Why does wheat cause arthritis?

Wheat causes arthritis.

Before you say "What the hell is he saying now?", let me connect the dots on how this ubiquitous dietary ingredient accelerates the path to arthritis in its many forms.

1) Wheat causes glycation--Glycation is glucose-modification of proteins in the body that occurs when blood glucose exceeds 100 mg/dl. Cartilage cells are especially susceptible to glycation. The cartilage cells you had at age 18 are the very same cartilage cells you have at age 60, since they lack the ability to reproduce and repair themselves. Proteins in cartilage are highly susceptible to glycation, which makes them stiff and brittle. Stiff, brittle cartilage loses its soft, elastic, lubricating function. Damaged cartilage cells don't regenerate nor produce more protective proteins. This allows destruction of cartilage tissue, inflammation, and, eventually, bone-on-bone arthritis.

Because wheat, even whole wheat, sends blood sugar higher than almost all other foods, from table sugar to Snickers bars, glycation occurs after each and every slice of toast, every whole wheat bagel, every pita wrap.

2) Wheat is acidifying--Humans are meant to consume a diet that is net alkaline. While hunter-gatherers who consume meat along with plentiful vegetables and fruits live a net alkaline diet (urine pH 7 to 9), modern humans who consume insufficient vegetables and too much grain (of which more than 90% is usually wheat) shift the body towards net acid (urine pH 5 to 7). Wheat is The Great Disrupter, upsetting the normal pH balance that causes loss of calcium from bones, resulting in decalcification, weakness, arthritis and osteoporotic fractures.

3) Wheat causes visceral fat--The extravagant glucose-insulin surges triggered by wheat leads to accumulation of visceral fat: wheat belly.

Visceral fat not only releases inflammatory mediators like tumor necrosis factor and various interleukins, but is also itself inflamed. The inflammatory hotbed of the wheat belly leads to inflammation of joint tissues. This is why overweight and obese wheat-consuming people have more arthritis than would be explained by the burden of excess weight: inflammation makes it worse. Conversely, weight loss leads to greater relief from arthritis pain and inflammation than would be explained by just lightening the physical load.

We need a name for this wheat effect. How about "bagel bones"?

Comments (48) -

  • Hans Keer

    11/13/2010 5:50:58 PM |

    Perhaps I could add a fourth factor: Arthritis is more and more sen as an autoimmune disease. Wheat is one of the most prominent initiators of autoimmune diseases http://bit.ly/a9Gvjk

  • Kathryn

    11/13/2010 5:51:53 PM |

    Not being critical or attacking your statements.  I do believe that wheat (& other grains in general) are detrimental to health.

    But my understanding is that pH in the body is in a very small window: between 7.35 and 7.45 is what i have read.  

    ??

  • terrence

    11/13/2010 6:12:25 PM |

    "Bagel Bones" - I like it!

    But, how about "Bread Bones", or "Bakery Bones"?

  • Pater_Fortunatos

    11/13/2010 6:43:03 PM |

    Kathryn

    blood pH and urine pH are quite different things, but the urine pH reflects the cost that body pay to maintain the blood ph in the range you just mentioned.


    Hans Keer thanks for the link.

    Dr Davis thanks for another great lesson of medicine , everyone could use it!

    I am waiting an article regarding "MEMBRANE UNSATURATION AND LONGEVITY" considering "Great Fish Oil Experiment" of Ray Peat.

  • Pater_Fortunatos

    11/13/2010 6:47:43 PM |

    Sorry for being rude, I should have said "I would appreciate"...

  • Anonymous

    11/13/2010 8:40:05 PM |

    food fractures

  • Anonymous

    11/13/2010 9:15:00 PM |

    Don't forget gluten triggering autoimmune disorders, like rheumatoid arthritis.

  • Evolutionary Diet

    11/13/2010 10:05:50 PM |

    I don't have arthritis yet, but bread sure causes me to have a lot of digestive problems. Unfortunately, I love bread, so it's a constant struggle.

  • Anonymous

    11/13/2010 10:22:11 PM |

    i love your articles on wheat and really liked the neurological impact of wheat as told by you dr. davis. great work.

  • Anonymous

    11/13/2010 11:59:29 PM |

    Wheat of Mass destruction

  • Jon

    11/14/2010 5:37:12 AM |

    Wow... Continually checking up on your articles has really opened my eyes to how bad wheat really is.

