fit into this? (Don't believe me? The American Heart Association says they're heart healthy!)

The first treatment for the Carbohydrate Intolerance Syndrome is elimination of carbohydrates, except those that come from raw nuts and seeds, vegetables, occasional real fruit (not those green fake grapes), wine, and dark chocolates.

Making sense out of lipid changes

27. January 2009 William Davis (9)
Maggie had been doing well on her program, enjoying favorable lipids near our 60-60-60 targets (HDL 60 mg/dl or greater, LDL 60 mg/dl or less, triglycerides 60 mg/dl or less). Last fall, her last set of values were:

Total cholesterol: 149 mg/dl
LDL cholesterol: 67 mg/dl
HDL cholesterol: 73 mg/dl
Triglycerides: 43 mg/dl

The holidays, as with most people, involved a frenzy of indulgent eating: Christmas cookies, cakes, pies, stuffing, potatoes, candies, etc.

Maggie returned to the office 6 pounds heavier with these values:

Total cholesterol: 210 mg/dl
LDL cholesterol: 124 mg/dl
HDL cholesterol: 57 mg/dl
Triglycerides: 144 mg/dl

In other words, holiday indulgences caused an increase in LDL cholesterol, a reduction in HDL, an increase in triglycerides, an increase in total cholesterol.

What happened?

At first glance, many of my colleagues would interpret this as fat indulgence and/or a "need" for statin drug therapy.

Having done thousands of lipoprotein panels, I can tell you that, beneath the surface, the following has occurred:

--Overindulgence in carbohydrates from the goodies triggered triglyceride (actually VLDL) formation in the liver, released into the blood.
--Increased triglycerides and VLDL triggered a boom in conversion of large LDL to small LDL (since triglycerides are required to form small LDL particles) via cholesteryl-ester transfer protein (CETP) activity.
--Increased triglycerides and VLDL interacted with HDL particles, causing "remodeling" of HDL particles to the less desirable, less protective small particles, which do not persist as long in the blood, resulting in a reduction of HDL.

The critical factor is carbohydrate intake. This triggered a domino effect that is often misintepreted as excessive fat intake or a genetic predisposition. It is nothing of the kind.

I discussed this phenomenon with Maggie. She now knows to not overindulge in the holiday snacks in future and will revert promptly back to her 60-60-60 values.

How to Give Yourself Hashimoto's Thyroiditis: 101

25. January 2009 William Davis (18)
I borrowed this from the enormously clever Dr. BG at The Animal Pharm Blog.


How to Give Yourself Hashimoto's Thyroiditis: 101

--lack of sunlight/vitamin D/indoor habitation
--mental stress
--more mental stress
--sleep deprivation... (excessive mochas/lattes at Berkeley cafes)
--excessive 'social' calendar
--inherent family history of autoimmune disorders (who doesn't??)
--wheat, wheat, and more wheat ingestion ('comfort foods' craved in times of high cortisol/stress, right? how did I know the carbs were killing me?)
--lack of nutritious food containing EPA DHA, vitamin A, sat fats, minerals, iodine, etc
--lack of play, exercise, movement (or ?overtraining perhaps for Oprah's case)
--weight gain -- which begins an endless self-perpetuating vicous cycle of all the above (Is it stressful to balloon out for no apparent reason? YES)


If you haven't done so already, take a look at Animal Pharm you will get a real kick out of Dr. BG's quick-witted take on things.


We are systematically looking for low thyroid (hypothyroidism) in everyone and findings oodles of it, far more than I ever expected.

Much of the low thyroid phenomena is due to active or previous Hashimoto's thyroiditis, the inflammatory process that exerts destructive effects on the delicate thyroid gland. It is presently unclear how much is due to iodine deficiency in this area, though iodine supplementation by itself (i.e., without thyroid hormone replacement) has not been yielding improved thyroid measures.

I find this bothersome: Is low thyroid function the consequence of direct thyroid toxins (flame retardants like polybrominated diphenyl ethers, pesticide residues in vegetables and fruits, bisphenol A from polycarbonate plastics) or indirect toxins such as wheat via an autoimmune process (similar to that seen in celiac disease)?

