Don't be a dipstick

If I want to know how much oil is in my car's engine, I check the dipstick.

The dipstick provides a gauge of the amount of oil in my engine. If the dipstick registers "full" because there an oil mark at one inch, I understand that there's more than one inch of oil in my engine. The dipstick provides an indirect gauge of the amount of oil in my engine.

That's what cholesterol was meant to provide: A gauge, a "dipstick," for the kind of lipoproteins (lipid-carrying proteins) in the bloodstream.

Lipoproteins are a collection of particles that are larger than a single cholesterol molecule but much smaller than a red blood cell. Lipoproteins consist of many components: various proteins, phospholipids, lots of triglycerides, as well as cholesterol. In the 1960s, methods to characterize lipoproteins were not widely available, so the cholesterol in lipoproteins were used as a "dipstick" to assess low-density lipoproteins ("LDL cholesterol") and high-density lipoproteins ("HDL cholesterol"). (Actually, even "LDL cholesterol" was not measured, but was derived from "total cholesterol," the quantity of cholesterol in all lipoprotein fractions.)

Some other component of lipoproteins could have been measured instead of cholesterol, such as apoprotein B, apoprotein C, or others, all meant to act as the "dipstick" for various lipoproteins.

Relying on cholesterol to characterize lipoproteins provides a misleading picture. Imagine watching cars go by at high speed while standing on the side of the highway. You want to count how many people--not cars, but people--go by in a given amount of time. Because you cannot make out the detail of each and every car whizzing by, you count the number of cars and assume that each car carries two people. Whether it's rush hour, Sunday morning, late evening, rainy, sunny, or snowing, you make the same assumption: two people per car.

That's what cholesterol does: It is assuming that each and every lipoprotein particle (car) carries the same amount of cholesterol (people).

But that may, obviously, not be true. A bus goes by carrying 25 people. Plenty of cars may carry just the driver. People carpooling may be in cars carrying 3 or 4 people. Assuming just 2 people per car can send your estimates way off course.

That is precisely what happens when your doctor tries to use conventional cholesterol values (total cholesterol, LDL cholesterol) to gauge the lipoproteins in your bloodstream. Measuring cholesterol can also provide the false impression that cholesterol is the cause of heart disease, even though it was originally meant to simply serve as a "dipstick."

What we need to do is to characterize lipoproteins themselves. We can distinguish them by size, number, density, charge, and the type and form of proteins contained within. It provides greater insight into the composition of lipoproteins in the blood. It provides greater insight into the causes underlying coronary atherosclerotic plaque. It can also tell us what dietary changes trigger different particle patterns and how to correct them.

Until you have a full lipoprotein analysis, you can never know for certain 1) if you will have heart disease in your future, or 2) how your heart disease was caused.

Unfortunately, the vast majority of doctors are perfectly content to just count cars going by and assume two people per car, i.e., confine assessment of your heart disease risk using cholesterol . . . just as drug industry marketing has instructed them.

It's not your job to educate your doctor. If he or she refuses to provide access to lipoprotein testing to better determine your heart disease risk, then consider going out on your own. Many of our Track Your Plaque program followers have obtained lipoprotein testing on their own through Direct Labs.

Comments (32) -

  • Anonymous

    10/3/2010 3:58:23 PM |

    Nice analogy.

    Any idea where we can go for equivalent tests in the UK?

    Nina

  • Kurt

    10/3/2010 6:02:39 PM |

    Thanks for the 10% off at Swanson's (your ad)!

    I took the VAP test and my results were excellent. It was very reassuring.

  • Jonathan

    10/3/2010 10:55:51 PM |

    That dipstick showing a lot or a little oil also doesn't tell you about the sand that chewed up your cylinders.

  • Kathryn

    10/4/2010 1:09:03 AM |

    I've used Direct Labs & others to order my own tests directly.  It works very well.

    Currently i'm working with a doc who seems willing to work with me.  However the cholesterol panel he ordered recently did not include the part that actually measures LDL (as opposed to "calculate" it).  He is not opposed to running that test, but tells me he doesn't know if Medicare (my insurance) will cover it.

    What is the name of the test i would need to run that actually measures LDL?

  • skepticaldoc

    10/4/2010 1:29:11 AM |

    Great analogy!!!

  • Anonymous

    10/4/2010 3:33:01 PM |

    Very nice post, but interesting irony.  The doctor implies it is drug companies responsible for the lack of useful testing, and then someone from the UK wants to know where he/she can go for equivalent tests.  Surely not to your primary care physician!  Many Canadians will also want to know because govts are much tighter than insurance companies, since the latter must compete for business.  Lesson: govt health care monopolies spend less because they do less (e.g., testing) and do it slower.