    I am somewhat of a bread lover, but after reading about the disabling effects of wheat, I think I'm going to become a vegetable lover instead.

    Smile Keep writing your articles to spread this unknown knowledge around!

  • Dr. William Davis

    11/14/2010 2:23:41 PM |

    Hi, Hans--

    Yes, indeed. Yet another path by which wheat can exert joint damage.

    I suspect that there is more to this autoimmune or inflammatory pathway than suggested by rheumatoid arthritis. Unfortunately, with negative serum markers for rheumatoid arthritis or "atypical" appearances of the joint inflammation, it is often just labeled "arthralgia" or a non-specific arthritis, treated with non-steroidal agents, then dismissed.

  • Dr. William Davis

    11/14/2010 2:25:19 PM |

    Hi, Kathryn--

    Pater's comments address your concern: Tissue and serum pH is indeed tightly regulated. But there's a price to pay to maintain normal pH when disruptive acids or bases (mostly acids) are introduced. This is reflected in urine pH, an expression of net change.

  • Stargazey

    11/14/2010 2:45:04 PM |

    So low urine pH=osteoporosis? Do we have a scientific citation for this?

    I've seen all over the internet that eating lots of meat causes low blood pH, which causes osteoporosis. Obviously, what we eat cannot influence our blood pH, or we'd be dead.

    But if low urine pH caused osteoporosis, wouldn't internists everywhere be advising patients to correct that? I see them prescribing drugs plus extra calcium plus vitamin D plus exercise, but never a word about changing the net pH of the diet. Odd.

  • Joseph

    11/14/2010 3:30:56 PM |

    It's nicely coincidental that you mention wheat as as a cause of low blood PH. I've just found I have low blood PH during a checkup, yes wheat is slightly acid but after doing a bit of research my thinking is that it was caused by the moderate to high protein, high fat diet I have been consuming on the recommendation of alot of paleo blogs.

    To answer Stargazey, here are 6 studies I found that support the link between protein, blood PH and bone density.

    Consumption of higher protein omnivorous diets promoted decreased bone mineral density after weight loss in overweight postmenopausal women.
    The control, nonmeat, chicken, and beef groups lost 1.5%, 7.7%, 10.4%, and 8.1% weight and 0.0%, 0.4%, 1.1%, and 1.4% bone mineral density, respectively.
    http://biomedgerontology.oxfordjournals.org/content/early/2010/07/05/gerona.glq083.abstract

    Results: After adjustment for age, sex, and energy intake and control for forearm muscularity, BMI, growth velocity, and pubertal development, we observed that long-term dietary protein intake was significantly positively associated with periosteal circumference (P < 0.01), which reflected bone modeling, and with cortical area (P < 0.001), bone mineral content (P < 0.01), and polar strength strain index (P < 0.0001), which reflected a combination of modeling and remodeling. Children with a higher dietary PRAL had significantly less cortical area (P < 0.05) and bone mineral content (P < 0.01). Long-term calcium intake had no significant effect on any bone variable.
    http://journal.shouxi.net/qikan/article.php?id=206948

    We conclude that excessive dietary protein from foods with high potential renal acid load adversely affects bone, unless buffered by the consumption of alkali-rich foods or supplements.
    http://jn.nutrition.org/cgi/content/abstract/128/6/1051

    Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture.
    http://www.ajcn.org/cgi/content/abstract/73/1/118

    Enduced acidosis caused the loss of calcium, sodium and potassium from the cells and bones of subjects
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292842/?page=6

    Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women
    http://www.ajcn.org/cgi/content/abstract/81/4/923

    Aside from protein, Ketone bodies are also acidic and cause acidosis in diabetics "diabetic keto acidosis" and alcoholics "alcoholic ketoacidosis"

  • Mike

    11/14/2010 3:56:53 PM |

    I find this topic extremely interesting, especially from an athletic standpoint.

    As far as acidity, osteoporosis, and Paleo, Don from Primal Wisdom delved into this in a nice 7 part series: http://donmatesz.blogspot.com/2010/03/paleo-diet-ph-does-it-matter-part-vii.html

    Add in resistance training, though, and the whole point of diet and osteoporosis becomes almost completely moot. VitD, Ca, K, P don't hold much against skeletal bone adaptation to picking heavy stuff up.

