Throw away total cholesterol!

17. May 2006 William Davis (1)
Richard's total cholesterol without treatment was 186 mg/dl. "That's great!" his doctor declared, referring to the conventional dictum that total cholesterols less than 200 carry low risk. Several fingersticks in a mall kiosk set up by a local hospital to check total cholesterols confirmed Richard's low number.

But after Richard's unexpected hospitalization and two stents for severe coronary blockages, he demanded better answers.

Tragically, the answer was there all along: Despite a "favorable" total cholesterol, his HDL ("good") cholesterol was a miserable 32 mg (ideal >60 mg).

Total cholesterol is actually the sum total of HDL cholesterol, LDL cholesterol, with a contribution from triglycerides. That's why a low total cholesterol can conceal a low HDL.

This situation is quite common. And low HDL is accompanied by a constellation of other undesirable causes of heart disease, most notably small LDL.

Don't accept total cholesterol as your sole measure of risk. It's nearly worthless. If you live in Bangladesh or a third world country, well perhaps that's the best you can get. But if you live in the U.S. or developed world, it's absurd to rely on total cholesterol.

Smart Start not so smart

15. May 2006 William Davis (2)



Kellogg's has crafted a campaign to support the American Heart Association featuring acress Sela Ward. Her attractive face, familiar to many TV and movie viewers, does add a comforting face to their efforts.

What's in this cereal made by the manufacturers of Pop-Tarts, Cheez-It, Rice Krispies, and Chips Deluxe cookies?

There are, indeed, some healthy ingredients: oat bran, potassium; you can even get a version made with soy protein. But there's sugar listed as the second ingredient. High-fructose corn syrup is also listed prominently. (Remember this issue? High-fructose corn syrup causes overwhelming sugar cravings, causes your triglycerides to skyrocket, and is probably among the principal food ingredients that make you obese.)

Upon detailed questioning of my patients struggling to lose weight, this and products like it are often among the "healthy" foods they've gravitated towards. We spend a great deal of time dissuading them of this idea.

A one-cup serving of Smart Start is low in fat (1 gram) but contains 43 grams of carbohydates, of which there are 14 grams of sugar. There are a meager 3 grams of fiber. To me, this sounds like a cupcake.

The Kellogg's people are exceptionally clever marketers. Partner with the American Heart Association and movie stars? Brilliant!

You should trust food manufacturer advertising about as much as you trust drug manufacturer advertising, which is to say not at all.

Kellogg's sold $10 billion dollars of food products last year. They are the world's leading producer of breakfast cereals. They are a leading producer of convenience foods: cookies, crackers, cereal bars, and frozen waffles under the brands Keebler, Pop-Tarts, Eggo, Cheez-It, Nutri-Grain, Rice Krispies, Famous Amos, and Kashi.

Can they cash in on healthy trends? They'll certainly try.

Does anybody have a normal vitamin D level?

15. May 2006 William Davis (0)
We now routinely check everyone's vitamin D blood level at the start of the program. (The measure to obtain is 25-OH-Vitamin D3. This is not to be confused with 1,25-OH2-vitamin D3, which is a kidney function measure.)

Of the 10 people with levels drawn today, none were even close to normal levels (which we define as 50 ng/ml)--not a single one.

The majority were in the range of severe deficiency (<20 ng/ml). Only two had levels in the 30s. None had higher. (Remember: I'm talking about people in Wisconsin, a terribly sunlight-deprived area much of the year. This might not apply quite as vigorously to Florida residents or others in sun-exposed regions.)

Curiously, I've also seen several people this week who had extraordinary quantities of coronary plaque on their heart scans (scores >1000), all of whom had extremely low vitamin D levels. One of these people had fairly unimpressive lipoproteins, with very minimal abnormalities identified. (This is quite unusual, by the way.) It makes you wonder if a profound deficiency of vitamin D is sufficient to act on its own as an instigator of coronary plaque.

The more we examine the issue of vitamin D deficiency, the more fascinating it gets. I suspect we've just scratched the surface and there's a lot more to learn about this tremendously interesting nutrient. Nonetheless, with what we're seeing in our experience, I'm urging everyone to get a blood vitamin D level.