  • Anonymous

    10/4/2010 4:15:09 PM |

    Long time reader, just wanted to post some info that comes within the industry:
    "The nmr is not an accurate test. I cannot tell you how many physicians have lost confidence in the results due to the high variance in particle number. One physician ordered 2 nmrs on the same patient by accident and the difference in LDL-p was over 800. Pathetic. Stick to apoB." Sorry that this complicates things.

  • CarbSane

    10/4/2010 9:21:17 PM |

    Unfortunately, some states (I think at this point only NY & Cali) do not allow patient initiated tests outside the "system".  

    With Obamacare, I fear more states will follow this, as gawd forbid anyone tries to get a handle on their own health markers, at their own expense and/or try to do anything (like changes in diet) to improve them.

  • Anonymous

    10/5/2010 3:14:15 AM |

    "With Obamacare, I fear more states will follow this, as gawd forbid anyone tries to get a handle on their own health markers, at their own expense and/or try to do anything (like changes in diet) to improve them."

    Please tell me what, specifically, in "Obamacare" would prohibit the sort of tests you're interested in?  I'm pretty sure you can't provide an answer.  Your claim (and fears) is not grounded in fact, but rests on the ideologically motivated obfuscations of others who have a vested interest in resisting meaningful healthcare reform.  I'm sure we all had it much better the day before "Obamacare" went into effect.

  • Anonymous

    10/5/2010 6:06:32 AM |

    Please post the components of the complete lipoprotein panel that you suggest.  Thank you

  • CarbSane

    10/5/2010 12:54:06 PM |

    Obamacare is all about government controlling the type of medical care we receive.  It is dictating the type of insurance we are required to carry, and it is all about getting our information into the "system".  

    If I'm willing to pay for any diagnostic test, why can't I do this without a note from my doctor?  You can't in NY and California.  I see this spreading to other states rather than being repealed.  Too much freedom.

  • Anonymous

    10/6/2010 9:34:11 PM |

    I too would like to avail of an NMR cholesterol test in Europe, so would appreciate any information on where it is available.

    I also read a review recently (but can't find it now) of the NMR and VAP tests, dated 2009. The author concluded that there was little consistency between them and suggested that perhaps the technologies were not yet mature. Any thoughts on that?

  • Anonymous

    10/7/2010 4:53:04 AM |

    I think this kind of test is only available in USA

  • Prostatic Adenocarcinoma

    10/7/2010 12:37:34 PM |

    I am quite interesting in this topic hope you will elaborate more on it in future posts.

  • Anonymous

    10/8/2010 5:10:07 AM |

    Hi Dr. Davis,

    Would be useful to get your thoughts if there is any truth to the claims that NMR and VAP are too imprecise to be reliable...

    Thanks,
    David

  • health

    10/8/2010 10:23:38 AM |

    If you're looking to buy best protein powder (or related protein products) but not sure what to look for, this free expert-nutrition tutorial can help.

  • grandpa

    10/8/2010 11:57:08 AM |

    I went to direct labs but not sure which ones are the ones to order. Any suggestions? Thanks in advance.

  • Anonymous

    10/11/2010 6:23:39 PM |

    Which test do we order at Direct Labs?

    THANKS

  • TedHutchinson

    10/11/2010 7:11:02 PM |

    Sorry I forgot to mention Direct labs also do the VAP Cholesterol Test

  • Anonymous

    10/12/2010 3:55:25 PM |

    @ Ted,

    Is it possible to have a blood sample drawn in the UK and sent to these labs for analysis?

    Keep up the good work on your own blog!

  • TedHutchinson

    10/12/2010 5:34:16 PM |

    Is it possible to have a blood sample drawn in the UK and sent to these labs for analysis?
    Sorry the answer's NO.
    Pity as I'd really like a VAP test done.

    But while I was talking to them I asked if there was any time limit on this months Vitamin D special offer $39 testing.
    They said tests ordered this month at $39 would be valid for 6 months.
    So US readers could buy/use one now 2nd week in October, buy a second next week for use in 3 months time (January) and a third before the end of October for use before the end of April before six months is up.
    That way they would have a pretty good idea of just how much D3/DAILY their individual body requires to stay above 60ng/ml through the winter.
    Altered post to make avoid potential misunderstanding

  • Anonymous

    10/12/2010 8:22:21 PM |

    @ Ted,

    Thanks for that.

    Do you know of any advanced lipoprotein available in Europe? Any advance on the standard TC/TG/HDL/LDL would be great.

    Seems a bit mad to have to go to the US to get a good cholesterol test!

  • Anonymous

    10/12/2010 8:24:07 PM |

    That should read 'any advanced lipoprotein testing...'

  • Dr. William Davis

    10/12/2010 11:00:02 PM |

    Gentlemen--

    Sorry, but I know of no way in the U.K. to obtain lipoprotein testing.

    Should you discover some means please come back and let us know.

    You might consider contacting one of the lipoprotein testing companies, such as Liposcience, Atherotech, or Berkeley HeartLab. (All have websites with contact info.)