I don't know, but we've got to deal with the thyroid-destructive aftermath: Look for thyroid dysfunction, even in those without symptoms, and correct it. This has become a basic tenet of the Track Your Plaque approach for intensive reduction of coronary risk.

Framing

24. January 2009 William Davis (0)
Heart health without a 12" incision



Heart health for less than $44,483 (Cost of a coronary stent according to the American Heart Association 2008 Update)



Track Your Plaque: A drug-free zone



Dr. William Blanchet: A voice of reason

Dr. William Blanchet: A voice of reason

24. November 2007 William Davis (21)
I don't mean to beat this discussion to a pulp, but looking back over the comments posted on www.theHeart.org forum, I am so deeply impressed with Dr. William Blanchet's grasp of the issues, that I posted his articulate and knowledgeable comments again.

Here is one post in which Dr. Blanchet, in response to accusations of trying to profit from heart scans, provides a wonderful summary of the logic and evidence behind the use of heart scans as the basis for heart disease prevention.


Yes, I have seen a dramatic reduction in coronary events.

Of 6,000 active patients, 48% being Medicare age and over, I have seen 4 heart attacks over the last 3+ years. 2 in 85 year old diabetics undergoing cancer surgery, one in a 90 year old with known disease and one in a 69 year old with no risk factors, who was healthy, and had never benefited from a heart scan.

The problem with coronary disease is that we rely on risk factors. Khot et al in JAMA 2003 showed that of 87,000 men with heart attacks, 62% had 0 or 1 major risk factor prior to their MI. According to ATP-III, almost everyone with 0-1 risk factors is low risk and most do not qualify for preventive treatment. EBT calcium imaging could identify 98% of these individuals as being at risk before their heart attack and treatment could be initiated to prevent their MI.

Treating to NCEP cholesterol goals prevents 30-40% of heart attacks. Treating to a goal of coronary calcium stability prevents 90% of heart attacks. Where I went to school, a 40% was an F. Why are we defending this result instead of striving to improve upon it? I am not making this up, look at Raggi's study in Arteriosclerosis, Thrombosis, and Vascular Biology 2004;24:1272, or Budoff Am J Card.[I believe it's the study Dr. Blanchet was referring to.]

I strongly disagree with the assertion that the stress test is a great risk stratifier. Laukkanen et al JACC 2001 studied 1,769 asymptomatic men with stress tests. Although failing the stress test resulted in an increased risk of future heart attack, 83% of the total heart attacks over the next 10 years occurred in those men who passed the stress test. Falk E, Shah PK, Fuster V Circulation 1995;92:657-671 demonstrated that 86% of heart attacks occur in vessels with less than 70% as the maximum obstruction. A vast majority of
patients with less than 70% vessel obstruction will pass their stress test.

Regarding [the] question of owning or referring for EBT imaging, I would be amused if it were not insulting. The mistake that is often made is that EBT imaging is a wildly profitable technology. It is not nearly as profitable as nuclear stress imaging. Indeed there are few EBT centers in the country that are as profitable as any random cardiologist's stress lab.

How can we justify not screening asymptomatic patients? Most heart attacks occur in patients with no prior symptoms and according to Steve Nissen, 150,000 Americans die each year from their first symptom of heart disease. My daughter is at this moment visiting with a friend who lost her father a few years ago to his first symptom of heart disease when she was 8 years old. That is not OK! We screen asymptomatic women for breast cancer risk. Women are 8 times more likely to die from heart disease than breast cancer. We do mass screening for colon cancer and we are over 10 times more likely to die from heart attacks than colon cancer. An EBT heart scan costs 1/8th the cost of a colonoscopy.

So what say we drop the sarcasm and look at this technology objectively. Read the literature, not just the editorial comments. This really does provide incredibly valuable information that saves lives.

Yes, a 90% reduction in heart attacks in my patients compared to the care I could provide 5 years ago when I was doing a lot of stress testing and referring for revascularization. Much better statistics than expected national or regional norms. I welcome your scrutiny.