Don't believe your LDL cholesterol!

14. May 2006 William Davis (0)
Harry's case is typical. For years, his doctor told him his LDL cholesterol of 123 mg was okay. But a heart scan score of 490 (90th percentile at age 52) made him question just where his coronary plaque came from.

Lipoprotein analysis told a very different story: His LDL particle number was 2400 nmol, meaning his trueLDL was more like 240 mg, nearly double the value of LDL obtained through his doctor. Harry had other sources of risk, too, but the LDL particle number was a clear stand-out.

Why does this happen? How can LDL cholesterol be so terribly inaccurate?

LDL cholesterols obtained in virtually all labs are not measured, they're calculated. The calculation was developed in the 1960s by Dr. Friedewald at the National Institutes of Health and therefore goes by his name (the Friedewald calculation). Dr. Friedewald derived this simple calculation to permit doctors across the U.S. to obtain LDL cholesterols, which were technically difficult to measure in those days by using measured HDL, total cholesterol and triglycerides.

Doctors were told that the only time that the Friedewald calculated LDL was inaccurate was when triglycerides exceeded 400 mg. So most family practitioners and internists still believe that calculated LDL's are, for the most part, quite accurate.

Nothing could be further from the truth. When LDL's are actually meaured, you find that LDL is rarely accurate. In fact, in our experience, inaccuracy of 30-50% is the rule, sometimes 100%. The one telltale hint that calculated LDL is wrong is when HDL is <50 mg--that's nearly everybody.

So what's your LDL? You won't really know unless it's measured. Our preferred method is NMR (LipoScience) LDL particle number, probably the most accurate of all. Second best: apoprotein B, direct measured LDL, and non-HDL. (We'll cover this issue much more extensively in an upcoming report on the www.cureality.com website in an extensive Special Report.)

Are you the exception?

14. May 2006 William Davis (0)

I read about 40 heart scans this morning. In the stack was a 41-year old man with a heart scan score of 841.

That's terribly high for anyone, let alone a 41-year old person. He's lucky to find out about this before catastrophe strikes.

People like this worry me. In general, we advise men to consider a heart scan age 40 and older; women 50 and older. If there's anything exceptional about your family history or your own history, then you might notch these numbers down another 5-10 years. For instance, if your Dad had a heart attack at age 43, you might consider a scan at age 35. Or, if you've had diabetes for several years and you're a 42-year old woman, you might think about a scan. (Men tend to develop measurable plaque by heart scans 10 years before women.)

There are no hard and fast rules. It's unusual for a male to have a score >0 before age 40. Likewise, it's very uncommon for a woman to have a score >0 before age 50. But there are occasional exceptions--but they can be very important exceptions.

Our 41-year old man with the score of 841, for instance, probably had a high score since his mid-30s. I've seen several women without any obvious risk factors with scores in the several hundred range in their early 40s.

My rule: When in doubt, opt for safety. Every day, I still read about people in their 30s, 40s, and 50s dying of heart attacks. It shouldn't happen.

When in doubt, get the heart scan. The most you'll lose is the cost of the scan and a modest exposure to radiation. If your score is zero, you know you're safe for the next 5 or more years. But if you have an exceptional score at a young age, take preventive action.

Self-empowerment in health: The new wave in health care

12. May 2006 William Davis (0)
Track Your Plaque is just one facet of the broad and powerful emerging wave of self-empowerment in health.

Hospitals, drug and device manufacturers, and the medical establishment don't like this idea. People managing their own health? That's ridiculous! Dangerous! But mostly unprofitable.

Self-empowerment means having easy access to simple, safe, and inexpensive diagnostic tests like heart scans, carotid scans, bone densitometry (for osteoporosis), cholesterol tests, abdominal ultrasound, even brain scans (e.g., CT or MRI) for people with a family history of brain aneurysm.

Opponents of this idea worry about the "false-positives" that come about with broad testing, i.e, detection of abnormalities that are artifactual. Our experience is that false-positives are only an occasional problem with any test. Instead, we find that most people have many true-positives. In CT heart scanning, for example, we find many unsuspected enlarged aortas (potential future aneurysms), valve disorders, and aortic calcium. These are all important in a preventive program. Unfortunately, your doctor's definition of false-positive often means that no corrective procedure or operation is required.