    While I've seen evidence of increased athletic performance by the addition of exogenous pH buffers (bicarbonate), I have NOT seen evidence of (quantifiable) ergogenic improvements due to an "alkaline" diet.  While there might be some merit there (I myself follow a fairly strict Paleo diet), attempting to be more "alkaline" by decreasing meat intake would only hinder my performance.

    Back on topic:  I'll echo what other have stated already, in that the mechanism for arthritis, specifically RA, would be auto-immune mediated with wheat gluten intake.  I'm surprised Dr. Davis did not mention this.

  • Lori Miller

    11/14/2010 5:04:58 PM |

    Eating very much carb in general makes my shoulder hurt. One of my dance teachers has said the same thing about her knees.

    FWIW, both surgical anesthetic (morphine?) and wheat make me feel lousy. I didn't have any withdrawal when I quit eating wheat.

  • Joe

    11/14/2010 5:16:54 PM |

    @Mike

    While exercise may mitigate some of the effects of Acidosis such as low bone density, stress (acidosis raises cortisol), risk of panic attacks (http://www.ncbi.nlm.nih.gov/pubmed/17713689); I've read acidosis is associated with many other diseases.

    The positive effects of bicarbonate during exercise are probably related to higher muscle protein catabolysis during acidosis which would probably continue after you stopped exercising.

    Another effect of protein is to lower serum testosterone and sex binding hormone globulin. Saturated fat raises it however (http://jap.physiology.org/cgi/content/full/82/1/49)

  • Mike

    11/14/2010 11:13:52 PM |

    @Joe,

    I have no doubts chronic acidosis has strong implications in many disease etiologies; I was just stating my experience (and opinion) on the effectiveness of an alkaline diet on athletic performance, and emphasizing resistance training for optimal bone density over dietary changes.

    On buffering:  I've personally trialed a few doses of sodium bicarb w/ short duration, highly glycolytic/lactate producing workouts, and the ergogenic (performance enhancing) effect has more to do with reduction in muscle fatigue secondary to reducing H+ ions than protein catabolysis.  I believe this is why many athletes have anecdotally adopted a "high alkaline" diet without actual quantifiable data on it.  By no means am I saying it's unhealthy (a diet high in vegetables and devoid of grains most surely IS healthy!), but it just doesn't make a difference, performance wise, like actual NaHC03 loading.

    I do agree on the effects of SFA and testosterone, though---hence my choice of whey protein and coconut milk PWO.

  • Stargazey

    11/14/2010 11:27:54 PM |

    Thanks for the references. Today is a work day for me, so I've only glanced at them, but it seems like the evidence either way is not overwhelming. I'll study it more carefully in the next few days as I find the time.

  • Andrea

    11/15/2010 11:07:16 AM |

    Hello Dr. Davis,

    I follow your blog regularly. Keep up doing the good work.I appreciate it.
    Regarding Oseoarthritis I slightly disagree:
    Osteoarthritis is one example of “The pitiful state of medical ignorance” as Dr. Mike Eades says. Patellofemoral syndrome can be rehabilitated. Your cartilage can actually get better! 80 % of Doctors and physiotherapists don’t know this. Health care system? Don’t get me started!
    I can't give you the link because the science stuff is in German.
    But here is a good post from Mark Sisson about the topic: “OA is not your destiny”.
    http://www.marksdailyapple.com/arthritis-diet/
    Here's what I have learned from my "private research":
    Movement is great for rehab but you have to start where you are. Too little load is bad for joints and too much load is bad.  Find the “magic zone” as physiotherapist Doug Kelsey says. Joints and ligaments need time to adapt. More time than muscles.
    Interesting fact I learned from smart PTs:  cartilage works actually better under load than without. Yup! Smile

    I am not too impressed by science because I know how it works. I always told my docs that the so called “chronic deseases” are not a disease but failure of self regulation in your body. This is the basic premise of Functional Medicine. Even if they believed me they shrugged their shoulders. They were not interested because they only had drugs and surgery as tools. And if you only have a hammer as a tool every problem looks like a nail.
    But here’s the good news: The docs slowly change their mind, even in Germany. Surprise…. Prof. Dr. Henning Madry, Arthritis Research, Saarland Medical School, Germany, says: Osteoarthritis is no wear and tear but a chronic disease like asthma and diabetes. Cartilage is damaged by accidents or sports injuries but very often it is induced by internal processes which are not understood. Cartilage gets weak and finally destroyed.This has nothing to do with aging per se. Many young people have OA today and many old people have no OA says Prof. Madry.
    Hey – that’s what I said for years! But I am not an MD – only a person with a brain.