  • Dr. William Davis

    10/14/2010 2:25:13 PM |

    In response to the several questions re: what lipoproteins to obtain.

    We start with a lipoprotein analysis (LDL, HDL, and VLDL quantification and particle size). Some forms of lipoprotein testing require that you specify lipoprotein (a), if you are interested in obtaining that measure.

    There are measures, of course, outside of lipoproteins that are also important, e.g., thyroid measures, 25-hydroxy vitamin D, blood glucose/HbA1c, etc., all relevant to heart disease prevention.

  • Anonymous

    10/15/2010 10:08:32 PM |

    I too, like Ted, would like to have an advanced lipoprotien test,as I think my LDL may be a shade high for comfort. My numbers are:

    TC:  6.7 or 259
    TG:  1.05 or 41
    HDL: 1.23 or 48
    LDL: 4.99 or 193
    TSH: 3.77
    Glucose: 5.2


    The only dietary changes I have made in the last year were to take 4 Minami MorEPA softgels most mornings and markedly reduce but not eliminate carbs from my diet.

    Dr Davis, I have contacted Liposcience and NMR. Liposcience have no facility to test outside of the USA. NMR have not replied. I will retry NMR and also contact the other company you mentioned.

    I will post any information I receive, here.

  • Anonymous

    10/15/2010 10:14:44 PM |

    Correction:
    Atherotech responded, no reply from Liposcience.

  • Anonymous

    10/15/2010 11:56:08 PM |

    Correction No 2:

    TG:  1.05 or 93

  • Anonymous

    10/16/2010 12:19:36 AM |

    http://circ.ahajournals.org/cgi/content/full/119/17/2396

  • Anonymous

    10/19/2010 10:26:57 PM |

    Reply from Liposcience:

    Thank you for your inquiry and interest in the NMR LipoProfile test.  currently, the NMR LipoProfile test is only available in the US and performed in our laboratory in Raleigh, NC. Early next year, a laboratory platform will be launched to allow for expanded offering of the test outside the US.

    Thank you,

    LipoScience, Inc.

    PS  The link I posted in the last entry from AHA Journals, is the paper I found on the inaccuracies of advanced lipoprotein testing. That said, I'd still do the NMR test, if I could.

Loading
Vitamin D: Treatment for metabolic syndrome?

Vitamin D: Treatment for metabolic syndrome?

Metabolic syndrome is that increasingly common collection of low HDL cholesterol, high triglycerides, high blood sugar, and high pressure that now afflicts nearly 1 in 4 adults, rapidly gaining ground to 1 in 3. Beyond these surface factors, metabolic syndrome also creates small LDL particles, VLDL, intermediate-density lipoproteins (IDL), increased imperceptible inflammation measured as higher c-reactive protein, and greater blood clotting tendencies. Metabolic syndrome is usually, though not always, associated with a big tummy ("beer belly," though I call it "wheat belly").

In short, metabolic syndrome creates a metabolic mess that leads to dramatic increases in heart disease, vascular disease and stroke, and cancer. The medical community has been paying increasingly greater attention to this condition because of its booming prevalence and because of the big bucks invested in "education" by the manufacturers of the diabetes and pre-diabetes drugs, particularly makers of Actos and Avandia.

But here's a curious observation:

Replacement of vitamin D to healthy levels (we aim for 50-60 ng/ml, or 125-150 nmol/l) yields:

--Higher HDL
--Lower triglycerides
--Lower blood sugar
--Reduced c-reactive protein
--Reduced blood pressure
--Reduced small LDL
--Enhanced sensitivity to insulin

(Whether blood clotting and effects on IDL should be added to this list is uncertain.)

It's obvious: Vitamin D is proving to be a very important and powerful corrective influence on many of the facets of the metabolic syndrome. In fact, I would go as far as saying that, side by side, vitamin D yields nearly the same effect as prescription drugs Actos and Avandia--without the extravagant cost (nearly $200 per month), leg swelling, congestive heart failure and heightened heart attack risk (with Avandia), and average 8 lb weight gain. Of course, vitamin D also provides benefits beyond metabolic syndrome like facilitation of coronary plaque regression, increased bone density, reduced arthritis, and reduced risk of several cancers.

You'd think that agencies like the American Diabetes Association (ADA) would be all over vitamin D like white on rice. Yet they remain curiously quiet about the entire issue. (That should come as no surprise to anyone familiar with the behavior and politics of this organization, the same outfit that has widely propagated the ADA diet, a program that accelerates diabetes and its complications. In my view, the ADA is an embarassment.)



For a really great story and video on vitamin D that includes a terrific interview with vitamin D guru and Track Your Plaque friend, California psychiatrist Dr. John Cannell, go to What's the Real Story on Vitamin D?. While the video will yield little new to readers of The Heart Scan Blog or Track Your Plaque members, it just feels really good to see a well-made, high-class video production echoing many of the things we've been talking about these past two years.