Other evidence that self-empowerment in health is growing:

--The nutritional supplement movement. What better example of power in managing your own health is there than the fabulous array of nutritional supplements available?

--Medications moving to over-the-counter status. Gradually, more and more medications are trickling into availability for you to obtain without a doctor's prescription.

--What I call "retail imaging", i.e. screening ultrasound, heart scans, full body scans, etc. that are available in most states without a doctor's order.

--The Internet. The rapidity and depth of information available on the Internet today is mind-boggling. It will fuel the self-empowerment movement by providing sophisticated information to the health care consumer previously available only through your physician.

--High-deductible health insurance plans. If health care consumers will bear more and more of the costs of health care, they will seize greater responsibility for early identification and prevention to minimize long-term costs.

There are more. But the movement is powerful and broad--and unstoppable. Let the establishment with vested interests in preserving the status quo fuss and complain, just like horse and buggy manufacturers did in the early 1900's when the autmobile came along.

Vitamin D deficiency is rampant

12. May 2006 William Davis (0)
Today alone I've seen several people with severe deficiencies of vitamin D.

We're now checking everyone's blood vitamin D level at the start of the program. The measure that most accurately reflects your vitamin D status is 25-OH-vitamin D3. This is very confusing to many physicians, who traditionally have thought of 1,25-di-Hydroxy vitamin D3 as the standard test to measure. What they're failing to recognize is that this second measure is a kidney product, not a reflection of vitamin D status.

Using 25-OH-vitamin D3, several people today alone had levels of <10 ng/ml, clearly in the category of severe deficiency (generally regarded as <20ng/ml).

The majority of people we see in the office are Wisconsin residents. It's no wonder they're deficient. Although it's mid-May, we've seen the sun only a handful of days this year. And most of the days have been too chilly to wear short sleeves and shorts to permit sufficient surface area for UV exposure.

Living in a sunny climate, however, is no guarantee that you have sufficient blood vitamin D levels. Two recent studies have shown that 30-50% of the residents of sunny southern Florida and Hawaii are also deficient. (Why, I'm not sure.)

Although our experience thus far is anecdotal in several hundred people, my impression is that people who have normal blood levels of vitamin D (we regard normal as 45-50 ng/ml) have a far easier time of halting or regressing coronary plaque.

Vitamin D is among the most exciting nutritional tools we've come across in a long time. The conversation is making the media, which impresses me tremendously, given the fact that nobody stands to profit financially to any significant degree through vitamin D supplementation.

For a wonderful collection of discussions on vitamin D, go to Dr. John Cannell's website, www.vitaminDcouncil.com. You'll find a huge quantity of scientific background and conversation on the whole idea. I believe you will be thoroughly impressed with just how powerful the argument in favor of vitamin D has become.

What if wheat products were illegal?

11. May 2006 William Davis (3)
Imagine if anything made of wheat were illegal: bread, bagels, crackers, pasta, pretzels, donuts, Shredded Wheat cereal, Raisin Bran, pastry, cookies, cakes, cupcakes. . . Your grocery store would then be unable to carry any of these products.

How empty would the grocery store shelves be?

There would be very little. The stores would be filled instead with vegetables and fruits, meats, and dairy products. But aisle after aisle would be empty. There'd be no cereal aisle. There'd be no snack chip aisle. The ordinarily overcrowded bread shelves wouldn't be there.

Bakery? Nope, not there either. Pasta and noodles? Empty. How about cakes and pastries? Also gone.

Getting the picture? American groceries are dominated by wheat products. What would happen to your health and the health of your family if wheat were abruptly removed from your choices? Would you be less healthy?

No. In fact, your health would be hugely improved. You'd lose a significant quantity of weight. Extraordinary numbers of people would lose diabetic or pre-diabetic tendencies. Feelings of sluggishness, sleepiness, and moodiness would dissolve. Blood pressure would be reduced. The incidence of cancer, skin disease, and inflammatory diseases would plumet.