  • Andrea

    11/15/2010 11:08:50 AM |

    Hello Dr. Davis,

    I follow your blog regularly. Keep up doing the good work.I appreciate it.
    Regarding Oseoarthritis I slightly disagree:
    Osteoarthritis is one example of “The pitiful state of medical ignorance” as Dr. Mike Eades says. Patellofemoral syndrome can be rehabilitated. Your cartilage can actually get better! 80 % of Doctors and physiotherapists don’t know this. Health care system? Don’t get me started!
    I can't give you the link because the science stuff is in German.
    But here is a good post from Mark Sisson about the topic: “OA is not your destiny”.
    http://www.marksdailyapple.com/arthritis-diet/
    I am not too impressed by science because I know how it works. I always told my docs that the so called “chronic deseases” are not a disease but failure of self regulation in your body. This is the basic premise of Functional Medicine. Even if they believed me they shrugged their shoulders. They were not interested because they only had drugs and surgery as tools. And if you only have a hammer as a tool every problem looks like a nail.
    But here’s the good news: The docs slowly change their mind, even in Germany. Surprise…. Prof. Dr. Henning Madry, Arthritis Research, Saarland Medical School, Germany, says: Osteoarthritis is no wear and tear but a chronic disease like asthma and diabetes. Cartilage is damaged by accidents or sports injuries but very often it is induced by internal processes which are not understood. Cartilage gets weak and finally destroyed.This has nothing to do with aging per se. Many young people have OA today and many old people have no OA says Prof. Madry.
    Hey – that’s what I said for years! But I am not an MD – only a person with a brain.

  • Andrea

    11/15/2010 11:10:15 AM |

    my comment - part 2
    Why are the causes of symptoms like OA not understood? Because nobody in the medical establishment looked for them. Big Pharma has no interest in research about the causes and definitively not in prevention or healing. Healthy people who are not drug junkies? Terrible for Big Pharma!
    Dr. Ron Rosedale, MD, says: “If you are going to treat a disease you need to get to the root of the disease….But the problem is that we don’t know what the root is, or we haven’t. (…) the problem is that medicine really isn’t a science, it is a business.”
    Nothing in the human body “just wears out”. Your pancreas doesn’t ” just wear out”. Stop eating tons of crap! Your liver doesn’t “just wear out”. Your eyes don’t “just wear out” – stop misusing and poisoning them. Read optometrist Jacob Liberman, PhD., or Leo Angart on why eyes get bad, you’ll be surprised. Liberman and Angart are seniors and don’t need the glasses they had as young men. Liberman’s deconstruction of “medical idiocy” in ophtalmology is great.

  • Monique

    11/15/2010 4:14:15 PM |

    Too much anything can be harmful. That is why you should have a nice balanced diet. Great, informative article.

  • Geoffrey Levens

    11/15/2010 7:59:50 PM |

    "Unfortunately, I love bread, so it's a constant struggle."

    There is hope!  My middle name used to be "toast", only 1/2 kidding.  I have eaten no bread for almost 3 years and the craving for it is gone. I have had a bite here and there and can feel the "hook" trying to reset so I just don't go there.  Most of the time I no longer even think about it. It does take time and persistence (stubbornness) to reset taste buds and mental concepts.

  • Daniel

    11/15/2010 8:37:26 PM |

    1.  There's no evidence for acid-base balance.

    2.  You missed a big one -- autoimmune reaction.

  • Dr. William Davis

    11/16/2010 2:34:33 AM |

    Funny, Daniel: I have an inch-thick file of research on acid-base disruptions from diet.

    Shall I file it in the fiction shelf?

  • Nick

    11/16/2010 3:15:02 AM |

    "Wheat causes glycation--Glycation is glucose-modification of proteins in the body that occurs when blood glucose exceeds 100 mg/dl. Cartilage cells are especially susceptible to glycation."

    Is there a citation for this claim?  I understand that there is evidence that when blood glucose levels exceed 140 mg/dl our organs can be damaged, but cartilage does not contain blood vessels, so why is it 'especially susceptible to glycation?