Comments (44) -

  • Anonymous

    12/21/2007 5:52:00 PM |

    > Whether blood clotting and effects on IDL
    >should be added to this list is uncertain.

    Meaningless anecdote: I've noticed an increased tendency to bruise easily since I've been taking higher doses of vitamin D, and had been wondering whether it was the cause. I definitely have metabolic syndrome.

  • mo79uk

    12/21/2007 7:36:00 PM |

    I wish Dr. Cannell would come talk the British media. We need a tank load of D talk to infiltrate here.

  • Mike

    12/22/2007 3:49:00 PM |

    An irrational fear of skin cancer prevents most people from getting their vitamin D from sunshine. The doses that the medical establishment recommends are so small as to be almost worthless.

  • MarilynMann

    12/22/2007 10:36:00 PM |

    It would be helpful if you could tell us where the research on vitamin D you are referring to is published.  Some of us like to go to the original source.

  • Dr. Davis

    12/23/2007 12:38:00 AM |

    See our special reports on the Track Your Plaque website with detailed references. Or, go to Dr. John Cannell's www.vitamindcouncil.com website.

  • Sue

    12/23/2007 2:38:00 AM |

    Is cod liver oil the best way to get vitamin D or just vitamin D3 capsules?
    Is there are connection with hypothyroidism and low vitamin D levels?

  • Dr. Davis

    12/23/2007 1:57:00 PM |

    Either source for vitamin D works.

    I do believe that correction of vitamin D has, in occasional instances, modestly increased thyroid function.

  • MarilynMann

    12/23/2007 3:45:00 PM |

    Cod liver oil has a lot of vitamin A, which in excess can lead to low bone density.  It is better just to take the vitamin D by itself.

  • g

    12/23/2007 9:20:00 PM |

    I agree -- over 20yrs ago it was suggested that increased thyroid doses are required in the winter time for hypothyroid pts on replacement (see below). IT sure seems to suggest that Vitamin D deficiency exacerbates hypothyroidism (and I'd go as far to say it even CAUSES it)?  I've observed this as well. (it's corrected with D3)

    In the second study, a corollary phenomenon occurred -- thyroid replacement in hypothyroid pts caused 25(OH)D to INCREASE (in the autumn when you'd normally expect it to decrease).  

    Isn't it fascinating how thyroid hormone and D3 hormone are interrelated.
    ---When D3 hormone (sunlight) is lacking, thyroid function suffers
    ---When thyroid hormone is lacking, a high D3 dose fails to increase 25(OH)D much....
    ---When thyroid hormone is NOT lacking, high dose D3 causes a large increase in 25(OH)D (in normal euthryoid controls)

    it all sounds very familiar to me...  Smile

    THANK YOU FOR ALL YOUR WORK AND INSIGHTS!! Keep up the strong work, g


    Metabolism. 1984 Mar;33(3):215-8. Links
    Is it necessary to adjust the replacement dose of thyroid hormone to the season in patients with hypothyroidism?Hamada N, Ohno M, Morii H, Jaeduk N, Yamakawa J, Inaba M, Ikeda S, Wada M.
    Hypothalamo-pituitary-thyroid activity varies with the temperature of the environment; we therefore measured variables involved with thyroid function in summer and winter in normal controls and in patients with primary hypothyroidism. All seven patients had impalpable thyroid glands and had received a set replacement dose of thyroxine for over a year. In the patients, serum T3 and FT4 levels were slightly but significantly lower in winter, and TSH levels and delta TSH at 30 minutes in the TRH tests were significantly higher. In the controls, there were no significant differences between summer and winter in these values. These findings suggest that the dose required for replacement of thyroid hormone in patients with hypothyroidism may be higher in winter than in summer.

    PMID: 6420646 [PubMed - indexed for MEDLINE]



    Acta Endocrinol (Copenh). 1986 Nov;113(3):329-34.Links
    Effect of vitamin D3 loading and thyroid hormone replacement therapy on the decreased serum 25-hydroxyvitamin D level in patients with hypothyroidism.Bársony J, Lakatos P, Földes J, Fehér T.
    Twelve hypothyroid subjects, 13 healthy and 12 healthy women with a slight deficiency of vitamin D were studied to distinguish seasonal changes from the thyroxine-dependent ones. Serum 25-hydroxyvitamin D levels of hypothyroid patients were lower than those of healthy individuals when the sera were obtained in the autumn. In hypothyroid patients a single oral dose of 100,000 IU vitamin D3 resulted in a smaller increase in 25-hydroxyvitamin D concentration than in controls having subclinical exogenous vitamin D deficiency. Substitution therapy with thyroid hormone, started in our study always in autumn, increased the 25-hydroxyvitamin D concentration in hypothyroid patients, which was opposite to the autumn-to-spring variation of this hormone observed in healthy controls. The increase of 25-hydroxyvitamin D, dehydroepiandrosterone and its sulphate values following substitution therapy in the hypothyroid patients may indicate that thyroid hormone(s) is (are) involved in the regulation of steroid hormone synthesis.