From a plaque control perspective, your HDL cholesterol would rise, triglycerides drop. Small LDL would improve dramatically.

The message: Slash wheat products from your diet. Yes, you'll miss the smell and taste of freshly baked bread. But you'll do it for many more healthy years. And you may do it without a 14 inch scar in your chest.

The sobering tale of small LDL

10. May 2006 William Davis (0)
Every day, I learn to respect small LDL more and more.

Small LDL particles, and its evil partner, low HDL, is among the most common reasons why someone fails to fully gain control of coronary plaque and heart disease risk.

Just yesterday, I saw a slender businessman (6 feet 1 inch in height, 186 lb.) whose small pattern persisted despite niacin, fish oil, oat bran, and raw almonds. We generally think of small LDL as an overweight person's pattern, but in some people the genetics are quite powerful and it can be expressed even in slender people.

The solution: More physical activity and exercise; cut back on processed carbohydrates, particularly wheat products like breads, pasta, crackers, breakfast cereals; think about magnesium (see our two recent reports on magnesium on the www.cureality.com membership website, the latest report to be posted this week); be sure sleep is adequate (gauge this by whether you're energetic during the day and don't fall asleep watching TV or movies). Lack of sufficient physical activity in people with sedentary jobs is probably among the most common reason the small LDL pattern persists.

Ignore small LDL and it can be like a hidden cancer in your body, growing and metastasizing (not literally, of course), fueling coronary plaque growth. Be sure your doctor assesses whether you have small LDL if you hope to gain control of your coronary risk.

Burn off the fat

9. May 2006 William Davis (0)

If you've ever wondered just how many calories you're burning with various activities like yard work, driving, climbing stairs, etc. go to this great website that will calculate it for you: http://www.caloriecontrol.org/exercalc.html.

Here are some examples:


Dancing for 30 minutes(fast, e.g., tango): 193 calories
Yoga for 30 minutes: 204 calories
Washing the car for 30 minutes: 173 calories
Vacuuming for 30 minutes: 88 calories

(All are for a 170 lb person.)

As you see, physical activity does not necessarily have to consist of exercise. It doesn't require fancy equipment or expensive outfits. But it does require you to keep moving. Sedentary work is among the most common reasons I see in my patients for failing to control weight and its associated lipoprotein patterns, like low HDL and small LDL.

If your work is sedentary, then a minimum of 60 minutes of physical activity per day is necessary to begin to correct weight-related patterns. If you gauge by calories burned, then a useful goal is 500 calories per day in physical activity--at a minimum.
Calcium chaos

Calcium chaos

23. January 2008 William Davis (30)

Imagine that I'm planning to build a wall of bricks. I start by throwing cement at a pile of bricks, hoping that it forms a nice, orderly brick wall.

Fat chance, you say.

I believe that is what appears to be emerging as the situation with calcium supplementation.

A recent study from New Zealand reported an experience with 1,471 postmenopausal women, mean age of 74 years, who were randomized to treatment with either calcium supplements or placebo. Calcium was supplied as calcium citrate (Citrical) to provide 1000 mg of (elemental) calcium per day (400 mg morning, 600 mg evening).

(Bolland MJ, Barber PA, Doughty RN et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. Brit Med J BMJ, doi:10.1136/bmj.39440.525752.BE; published 15 January 2008)

Over 5 years, women taking calcium had twice the risk of having a heart attack compared with women taking the placebo; women taking calcium had a 47 percent higher risk of having any one of three "events" (heart attack, stroke or sudden death) than women in the placebo group.

The findings of this study run counter to what we've been telling people all these years: Calcium supplementation, usually taken to halt deteriorating bone health and osteoporosis, modestly reduces blood pressure, reduces LDL and raises HDL cholesterol. At first blush, we might thereby presume that it also reduces cardiovascular events.

This study suggests that calcium supplementation does not result in reduction of cardiovascular events, perhaps even increases risk.

Certainly, this new finding will serve to confuse the public even more than it is already, particularly when it comes to strategies that modify risk for heart attack. However, this may make more sense once we stop and think for a moment.