    To be clear, I don't eat wheat, but why single out wheat as a cause of arthritis if any food that raises blood glucose levels per the claim above would cause arthritis?

  • Daniel

    11/16/2010 4:48:44 PM |

    Dr. Davis,
    You can start by posting some links on your blog, I suppose.

    Wikipedia says this about acid/base balance: http://en.wikipedia.org/wiki/Alkaline_diet

    I think if you characterize your dietary advice in terms of getting adequate minerals, it would have more solid grounding than characterizing it in terms of ph.

  • rhc

    11/16/2010 6:43:15 PM |

    @Andrea
    Would you mind posting the link to the German research you were talking about? I'm German and would love to read it.
    day. Thank you!

  • Jack

    11/16/2010 8:41:17 PM |

    Funny, Dr. Davis, I've read well written pieces from WAPF and Stephen G. on why the acid/base balance theories are not well founded when picked apart.

    ACID BASE BALANCE

    So I dunno if storing your files on the fiction shelf is the best option, but you might wanna at least place it on the "still under review" shelf.

    -Jack

  • Anonymous

    11/16/2010 9:10:35 PM |

    What in medical science is not still under review, aside from how to set a broken bone ?

  • lala

    11/17/2010 3:24:55 AM |

    Thanks for your post and welcome to check: here.

  • Andrea

    11/17/2010 11:54:05 AM |

    @ rhc
    No problem - here is the interesting geek stuff in German:

    Claudia Dickinson:
    Der Knorpel - regenerativ und therapierbar!
    http://www.claudiaploke.de/download/physiomed/pm_4_2001.pdf
    I traveled from Berlin to Karlsruhe to get assessment and diagnosis from Claudia. Orthopedic doctors? Don’t get me started! As famous composer Hanns Eisler said: "My whole life I fought against stupidity – in music and elsewhere. I am afraid I have lost."
    I could write a book about stupidity (and denial of assistance & malpractice)  in orthopedics.

    Markus Gunsch:
    Die Behandlung des patellofemoralen Schmerzsyndroms mit Kompression und deren Wirkungsweise
    Gekürzte und überarbeitete Fassung der Diplomarbeit, die bei der Hogeschool van Amsterdam, Fakultät Gesundheitswesen, Institut Physiotherapie, Amsterdam im August 2004 vorgelegt worden ist.
    http://www.wsz-muc.de/_downloads/a_kg01.pdf
    http://www.wsz-muc.de/_downloads/a_kg02.pdf

    Gunsch:
    Patellofemorales Schmerzsyndrom_Kompression hilft
    http://www.wsz-muc.de/_downloads/PM_1_2010_Gunsch2.pdf

    Prof. Henning Madry, Universität Saarland: Arthrose ist keine "Alterserscheinung", sondern eine chronische Krankheit
    http://idw-online.de/de/news377579

  • Anonymous

    11/17/2010 1:29:24 PM |

    You need a TWEET THIS button on your posts.

  • rhc

    11/17/2010 3:54:42 PM |

    @Andrea,
    WOW l lots to read..will get to it later in the day. Thanks a lot!

  • Igor

    11/17/2010 7:30:56 PM |

    Hello

  • elpi

    11/18/2010 1:20:17 AM |

    I do have arthritis and I hate it. .I can't stand in cold places, so sad. Thanks for sharing. I should avoid wheat

  • Stargazey

    11/18/2010 2:23:40 AM |

    Joseph, thanks for the citations.

    It appears from this reference Acid diet (high-meat protein) effects on calcium metabolism and bone health, that a high dietary protein intake causes more absorption of calcium from food, and consequently more calcium excreted in the urine.

    From this reference Protein and calcium: antagonists or synergists?, because bone is 50% mineral and 50% protein by volume, a high-protein diet and calcium supplementation are essential for maintaining and enhancing bone status. If only one element is present in sufficient quantity, bone may actually be lost.

    As other commenters have indicated, acid-base balance has little or nothing to do with the process.

  • Anonymous

    11/18/2010 8:37:11 PM |

    dr. davis whats your take on brown rice?

  • Andrea

    11/18/2010 9:14:20 PM |

    @rhc
    you are welcome!  Smile

  • Plastic surgeon Los Angeles

    11/19/2010 5:38:34 AM |

    I thought you would say that the modern human is health conscious and keeps a right percentage of foods in the diet.At least what IO see is healthy buddies exercising everyday and etching for calorie free health food these days.