    PMID: 3024434 [PubMed - indexed for MEDLINE]

  • g

    12/23/2007 9:32:00 PM |

    This is very hopeful...Vitamin D3 stalls thyroid cancer, one case report:

    Endocr J. 2005 Oct;52(5):613-6. Links
    Vitamin D3 treatment for locally advanced thyroid cancer: a case report.Morishita M, Ohtsuru A, Kumagai A, Namba H, Sato N, Hayashi T, Yamashita S.
    Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Japan.

    There are many intricacies in the surgical treatment of locally advanced thyroid cancer, including the medical management of the remaining functional organ and any cosmetic impairments, which are sometimes very difficult to manage and eventually carry a relatively high morbidity and mortality. Here, we report on a case of a 65-year-old female with an extremely locally-advanced thyroid cancer involving both lobes of the thyroid, blood vessels, trachea and esophagus. Despite the severity of her condition, oral administration of vitamin D3 (alphacalcido) has stalled both the tumor growth and further increases of serum thyroglobulin (Tg) level, and has led to a good preservation of quality of life for the last two years. Several reports have previously demonstrated the efficacy of vitamin D3 to inhibit the proliferation of thyroid cancer cell lines in vitro, but clinical evidence has been limited so far. Therefore, this case report provides important evidence for the effectiveness of vitamin D3 therapy against advanced thyroid cancers.

    PMID: 16284441 [PubMed - indexed for MEDLINE]

  • g

    12/23/2007 9:42:00 PM |

    Another good story... 3mon old child with depressed thyroid function, CHF and profound Vitamin D deficiency in Oslo, Norway -- corrected with a Vit D analogue:

    Acta Paediatr. 1995 Jan;84(1):106-8
    Congestive heart failure caused by vitamin D deficiency?Brunvand L, Hågå P, Tangsrud SE, Haug E.
    Department of Paediatrics, Ullevål Hospital, Oslo, Norway.

    We describe a child, 3.5 months old, with severe vitamin D deficiency, profound hypocalcaemia, hyperphosphataemia, dilated left ventricle, severely reduced myocardial contractility and congestive heart failure. She also had depressed thyroid function with subnormal thyroxine and non-detectable serum thyrotropin (TSH) levels. The child promptly responded to calcium infusions, conventional anticongestive therapy and calcitriol. She is now 3 years old and received no medication. Myocardial function is normal but she has motor delay. We believe that her transitory congestive heart failure was caused by severe vitamin D deficiency with profound hypocalcaemia.

    PMID: 7734890 [PubMed - indexed for MEDLINE]

  • Dr. Davis

    12/23/2007 11:31:00 PM |

    Thanks, Marilyn. You're absolutely right.

    In all honesty, I virtually never use cod liver oil, but for some reason some people gravitate towards it, perhaps since they took it as children.

  • Jerome

    12/24/2007 1:55:00 PM |

    I went to a local vitamin supplier yesterday to get some Vitamin D after reading your blog, which is most interesting I might add.  At this store they had Vitamin D2 and D3 but no D1.  Is there such a thing (D1) and which is the one I should be taking to benefit as suggested in the blog?

  • Dr. Davis

    12/24/2007 4:59:00 PM |

    Hi, Jerome--

    Vitamin D3 is the only form I recommend. In my view, vitamin D2 is a worthless scam, whether it's in milk, a multivitamin, or a prescription product. I've never heard of vit D1.

  • jpatti

    12/24/2007 4:59:00 PM |

    I liked the *idea* of cod liver oil, as it would replace both fish oil and vitamin D tablets - a total of 8 pills in my 26-pill regimen.

    I bought what was supposed to be one of the best tasting ones and... it made me retch.  It also sort of tingles in your mouth.  And because it's oily, you can't rinse it out of your mouth.  It's just icky.

    I gave some to the cats, figuring it would be a healthy snack for them... and all four of them refused it.

    If someone can get it down, I think it's great stuff.  For me, I'll stick to the extra 8 pills...

  • Sue

    12/25/2007 2:20:00 AM |

    Thanks for all the helpful comments.  I've got cod liver oil in the fridge so I think I will use it up and then get D3 capsules.
    I take the cod liver oil with lemon juice.  I put the cod-liver oil in a little shot glass and squeeze some fresh lemon into the shot glass aswell and drink it in one swoop.  I then wash it down with some water with fresh lemon squeezed into it.  Gets rid of some of the icky fishy taste. The lemon also helps with digesting the fat.