Calcium supplementation inarguably slows, occasionally halts, calcium resorption from bone (through suppression of parathyroid hormone). Calcium also accumulates as part of atherosclerotic plaque in coronary and other arteries.

How does oral calcium know where to go--bones, not arteries or kidneys, in addition to serving all its other crucial functions?

Keep in mind that, in many roles, calcium is passive, something that responds to control exerted by some other factor. Vitamin D is that factor. Vitamin D controls the absorption of calcium in the intestinal tract (calcium aborption quadruples when vitamin D is restored to normal), it controls whether calcium is deposited in bone or extracted from arteries. It is the master control over the fate of calcium. Calcium just goes along for the ride.

Bone and arterial health do indeed intersect via calcium, but not through calcium supplementation. Instead, the control exerted by vitamin D (and vitamin K2, another conversation) connects the seemingly unrelated processes.

At what calcium dose threshold do the benefits stop and the adverse effects begin? That remains unanswered, particularly in light of this new study. However, this study calls into serious question the wisdom of supplementing calcium at a dose of 1000 mg, particularly when taken without normalization of vitamin D.

Calcium is therefore emerging as an important player in artery health. But just taking calcium makes no more sense than our brick wall and cement analogy. You might regard vitamin D as the mason that skillfully lays down both brick and cement in a neat, orderly way.
Tags :

Comments (30) -

  • Anne

    1/23/2008 7:47:00 AM |

    Dear Dr Davis,

    Sometimes I think I must be living in the Matrix - I thought this article so interesting as I have been prescribed calcium supplements for osteoporosis, but just a few weeks ago I had to stop taking them because I discovered they were the cause of severe diarrhoea I had been having for nearly a year. Stopping the calcium supplements halted the diarrhoea straight away, trying it again, even a different make, brought it back even on low dose. Anyway, it was just then that I read a lot about vitamin D3 on your blog and Dr Eades, just at that very time, so I upped my D3 intake to 5,000iu in the hopes it will help me absorb as much of my dietary calcium as possible. I cannot take dairy products so I get my calcium from leafy green veggies, nuts, seeds and fish. And now you wrote on your blog to look at vitamin D3 for aortic valves (I'm the one with bicuspid aortic valve) too. The Matrix ! Or I've found the best doctors on the internet Smile

    all the best,
    Anne

  • Anonymous

    1/23/2008 5:23:00 PM |

    I'm taking Vit D3 in gel form for my bones, heart, and to help prevent cancer, until it warms up here so I can get some sun. I'll be getting plenty of direct sun while gardening and bike riding, but the rest of the time outside, I'll sit in the the shade so I won't get too much UVA, since my family had a few skin cancers (caught early).

    I'm going to look for natto when I finally make it to the Asian store. I've heard it tastes pretty bad for people that have never eaten it, so I'll have to try to mix it in with something else probably. I've also read that some people compare it to blue cheese, so maybe I'll start with blue cheese recipes to try to mellow the natto taste.

    S

  • Red Sphynx

    1/23/2008 6:50:00 PM |

    Granted, calcium supplements leave a lot to be desired.

    But this article didn't cast any light on the problem.  Read Sandy Szwarc' excellent Fisking of this study over at JunkFoodScience.

    Adam Becker Sr

  • Anonymous

    1/23/2008 8:53:00 PM |

    Doesn't calcium compete with magnesium for absorption from the gut?  In which case, supplemental magnesium in addition to the calcium would be indicated

  • Anonymous

    1/24/2008 12:49:00 AM |

    I am so confused about this whole chotesterol/ heart attack risk argument. I've been reading your blog for months now and follow everything you say because it sounds like it all makes great sense. So whats the problem? We keep hearing more and more that total cholesterol, as was once thought, is not a very good indcator of impending heart attack. So how come Dr.William Castelli, the one time director of the famous Framingham Study says in over 60 years following thousands of people, they have NEVER had a heart attack in ANYONE with a total cholesterol below 150 regardless of what the HDL may be? If that doesn't indicate that total cholesterol CAN be a strong indicator I don't know what can. I understand if your cholesterol is higher than 150 this may not tell you anything, but for those of us below doesn't it? Or does no heart attacks in a 60 year period with thousands of people tell us nothing?