That's probably the best, most concise summary of why heart scanning makes sense that I've ever heard. And it comes from a primary care physician in the trenches. With just a few paragraphs, Dr. Blanchet, in my view, handily trumps the arguments of my colleagues arguing to maintain the status quo of cholesterol testing, stress tests, and hospital procedures.


Note:
Dr. Blanchett talks openly about his affiliation with an imaging center in Boulder, Colorado, Front Range Preventive Imaging. I'm no stranger to the accusations Dr. Blanchet receives about trying to profit from the heart scan phenomenon. Ironically, heart scanning loses money. It is a preventive test, not a therapeutic, hospital-based procedure. Free-standing heart scan centers that do little else (perhaps virtual colonoscopies) usually manage to pay their bills but make little profit. Hospitals that offer heart scans usually do so as a "loss-leader," i.e., an inexpensive test that brings you in the door in the hopes that you will require more testing.

Accusations of profiteering off heart scans are, to those in the know, ridiculous and baseless. On the contrary, heart scans are both cost-saving and life-saving.
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Comments (21) -

  • wccaguy

    11/24/2007 6:19:00 PM |

    I had an opportunity to speak with Dr. Blanchet for a few minutes recently.  A great doctor and a nice guy.

    He's in Boulder, Colorado.  Here's the web site link I was able to contact him through.  (I've separated out the link onto two lines to ensure that the complete link appears in comments.  You'll need to put the two lines together as a single URL to paste into your browser.)

    http://www.bch.org/caregiver/
    physiciandetail.cfm/184

    If I lived close to Boulder, Colorado, I'd be working to make him my primary care physician.

  • Rich

    11/24/2007 8:13:00 PM |

    Dr. Davis:

    Thank you!

    About profitability: My calcium scan in California cost $500. The new-ish GE scanner that was used costs $1.8 million. I estimate that the $500 fee can only yield about $100 gross margin under high-patient-volume circumstances.

    -Rich

  • Dr. Davis

    11/24/2007 8:33:00 PM |

    I am not one to moan about the costs of running a scan center, since I've never had any financial interest in a scan center (despite numerous accusations of "secret arrangements," etc.), but costs of running a center also include:

    1) $12,000 or so a month upkeep. No kidding. The GE's of the world, though they do great engineering work, make many times their investment back just from the rich  maintenance contracts. I've seen these maintenance contracts break the back of many independent scan centers.

    2) Because physicians are so hard to educate on the value of heart scans, scan centers by necessity rely on advertising, which is very costly.

    3) Paying physicians to read scans. I can tell you from personal experience, since I do read scans and receive a small fee for each reading, that the reading fee is paltry. If I were doing this for money, I wouldn't waste my time. But it's not about money. It's about providing a necessary and important service.

    This is why independent scan centers have struggled across the country. It is getting better, but mostly because of the adoption of the new CT technologies by hospitals.

  • TedHutchinson

    11/25/2007 10:36:00 AM |

    Here are the actual prices those lucky enough to live in USA can get a Coronary Artery Scan ("heart scan") — EBT examination of heart with calculation of coronary calcium score. Includes all interpretations and comprehensive report. Radiologist examination of chest images. Report sent to patient and physician if requested. (For repeat scans, calcium volume scoring and notation of rate of progression or reversal)
    If claim is submitted to the insurance company and it is denied because it is considered "Not a Covered Benefit" $440
    35% Discount if paid at the time of service (Patient waives the rights to receive Health Insurance Claim Form) $395
    Anyone who thinks those prices are unreasonably high should see prices in the UK where Coronary Artery Scans cost £525.
    However, as it costs me about that to get my car serviced in the UK and there's no guarantee the work won't be done by an untrained lad on a job creation scheme, it's still good value.

  • Paul Kelly - 95.1 WAYV

    11/26/2007 1:28:00 PM |

    Is an EBT scan the same as a CT scan? My understanding is that it's the same thing...only faster. True? Are the levels of radiation the same?

    Thanks!

    Paul

  • G

    11/26/2007 11:16:00 PM |

    Has any had a scan in the Bay Area? I know that Walnut Creek and San Jose offer sites...  Any recommendations?  I'm thinking about getting my dad and husband xmas gifts...  I thought the price was bout $199 but I guess prices are higher now...inflation? being Calif?