  • cheron

    12/27/2007 7:19:00 AM |

    I wouldn't necessarily be afraid of the A, as we can be deficient in the A as well.  Perhaps alternating between A-containing and A-less forms of D supplements would work.  That way you get a vacation from the A periodically.

    As for surviving the fish taste...try following it up with a bite of something else that's strong tasting and contains fat, like cured olives or a tuna salad sandwich.

  • Anonymous

    1/1/2008 11:37:00 AM |

    Hi Dr. Davis,

    Have you seen literature making a connection to the plaque linked to Alzheimer's disease with the plaque responsible for heart disease?  I was asked this question by a distant cousin yesterday that wondered if the supplements recommended for TYP ,like vitamin D and K2, could help prevent those at risk for Alzheimer's (his grandmother, and mother both came down with Alzheimer's)

  • Dr. Davis

    1/1/2008 2:37:00 PM |

    No, sorry, they are two completely unrelated phenomena, despite the use of the word "plaque" to describe both.

  • MarilynMann

    1/1/2008 11:31:00 PM |

    Fish oil benefits
    Medical Research News
    Published: Sunday, 30-Dec-2007  

    It's good news that we are living longer, but bad news that the longer we live, the better our odds of developing late-onset Alzheimer's disease.
    Many Alzheimer's researchers have long touted fish oil, by pill or diet, as an accessible and inexpensive "weapon" that may delay or prevent this debilitating disease. Now, UCLA scientists have confirmed that fish oil is indeed a deterrent against Alzheimer's, and they have identified the reasons why.

    Reporting in the current issue of the Journal of Neuroscience, now online, Greg Cole, professor of medicine and neurology at the David Geffen School of Medicine at UCLA and associate director of UCLA's Alzheimer Disease Research Center, and his colleagues report that the omega-3 fatty acid docosahexaenoic acid (DHA) found in fish oil increases the production of LR11, a protein that is found at reduced levels in Alzheimer's patients and which is known to destroy the protein that forms the "plaques" associated with the disease.

    The plaques are deposits of a protein called beta amyloid that is thought to be toxic to neurons in the brain, leading to Alzheimer's. Since having high levels of LR11 prevents the toxic plaques from being made, low levels in patients are believed to be a factor in causing the disease.

    Alzheimer's is a debilitating neurodegenerative disease that causes memory loss, dementia, personality change and ultimately death. The national Alzheimer's Association estimates that 5.1 million Americans are currently afflicted with the disease and predicts that the number may increase to between 11 million and 16 million people by the year 2050.

    The researchers examined the effects of fish oil, or its component DHA, in multiple biological systems and administered the oil or fatty acid by diet and by adding it directly to neurons grown in the laboratory.

    "We found that even low doses of DHA increased the levels of LR11 in rat neurons, while dietary DHA increased LR11 in brains of rats or older mice that had been genetically altered to develop Alzheimer's disease," said Cole, who is also associate director of the Geriatric Research Center at the Veterans Affairs Medical Center.

    To show that the benefits of DHA were not limited to nonhuman animal cells, the researchers also confirmed a direct impact of DHA on human neuronal cells in culture as well. Thus, high levels of DHA leading to abundant LR11 seem to protect against Alzheimer's, Cole said, while low LR11 levels lead to formation of the amyloid plaques.

    Fish oil and its key ingredient, omega-3 fatty acids (found in fatty fish like salmon), have been a mainstay of alternative health practitioners for years and have been endorsed by the American Heart Association to reduce the risk of cardiovascular disease.

    Fatty acids like DHA are considered "essential" fatty acids because the body cannot make them from other sources and must obtain them through diet. Years of research have shown that DHA is the most abundant essential fatty acid in the brain, Cole said, and that it is critical to fetal and infant brain development. Studies have also linked low levels of DHA in the brain to cognitive impairment and have shown that lower levels may increase oxidative stress in the brains of Alzheimer's patients.

    Based on the positive results, the National Institutes of Health is currently conducting a large-scale clinical trial with DHA in patients with established Alzheimer's disease. For those patients, Cole said, it may be too late in the disease's progression for DHA to have much effect. But he is hopeful that the NIH will conduct a large-scale prevention clinical trial using fish oil at the earliest stages of the disease - particularly because it is unlikely that a pharmaceutical company will do so, since fish oil in pill form is readily available and inexpensive.

    Still to be determined, he said, "is what the optimal dose should be. It could be that a smaller amount might be helpful, especially in a place like the south of France, where people are already on a Mediterranean diet."

    Here in the United States, though, where fish consumption is not very high, the dose may need to be higher.

    "There's a deficiency of DHA to begin with," Cole said, "and this may contribute to the low LR11 seen in many Alzheimer's patients."

    http://www.ucla.edu/

    This is for the person asking about Alzheimer's.