  • Stelucia

    11/19/2010 10:33:16 AM |

    Wheat is not the cause for Rheumatoid Arthritis but only a co-factor. It is more likely to be an infection as both doctors Wyburn-Mason and  Brown claim. As a former RA pacient who got healed using the Wyburn-Mason protocol, I tend to support the infectious nature of RA, not the autoimmune theory.

  • Anonymous

    11/19/2010 1:41:53 PM |

    dr. davis whats your take on brown rice? is it a good replacement for wheat? a cup full at mealtimes?

  • Maria

    2/8/2011 8:29:21 AM |

    hi,
    nice posting about wheat cause arthritis.These are many forms wheat cause arthritis are as follows.
    Wheat causes glycation
    Wheat is acidifying
    Wheat causes visceral fat
    Arthritis

  • JB

    10/7/2011 1:11:25 PM |

    I had joint pain in my elbows and fingers for 3 or 4 years and it was getting worse.  After researching on the internet I heard about the wheat - arthritis connection, so I though I'd give it a shot.  I've now been off wheat for four months and the joint pain is gone.  I've done "experiments" where I reintroduce wheat products for one meal and the joint pain will return for the next two days. I've also lost ten pounds and most of my wheat belly.  A no wheat diet takes some planning but well worth it.

  • Dr. William Davis

    10/8/2011 2:18:31 AM |

    That's pretty solid, JB.

    I call it the "on again, off again" phenomenon in which you stop wheat, the symptoms stop; resume wheat, they come back. The effect can be repeated at will.

    In my mind, that is pretty solid proof of an association.

  • Anne

    11/9/2012 2:41:59 PM |

    I have bought and read your book on wheat, and it was a great discovery for me. You see, my mother's family were Italians, and pasta, pizza, biscotti, and so on, is standard fare in Italy. So, I would never, ever have thought that my joint pain in the fingers could be linked to wheat consumption. But my mother also told me that there is a strong arthritis predisposition in the family. So, when I read your book I connected the dots.
    I have taken wheat out of my diet and the joint pain is gone (it was not a big pain, it was very subtle, I'm only 37, but I was wondering why I had it). Same as JB who left a comment above: I've done the test of eating a plate of pasta, and on the same day, a few hours later, the joint pain was back. So, I'm off the wheat, and I thank you so much for having written this great book!

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A Heart Scan Blog reader recently posted this comment:

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 [CT angiogram]. 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?



There was a time not long ago when I saw heart scan centers as the emerging champions of heart disease detection and prevention. Heart scans, after all, provided the only rational means to directly uncover hidden coronary plaque. They also offered a method of tracking progression--or regression--of coronary plaque. No other tool can do that. Carotid ultrasound (IMT)? Indirectly and imperfectly, since it measures thickening of the carotid artery lining, partially removed from the influences that create coronary atherosclerotic plaque. Cholesterol? A miserable failure for a whole host of reasons.

Then something happened. General Electric bought the developer and manufacturer of the electron-beam tomography CT scanner, Imatron. (Initial press releases were glowing: The Future of Electron Beam Tomography Looks Better than Ever.The new eSpeed C300 electron beam tomographic scanner features the industry’s fastest temporal resolution, and is now backed by the strength of GE Medical Systems. Imatron and GE have joined forces to provide comprehensive solutions for entrepreneurs and innovative medical practitioners.)

Within short order, GE scrapped the entire company and program, despite the development of an extraordinary device, the C-300, introduced in 2001, and the eSpeed, introduced in 2003, both yanked by GE. The C-300 and eSpeed were technological marvels, providing heart scans at incredible speed with minimal radiation.

Why would GE do such a thing, buy Imatron and its patent rights, along with the fabulous new eSpeed device, then dissolve the company that developed the technology and scrap the entire package?

Well, first of all they can afford to, whether or not the device represented a technological advancement. Second (and this is my reading-between-the-lines interpretation of the events), it was in their best financial interest. Not in the interest of the public's health, nor the technology of heart scanning, but they believed that focusing on the multi-detector technology to be more financially rewarding to GE.

GE, along with Toshiba, Siemens, and Philips, saw the dollar signs of big money with the innovations in multi-detector technology (MDCT). They began to envision a broader acceptance of these devices into mainstream practice with the technological improvements in CT angiography, a device (or several) in every hospital and major clinic.