    THANKS in advance!

    What is it with all you William/ Bill cardiologists...  all achieving medical miracles in a world of super-sized ego's and Pharma-driven gimmicks...

  • G

    11/27/2007 12:07:00 AM |

    Dr. Davis, You mentioned that for patients with Type 2 diabetes in your book (yes, finally got my hands on a copy! -- will need to order FAR in advance for Xmas gifts this yr! I'm giving the 'gift of life'!!) that reversal is rare?

    Now with so many tools (and the ability for you to post and share your progress) it seems like that is no longer true? Would you say so in your practice? and to what degree at this current time? what if pts are really really extremely aggressive with carbs, exercise and dramatic wt loss?

    BTW, the patient we discussed earlier (it's been about 1 mon now)is now doing substantially better.  He's exerting without angina! THANK YOU SO SO MUCH!! We actually stopped Actos and I think that made a huge difference also. (When combined with insulin, there appears to be a large increase in CHF (although person had no edema, PND or other signs), just shortness of breath with any exertion.)
    We're normalizing the Vit D and I think that has made the h-u-g-e-s-t difference (besides possibly the Actos -- no echo so don't know?). I haven't had a chance to start as many as the other interventions yet but will. He's doing a lot more raw nuts as well (and no wheat). DO you think the omega-6's are bad -- found in wheat, corn products? (I don't recall reading that here yet?) Especially for certain subpops? like high Lp(a) like my friend?

    Other labs have come back. I was wondering if I could get your thoughts briefly?
    CRP 0.5 (yes couldn't BELIEVE it!)
    DHEA-S 275 ug/dL
    TESTOST 440 ng/dL
    lipoprotein(a) 110 (wow)
    PTH 23
    Fructosamine 300 (we're getting there)
    Home glucose averages now 140s (1hour postprandially -- getting better! my goal normal < 120-130)

    Specifically, is there room to go with DHEA (for the Lp(a))? alpha-lipoic acid (not mentioned in book or blog? any experience yet?)  

    (L-carnitine and the Heart Bar are scheduled for his next visit)
    I am so grateful for all your commentary and advice...

  • Dr. Davis

    11/27/2007 12:30:00 AM |

    Thanks, G.

    I don't know much about the San Jose center, but I do know that the Walnut Creek scanner is an EBT device. They are also very interested in prevention/reversal there.

  • Dr. Davis

    11/27/2007 12:37:00 AM |

    The entire vitamin D concept is new since I wrote Track Your Plaque in 2003. Since then, I have seen type II diabetics drop their heart scan scores with addition/correction of vitamin D blood levels.

    For Lp(a), I nearly always try niacin first, then DHEA and/or testosterone as adjuncts. However, there may be little room for much testosterone supplementation, given a "middling" testosterone level. DHEA works better in females, but can still exert some effect in males (using doses of 25-50 mg per day in males). I've been disappointed with l-carnitine's effect, for the most part.

    I've not systematically used lipoic acid. I'm presuming you mean to enhance insulin responsiveness. When I have tried it, the results were small, but only in a few patients.

    Wheat avoidance, vitamin D, and exercise exert enormous effects, as you are witnessing. Keep up the great work with your people!

  • G

    11/27/2007 1:00:00 AM |

    Hi! Thank you for responding! I'm so relieved that your seeing the same progress in Type 2 DM's (and Dr. Blanchet as well)!
    I had thought as much...  I know when you published the book, it was already 'out-dated' by 12-18months, right? Your frustration is palpable but you are so correct, I certainly would not be of such enormous help to the individuals I work with if I hadn't come across your information 6-8wks ago (to share the hopefulness of actual CAD secondary and primary reversal)! Keep up the strong work!
    Regarding lipoic acid, it has been mentioned by people studying longevity (many of course support the same lifestyle changes as you -- the CRON-ers, Bruce N. Ames, etc). It is usually mentioned in conjunction with L-carnitine for mitonchondrial rejuvenation.