  • Dr. Davis

    1/24/2008 2:44:00 AM |

    I do not agree with Dr. Castelli's observation. I have seen MANY heart attacks with total cholesterols <150 mg/dl. I do not understand the discrepancy.

    For instance, an HDL of 23 mg/dl--very high risk--can easily be concealed within a low total cholesterol, as can smoking, diabetes, and Lp(a).

  • Peter

    1/24/2008 9:05:00 AM |

    Anonymous, even the most cursory glance at any of the aggressive LDL-C lowering trials will give you the information about the accuracy of Dr Castelli's statement. Let's not be too explicit.

    Peter

  • donnyrosart

    1/24/2008 1:33:00 PM |

    It looks like going into the study, the authors suspected the opposite (calcium prevents heart disease) was true. They mention speculation that calcium supplementation might be heart healthy by increasing malabsorption of fat, and quote a study where calcium supplementation doubled fecal fat and bile. Personally, I try to eat things I'd like to absorb.
    The first study they reference to (I think it's their own study) showed calcium supplementation increased Hdl, and decreased ldl, but had no effect on triglycerides. If ldl decreases, but triglycerides remain the same, does that suggest anything about ldl particle size?
    Really like your blog.

  • Dr. Davis

    1/24/2008 4:19:00 PM |

    Good question.

    I've not looked specifically for a LDL size effect from calcium, nor am I aware of any specific literature to this effect. However, I do believe that many of us are trending towards less and less calcium supplementation, particularly in light of vit D supplementation.

  • Anonymous

    1/24/2008 7:59:00 PM |

    I apologise maybe I worded my question incorrectly. Dr. Castelli doesn't claim that if you have a total cholesterol under 150 you will not have a heart attack, he says in The Framingham study ( involving 3 generations and over 10,000 people ) there has never been one. I suppose we could blow this off and claim he's lying ( I doubt it ) or try to learn something from it. Thats a VERY large long lasting study and once again he has said "under 150 REGARDLESS of HDL score" there HAS to be a reason for this, I was just wondering if anyone had a guess.

  • brittany lady

    1/24/2008 10:59:00 PM |

    This now has me totally confused.  My doctor recommended I take 1,000 mg. of Calcium in supplement form every day, and to make sure I get 800 mg. of Vitamin D.  I have done so faithfully plus drinking about 10 oz. of calcium added Lactaid fat free milk. I also learned after an x-ray, stress test and heart imaging that I have calcification at the base of my aorta, but my heart is not enlarged.  This has happened since 1999, and I have only been taking Vitamin D for the past year and a half. Now I wonder if large doses of Calcium before having my vitamin D levels tested might have caused this. On another note, I had very high triglycerides and started taking 2000 mg. of fish oil capsules daily.  My triglycerides dropped from 375 to 160 in 6 months.  That might be a solution to someone with these concerns.

  • Anne

    1/25/2008 8:23:00 AM |

    Since being diagnosed with osteoporosis last year I have done a lot of research on it and on various therapies. I am, btw, only 54 so it was a big shock. Anyway, looking at things logically, there is no way that someone my age would have got osteoporosis from lack of calcium, so why do they prescribe it ? It seems based on research done on elderly ladies in nursing homes. I've got osteoporosis because of health issues when I was younger yet, I was still told the usual to take 1000mg calcium and 800iu vitamin D. I refused bisphosphonates and have been prescribed Strontium Ranelate instead. I hope Strontium doesn't cause calcification, I don't think they know enough about it so I feel rather a guinea pig. Now that I can't tolerate calcium and have stopped taking it and upped the Vitamin D3 to 5000iu I feel more confident that this will help not only my bones but also my heart health. I also take 2,000mg of fish oil.....my triglycerides are currently 0.6 (53).

    Anne

  • Anne

    1/25/2008 1:39:00 PM |

    Something else to make one realise that calcium may not be as important as we have been told - if you look at countries in Africa where some people have sub-optimal diets and low in calcium, you usually don't often find osteoporosis ! I would hazard a guess that the reason they don't get osteoporosis is because they have plenty of Vitamin D from the sunshine and they probably do a lot of physical work.