Anyway, this represents a long and winding return to the original issue: How I once believed that heart scan centers would be champions of heart disease detection and reversal. This has, unfortunately, not proven to be true.

Yes, there are heart scan centers where you can obtain a heart scan and also connect with people and physicians who believe in prevention of this disease. I believe that Milwaukee Heart Scan is that way, as is Dr. Bill Blanchet's Front Range Preventive Imaging, Dr. Roger White's Holistica Hawaii, and Dr. John Rumberger's Princeton Longevity Center.

But the truth is that most heart scan centers have evolved into places that offer heart scans, but more as grudging lip service to the concept of early detection earned with sweat and tears by the early efforts of the heart scan centers. But the more financially rewarding offering of CT coronary angiograms, while a useful service when used properly, has corrupted the prevention and reversal equation. "Entry level" CT heart scans have been subverted in the quest for profit.

CT angiograms pay better: $1800-4000, compared to $100-500 for a heart scan (usually about $250). More importantly, who can resist the detection of a "suspicious" 50% blockage that might benefit from the "real" test, a heart catheterization? Can anyone honestly allow a 50% blockage to be without a stent?

CT angiograms not only yield more revenue, they also serve as an effective prelude to "downstream" revenue. By this equation, a CT angiogram easily becomes a $40,000 hospital procedure with a stent or two, or three, or occasionally a $100,000 bypass. Keep in mind that the majority of people who are persuaded that a simple heart scans are not good enough and would be better off with the "superior" test of CT angiography are asymptomatic--without symptoms of chest pain, breathelessness, etc. Thus, the argument is that people without symptoms, usually with normal stress tests, benefit from prophylactic revascularization procedures like stents and bypass.

There are no data whatsoever to support this practice. People who have no symptoms attributable to heart disease and have normal stress tests do NOT benefit from heart procedures like heart catheterization. They do, of course, benefit from asking why they have atherosclerotic plaque in the first place, followed by a preventive program to correct the causes.

So, beware: It is the heart scan I believe in, a technique involving low radiation and low revenue potential. CT angiograms are useful tests, but often offered for the wrong reasons. If we all keep in mind that the economics of testing more often than not determine what is being told to us, then it all makes sense. If you want a simple heart scan, just say so. No--insist on it.

Take trust out of the equation. Don't trust people in health care anymore than you'd trust the used car salesman with "a great deal."

Finally, in answer to the reader's last comment about 30% of people needing heart catheterizations having zero calcium scores, this is absolute unadulterated nonsense. I'm hoping that the nurse who said this was taken out of context. Her comments are, at best, misleading. That's why I conduct this Heart Scan Blog and our website, www.cureality.com. They are your unbiased sources of information on what is true, honest, and not tainted by the smell of lots of procedural revenue.

Comments (13) -

  • Anonymous

    11/30/2007 8:13:00 AM |

    Hmmn - reminds me of a book I read called "Coronary: A True Story of Medicine Gone Awry," recommended by you, Dr. Davis.  Unnecessary procedures for profits.

    It's a scary world out there in medical land.

  • Anne

    11/30/2007 12:35:00 PM |

    The local heart hospital has a "Heartsaver CT" http://www.heartsaverct.com/index.aspx?CORE_ElementID=HSCT_AHH_Home

    Is this the same as the CT Heart Scan?

  • Anonymous

    11/30/2007 1:11:00 PM |

    I saw another car Bill had worked on this month.  My father and I have an auto hobby shop were we'll bang away on making our own hot rod cars and from time to time a friend or friend of a friend in this case will ask to bring a car by for inspection.  The guy has been having many problems with his hot rod and for repairs had been taking it to Bill's place.  I had an idea of what to expect.  Sure enough Bill had done it again.  Bill's scam is that he will splice a weaker gage wire into a hidden unseen area.  The weak gage can not handle the power load for long and once the wire melts and the part stops working, he explains that the engine part broke, new parts need to be ordered and of course that intales hours of labor costs.  
        

    After reading this blog it reminded me of scammer auto shops.  Hospitals have their scams too.    I wish I could walk into a doctor’s office and expect that only the best, least expensive, treatment will be offered me - but I now know that isn't the case.  I can't be lazy.  I need to educate myself in the basics of medical care to ensure I receive the best treatment for me.  Thanks for being a good teacher Dr. Davis.