    Marilyn
      




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  • Anonymous

    1/2/2008 6:43:00 PM |

    Hi Marilyn,

    Thanks for sharing the great information on fish oil/DHA!  I'm going to pass this on to my relative.

  • J. Michael

    1/3/2008 2:07:00 PM |

    It is rather difficult to find good D3-sources in Europe. Swanson's seems to be available; gelatine capsules although with a white powder inside. Are they any good?

  • Dr. Davis

    1/3/2008 9:08:00 PM |

    I do not advocate use of powder preparations of vit D. The absorption is simply too erratic. oil-based gelcaps are best.

  • moblogs

    1/4/2008 1:25:00 PM |

    I wonder what you think of this report? http://www.eurekalert.org/pub_releases/2008-01/bu-vdi010208.php I'm guessing that this is probably Hollick's idea of infiltration - get them to at least accept profitable D2 more before winning them over with D2.

    Also, last year I was prescribed 400IU of D2 which raised my 10nmol/L to 21nmol/L; in realising this is inadequate what would you recommend is a good plan for me?

  • Dr. Davis

    1/4/2008 1:35:00 PM |

    I don't know what to make of Holick's study. He is a source of reliable observations. However, his experience is dramatically different from my experience and that of many others. I have seen D2 have no effect whatsoever repeatedly. I had one woman who had been taking 50,000 units D2 per day have a blood level of D3 of 4 ng/ml.

    Most of my patients take somwhere in the 4000-6000 units per day of vit D3 to generate a blood level of 50-60 ng/ml.

  • Anonymous

    1/4/2008 4:35:00 PM |

    I saw the study about the vitamin D2 being just as good as D3 also.  Here is the link I read: http://www.nutraingredients.com/news/ng.asp?n=82331-vitamin-d-cholecalciferol-ergocalciferolI thought the article was interesting, until I read the part of the company that made the softgels.  I'd question  what where the Q/C of the content? Did an independent lab test the softgels?

  • Dr. Davis

    1/5/2008 1:52:00 AM |

    Excellent point.

    To me, there is absolutely no reason to take vit D2, given the uncertainty. It is not cheaper, more effective, nor more available. It may, however, be more profitable for a drug company. D3 is the human form; D2 is the plant form.

    Is there any reason at all to take D2? I don't think there is.

  • g

    1/7/2008 12:29:00 AM |

    Thanks for the information on Alzheimer's (AD) known now as 'Type 3 Diabetes.' It's conjectured that profound Insulin Resistance in the brain occurs prior to amyloid development in AD patients.  The brain can only use two types of fuel -- ketones (ie like during starvation) and glucose.  There appears to be a problem with excessive glucose.  Some neurobiologist experts believe a mildly ketotic diet may be beneficial for preventing this type of insulin resistance.

    Many benefits in recent studies have shown that fish oil significantly decreases IR associated with Type 2 Diabetes, NAFLD (a precursor to diabetes and believed to be a new indicator for Metabolic Syndrome, non-alcoholic fatty liver dz) and even cancers -- including prostate (shown by Vieth) and glioblastoma -- a rare malignant brain cancer -- thought to be incurable but now being 'cured' with fish oil (and tamoxifen, etc cocktail).

    Thanks ! !  g

  • g

    1/7/2008 4:36:00 PM |

    sorry -- Vieth is in vitro data -- don't know if in vivo data exists yet

  • Anonymous

    1/8/2008 12:23:00 PM |

    Seems word is leaking into the mainstream press about vitamin D.  Last night NBC Nightly News ran an article about the connection between low vitamin D levels and increased risk for heart disease.

  • Paul Kelly - 95.1 WAYV

    1/8/2008 7:28:00 PM |

    Hi Dr. Davis,

    I know that you recommend oil-based / gel caps for Vitamin D as opposed to tablets. Does the same hold true for daily multi-vitamins? Is a capsule and a gelcap the same thing?

  • Renee

    1/8/2008 8:57:00 PM |

    Wow another sickness that not enough Vitamin D is contributed to.  I just read an article at Here Comes The Sun talking about ways you can intake more Vitamin D.  Check it out.

  • Dr. Davis

    1/9/2008 3:33:00 AM |

    Paul--
    Vit D gelcaps contain oil. Gelcaps are capsules. However, not all capsules are gelcaps; some contain powder.

    Oil-based vitamins like A, D, and E are best taken as an oil. The D, for instance, in your multivitamin probably doesn't work at all, or absorption is erratic.

    Gelcaps are no more expensive, so why bother with tablet or powder forms?

  • moblogs

    1/21/2008 11:54:00 AM |

    Just wondered what your opinion on this anti-D report is? http://www.prweb.com/releases/2008/1/prweb639651.htm

    For what it's worth, I think this guy is going too far. His Marshall Protocol might be entertainable for those with certain autoimmune diseases, but saying D is bad for everyone based on his *personal* model seems nuts. Furthermore, his basic assumption is that everyone with low D 'is' ill, rather than has the potential to. And yet we know treating D in associated illness restores health.