    I appreciate the info on the Walnut Creek site! We'll be checking it out! Take care, G

  • larry

    11/27/2007 6:45:00 AM |

    I get more impressed every time I read this blog!

    I am thinking about firing my Cardiologist and would like to know about Heart Scan Centers in Portland, OR as well as a Cardiologist to refer.

    Briefly, my medical history is that I have survived a Stroke in May 2004.

    In 2006, I didn't feel well and went to my Primary Doctor. He did a Nuclear Stress Test in his office. I was advised to not take my Beta Blockers for the test. I experienced a life threatening arrhythmia during the test. I went home and was advised to take my Beta Blocker for another test the next day. This time I was told things were fine.

    Three months later I had chest discomfort which brought me to the ER. No heart attack but sent to a Cardiologist for more testing. Again, round two of the Nuclear Stress Test and was advised not to take my Beta Blockers. I voiced my hesitation. Not being a Cardologist, I proceded to take the test. This time I had V-Tach.

    I have had a triple bypass on my left Coronary Artery and a stent the size of Rhode Island in my right Coronary Artery. Surprizing, no MI at any time.

    I have lost close to 35 pounds since surgery and am an avid bicycler. I have pedalled close to 600 miles during the month of August during lond distance events.

    The more I read about diets and heart disease, it appears to me that the AHA Cardiac Diet is a waste of time.

    Help me, Doc! Point me in the right direction!

  • Dr. Davis

    11/27/2007 12:01:00 PM |

    Hi, Larry--

    For the closest scan center, see our Scan Center listings on the www.trackyourplaque.com website. However, be warned that we rely on people like you to update us and thus the listing is neither complete or up-to-date. (As we grow, we clearly need to hire somebody just to keep this service updated.)

    I would invite you to look at our membership website, www.trackyourplaque.com. At your stage of the game, while a heart scan may or may not be possible anymore, the principles of the program still apply. I would suggest to you that, given what you've told me, the causes of your heart disease have yet to be uncovered. This will be crucial for long-term prevention/slowing/reversal of your disease.

    We are only starting to develop a listing of interested physicians. However, a lipidologist might be someone to look for in your area.

  • larry

    11/27/2007 4:49:00 PM |

    My heart disease was caused by smoking. I stopped smoking in 1993 after a lifetime of abuse. High blood prsseure was the cause of the stroke. My carotid arteries are clear.

    My LDL was 29 after surgery and my HDL was 65. I believe that exercise is key to me, but I must 'feed the machine' that propels me on my bike.

    Thanks for the imput, I will look into it..

  • Dr. Davis

    11/27/2007 10:52:00 PM |

    Don't forget about lipoprotein(a), a very important pattern that is hugely ignited by smoking.

  • Paul Kelly - 95.1 WAYV

    11/29/2007 7:42:00 PM |

    Hi Dr, Davis,

    You wouldn't believe the trouble i'm having trying to get someone to give me a CT Heart Scan without trying to talk me into a Coronary CTA. Every facility I've talked to keeps harping on the issue that calcium scoring only shows "hard" plaque...and not soft. I also had a nurse today tell me that 30% of the people that end up needing a coronary catheterization had calcium scores of ZERO. That doesn't sound right to me. What determines whether or not someone needs a coronary catheterization anyway?

    As always - thanks in sdvance for your response!

    Paul

  • Dr. Davis

    11/29/2007 11:56:00 PM |

    Paul-

    Please see an upcoming Heart Scan Blog on this question. I am embarassed and angered that scan centers dispense such information.

  • Dr. Davis

    12/6/2007 2:21:00 AM |

    Paul--

    A full length report on this topic is on the Track Your Plaque website. I would invite you to take a look. Both devices are reasonable choices for a heart scan, though EBT has less than half the radiation exposure of a 64-slice device.

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    That's probably the best, most concise summary of why heart scanning makes sense that I've ever heard. And it comes from a primary care physician in the trenches. With just a few paragraphs, Dr. Blanchet, in my view, handily trumps the arguments of my colleagues arguing to maintain the status quo of cholesterol testing, stress tests, and hospital procedures.

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