  • Dr. Davis

    11/30/2007 1:23:00 PM |

    Yes, it looks like it is the real thing, a simple heart scan, judging from their comment that "There are no needles, no dyes, no injections and no exercise." CT angiograms require needles, dye, and injections.

  • Mike

    11/30/2007 3:27:00 PM |

    The CT angiogram makers are generating lots of reports on how great their machines are.

    http://www.theheart.org/viewArticle.do?primaryKey=830205&nl_id=tho28nov07

  • Dr. Davis

    11/30/2007 3:41:00 PM |

    They certainly are. Big bucks, big marketing.

    I do believe, in all honesty, that the new devices really represent great advances in diagnostic imaging. It's their mis-use and over-use that I object to. Of course, the manufacturers keep their lips closed about it because overuse drives more sales.

  • Paul Kelly - 95.1 WAYV

    11/30/2007 5:00:00 PM |

    Hi Dr. Davis,

    I've learned from reading your blog that typically 20% of TOTAL PLAQUE is calcified or "hard". Is that a steadfast rule - or is that an average? What if someone has a calcium score of zero (or close to it)? Can it be assume that that person also has very little in the way of "soft" plaque?

    Thanks!

    Paul

  • Dr. Davis

    11/30/2007 5:12:00 PM |

    Speaking generally, people with zero heart scan scores have heart attack rates of near zero (if asymptomatic).

    The likelihood of detecting pure "soft" plaque in someone without symptoms and a zero heart scan score is <5%. It does happen, particularly when certain severe risks for heart disease are present (e.g., very high LDL/small LDL). It is exceptional, however.

  • noreen

    12/1/2007 12:55:00 AM |

    Since I can't afford the current local price of a 64 slice CT scan ($1100), I've decided to get a lipoprotein breakdown to determine my risk.   I can use your "treatment" protocol of supplements to try and achieve the 60-60-60 values when I see the results.   Is this a good plan?

  • Dr. Davis

    12/1/2007 1:47:00 PM |

    Hi, Noreen--

    I'm afraid that you may regret not getting the scan a few years from now. After you've successfully corrected lipoproteins, you may want to know if you've also successfully controlled plaque growth, the MORE IMPORTANT parameter.

    Have you thought about looking elsewhere for a scan? In Milwaukee, for instance, scans can be obtained for as little as $79. (Though the low-priced scans also come with a sales pitch for CT coronary angiography. Just say "no thanks.")

  • mike V

    12/1/2007 8:49:00 PM |

    I am 72 and pretty healthy.
    This year I have been seeing a cardio because of some nocturnal palpitations. He has subjected me to a series of tests-sleep-ultrasound-both negative, and a nuclear stress test which gave a hint of possible blockage. He recommended either an angiography or a CTA scan. I chose the latter, and was rated "normal".
    I asked if this meant normal for my age. He said "no, normal for any age, I couldn' find any trace of hard or soft plaque". Yes he is part of a large group.

    My father died of a second heart attack at 76.
    I have taken vitamin D, fish oil, magnesium, pantethine, flaxseed, co-Q10, lutein, olive oil, for some years.
    I am trying hard not to feel smug, but should I feel safe?
    We are still working on the nocturnal palpitations which seem to be dependent on sleep position.
    I have bradycardia, and no other obvious health 'problems'.

  • Harry35

    12/2/2007 12:30:00 AM |

    With regard to the 20% value for calcified plaque, if you look at figure 1 from Rumberger’s classic 1995 paper (Circulation. 1995;92:2157-2162.), it shows the plaque area and calcium areas for each of 13 hearts that were examined on autopsy. If you take the points in this graph and determine the areas for each heart, the data shows that the calcium area and calcium percentage increases with plaque area. Unfortunately the paper doesn’t say what the calcium scores were for each heart, only the calcium areas and total plaque areas. However, over the range of plaque areas of the 13 hearts, the percentage of calcium in plaque increased from 0% to 14% for the 9 hearts with with plaque areas less than 150 square mm to 14% to 28% for the hearts with the plaque areas greater than 230 square mm. So from that we can conclude that the 20% value is an average, and that the calcium percentage increases as more and more plaque accumulates.

    Harry35

  • Anonymous

    3/5/2010 5:20:16 PM |

    Sehr interessant!

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