    Would this guy withhold blood because a bullet causes bleeding? No wonder he's not an MD.

  • Dr. Davis

    1/21/2008 1:05:00 PM |

    Is this guy from the same planet?

    I've witnessed such extraordinary effects of vitamin D replacement that, for me, there is no turning back. Thus far, the effects of vitamin D replacement have paralleled the effects of sun exposure (except for the tan, of course).

    For every new idea, there will always be those who protest. Some have validity, some are plain kooks.

  • Anonymous

    1/24/2008 3:40:00 AM |

    Dear Dr. Davis,

    Thank you for your support of Vitamin D. I recently was tested and found to have a level of 37. I do have a question or two, though. I was on the mega-dose (50000IU twice a week for four weeks).

    I am now on 2000IU per day (just started this past Sunday). I have all of the Metabolic Syndrome symptoms except the high glucose (my last fasting was 81).

    How long do you think I should continue on this does before I have my level checked again? And how long before I would start to see results?

    My doctor seems very concerned about my CRP (3.1), and I'm really hoping that this vit d. regime helps.
    Thank you.

  • Dr. Davis

    1/24/2008 12:50:00 PM |

    Unfortunately, the "mega-dose" you refer to probably yielding nothing--it was probably vitamin D2 (ergocalciferol). In my experience, this synthetic form fails to be converted to the active form in humans, D3.

    We wait at least 4 weeks before checking a blood level, ideally 8 weeks.

  • Linda

    7/20/2009 7:30:21 PM |

    Just found out that I have
    vitamin D deficiency.  I have
    neuropathy, muscle weakness
    and arthritis.
    I hope taking the 50,000 units
    three times a week helps.
    We must certainly need our D,
    I'm proof.

  • Anonymous

    1/16/2010 2:53:37 AM |

    I have been detected with high TSH levels - 6 (the thyroid hormones are within range)and low Vit D - 25.
    Additionally, my cholesterol is 223 (good one is 81).
    I also seem to be getting ovarian cysts.
    Is all this related?

  • Anonymous

    2/15/2010 1:20:25 PM |

    quite interesting post. I would love to follow you on twitter.

  • shaheel

    9/27/2010 1:00:12 PM |

    Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

  • buy jeans

    11/3/2010 6:51:49 PM |

    In short, metabolic syndrome creates a metabolic mess that leads to dramatic increases in heart disease, vascular disease and stroke, and cancer. The medical community has been paying increasingly greater attention to this condition because of its booming prevalence and because of the big bucks invested in "education" by the manufacturers of the diabetes and pre-diabetes drugs, particularly makers of Actos and Avandia.

  • liposculpture guide

    1/31/2011 4:15:52 AM |

    Vitamin D is proving to be a very important and powerful influence on many of the facets of the metabolic syndrome. Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases.

  • robrob

    2/5/2011 6:42:42 PM |

    I was wondering can you have a genetic compenont against making enough vit d by the sun? I bask in the sun for hours (since I love it so much and I am drawn to it like postive charge does to negative charge) yet I am d deficient, I suffer terrible metabolic syndrome, the whole nine yards just short of type 2. my doctor calls me prediabetic.

    I have even improved my diet big time over the last 3 years. lower gi, lower sat fat, more veggies etc. omega 3 fish oil

    I never use sunscreen and I never burn. just a nice light brown tan.I keep this tan by the way almost the whole winter. I started to take a cal vita d mag supplement chewables and I drink whole milk with it to make sure I absorb them being fat soluable and all. I can't expose my belly for more than a few minutes that will burn. ouch!

    being obese I am sure whatever cal vita d I take is going to end up in storage hoarding it an all. what can I do? I now drink more whole milk, eat organic bacon per suggestion from article the obesity epidemic is metabolic syndrome a nutritional deficiency. by stephanic seneff. real nice lady by the way.

    anyway slowly after implementing her suggestions my fasting hypoglycemic especially at night has improved, i don't run to the bathroom like i used to, I am more relaxed too. I have more energy, all this is a slow process not overnight. over many months.

    I don't have to eat at 3 in the morning anymore because of getting super hungry, nervous sweaty etc.

    but I still suffer some of the symptoms just not as severe. is there anything else I can do to speed up the improvments in mets?

    reduced cal diets do not work I get to hungry can't sleep and lose all energy. even a slight reduction which I have done makes me to hungry to sleep at night. or forces me up to eat after a couple of hours of sleep.

    forcing my body to get by on less caloires is not an option. (losing weight is always touted by my doctor to cure mets but mets was caused by my dieting history) I have lost hundreds of pounds over my 35 dieting history.

    I would like to hear any suggestions you may have. my doctor keeps pushing weight loss but that is what got me like this in the first place.

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