    Anne

  • Dr. Davis

    1/25/2008 1:51:00 PM |

    Great thought.

    I am impressed that many of the "holes" in our thinking about health and nutrients is filling in with greater understanding of the role of vitamin D.

  • Rick

    1/25/2008 5:19:00 PM |

    Dr. Castelli also made the following observation:

    "For example, in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol."

    For Dr. Eades's typically insightful take on the issue, go here:

    http://tinyurl.com/2d7bzw

    and here:

    http://tinyurl.com/24uqj2

  • Dr. Davis

    1/26/2008 5:05:00 AM |

    I couldn't agree more.

    Cholesterol (total and LDL) are lousy predictors of heart disease. They are, indeed, factors. But in the long list of factors causing heart disease, cholesterol is way down.

    But cholesterol is, no doubt, the most profitable. Revenues for statin drugs topped $27 billion last year.

  • Anonymous

    1/26/2008 3:05:00 PM |

    Great articles Rick, read them both and found them quite interesting however a little disappointed neither had anything to do with why after 60 years and following over 10,000 people NOT ONE of them with a total cholesterol under 150 ever had a heart attack. I eat low carb, loved Taubes book explaining the myths about eating fat, big proponent of Track your plaque and think Dr. Davis is brilliant and well ahead of his time. And yet either we think Dr. Castelli is a liar or anybody with ANY interest in preventive cardiology would want to know why no heart attacks in anyone with tot cholesterol under 150 in over 60 years in such a large group of people. My god we hear all the time about the stunning results of the HATS Trial which included a grand total of 161 people.

  • MAC

    1/26/2008 5:38:00 PM |

    Dr. Davis,
        Found this study while perusing Science daily today. Not sure how or if this intersects at all with the good results you get with Vit D.

    Vitamin D Deficiency May be a Sympton of Disease: Supplementations may make it worse:

    http://www.sciencedaily.com/releases
    /2008/01/080125223302.htm

    "Low blood levels of vitamin D have long been associated with disease, and the assumption has been that vitamin D supplements may protect against disease. However, this new research demonstrates that ingested vitamin D is immunosuppressive and that low blood levels of vitamin D may be actually a result of the disease process. Supplementation may make the disease worse."

  • Dr. Davis

    1/27/2008 2:18:00 AM |

    It refers to the so-called "Marshall Protocol." Having read his arguments, he mixes science with conjecture and enormous leaps of speculation, all with zero experience in real, live humans. (He's a "bench" researcher with experience that doesn't extend beyond mice and cell cultures.)

    It reminds me an awful lot of the pseudo-scientific tangent that misled Linus Pauling and Mathias Rath.

  • Rick

    1/27/2008 7:40:00 AM |

    Anonymous,

    No need to be disappointed.  Here's the relevance.  Dr. Eades quoted Dr. Kannel, who preceded Castelli as director of the Framinham study as saying:

    "...it is not possible to select a critical lipid value that separates potential CHD candidates from the rest of the population."

    That appears to contradict the implications of Castelli's quote.

    Dr. Eades also made the case that sometimes the pronouncement of the researchers is not supported by the evidence.

    What percent of the population had cholesterol lower than 150?  What was their age distribution?  These would be important things to know.

    In looking at a graph of the distribution, it appears that less than 5% of the population were in that category.  

    BTW, can you you provide a citation for your quote of Dr. Castelli?  Thanks.

  • Stan

    1/27/2008 3:32:00 PM |

    anonymous,

    Castelli said that there was no heart attack at all in the sub-population below 150mg/dl of cholesterol, and he said also
    that, quote:

    "For example, in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol."

    This is a speculation but one possible explanation behind those two seemingly contradictory informations is that the
    subpopulation of people who had naturally low cholesterol in Framingham, were all young and/or  were all eating more animal fat and less carbohydrates than the other groups!  Younger people are more active and eat more calories too. Both factors (young age and a higher animal fat lower carbohydrate nutrition) tend to associate with low cholesterol
    and are simultanously cardioprotective.

    Is it improbable? I dont' think so. Dr. Davis's own results on vitamin D3 and essential fatty acids supplementation (naturally present in animal food, dairy, eggs, meat and fish!) also seem to point in the same direction.

    It would also fit another observation: I remember some published data on Masai population who also have or had very low total cholesterol (I think about 160 mg/dl on average), follow a high fat low carbohydrate nutrition and have very little heart disease!

    Stan (Heretic)

  • Anonymous

    1/28/2008 3:38:00 PM |

    http://tinyurl.com/24uqj2, Rick try this one but any search on google brings many citataions.

  • Anonymous

    1/28/2008 3:41:00 PM |

    Rick heres another better one.http://findarticles.com/p/articles/mi_qa3987/is_20070409/ai_n19031299/pg_2

  • Rick

    1/29/2008 12:32:00 AM |

    Anon,

    Thanks for the links, but the first one is the link I gave you, and the second is truncated.  

    If it's the article by the chiropracter, I've already seen that, but was hoping for  a primary source so I could read the context.  I've done a fair amount of googling but haven't been able to find it.

    Your quote speaks of 60 years of research, yet the artcle you cite (at least I think it's the same artcle) speaks of 40 years and the Framingham website is proudly celebrating 50 years of research.

    This is not to nitpick but it does make me wonder if this isn't one of those internet quotes that takes on a life of its own.

    I agree with you that it is confusing because so much of what I have read, along with my own experience renders his observation, whether true or not, meaningless.

  • Anonymous

    1/29/2008 12:51:00 AM |

    http://findarticles.com/p/articles/mi_qa3987/is_20070409/ai_n19031299/pg_2
    This article explains Dr. Castelli's position well.

  • Anonymous

    1/29/2008 12:55:00 AM |

    http://findarticles.com/p/articles/mi_qa3987/is_20070409/ai_n19031299
    Read this one Rick.

  • Anonymous

    1/30/2008 3:07:00 PM |

    The Framingham Study was begun in 1948. That seems to be the one point that is a fact.

  • Rick

    1/30/2008 7:14:00 PM |

    Thanks for the link.  That is one of the articles I'd already seen. ( Not to put too fine a point on it, but he does refer to 40 years, not 60 as in your quote.)

    The data I've seen confirms his statement.  People whose TC was below 150 didn't evidence CHD.  But, as I mentioned above, the number of those people was extremely small, less than 5% of the population. It may be true the nobody who's run a sub 2:10 marathon has suffered a heart attack, but so what?

    For the vast majority of the population in the study, those between 150 and 370, some did have CHD, some didn't.  The correlation was not strong except on the edges.  

    So what can we take away from this?  Get your TC below 150 and you're immune from CHD?  The same research shows correlation with low levels of TC and all cause mortality.  So choose your poison.

    And if, despite your best efforts, your numbers creep up above 150, are all bets off?  My TC over the years, has ranged from 140 to 180, most recently 160, yet my plaque burden put me in the 50th percentile for my peer group.  So the importance of Dr. Castelli's observation is lost on me.

    As pointed out by Dr. Davis, and many others, total cholesterol alone is not a very useful indicator. Check out the post on the Vytorin study. Those whose cholesterol dropped the most experienced a greater increase in plaque.

    So, while Castelli's statement is based in fact, there is a lot of room for interpretation.  And most of the rest of what is attributed to him in that article is speculation.

    Yes, Framingham was begun in 1948, but I doubt the data is available instantaneously.

  • Anonymous

    6/4/2008 1:31:00 PM |

    My sister and I got in argument at a picnic about whether calcium supplements are a good idea.  Afterward she sent me an article in favor, and I sent her one against.  Then I realized you wrote both articles!

  • ccruby

    8/17/2008 1:30:00 AM |

    Mayo Clinic diagnosed me with fluid around my heart.  I could feel it sloshing around.  Stopped calcium/mag and estrogen supplements and I could no longer feel it; I also kept telling it to go away.  Went back a couple of months later for MRI--Mayo said I had fat around my heart.  I know the original diagnosis was correct.

Add comment

Loading