My sister called today . . .

My younger sister, aged 48 years (sorry, sis), called this morning.

"I'm going to my doctor today. What labs should I tell him to draw?" she asked.

"Why do you have to tell him? Can't you just ask him what he thinks should be drawn?"

"No," she said. "He just draws what I tell him to."


Maybe my sister is bossier than most. But I've heard this from many patients, as well. They go to their primary care physician and end up requesting this or that test. Sometimes their doctor complies. Often, they resist and refuse to do so.

I've heard many complaints from patients about doctors refusing to order even fairly benign tests like a vitamin D blood level or lipoproteins, even a C-reactive protein.

The number of these sorts of complaints seems to be growing. Ten years ago, it rarely happened. Today, I hear this nearly every day.

I think it is symptomatic of the growing discontent we all have with the status quo in healthcare. We are all expected to submit to the paternalistic, what-can-you-possibly-know mentality that still rules the day in medical offices. Only 40-50 years ago, if you wanted to look at a medical book, you'd have to ask the librarian for special permission so that they could make sure you weren't just a pervert trying to look at naked bodies. Today, every manner of medical and health information can be found online. Quite a contrast.

We are entering a new age, one in which people are far better informed, have surfed the internet and read media reports on health topics, have been exposed to drug company advertising, and know a fair amount about nutritional supplements. I think the system needs to change to accommodate this rapidly growing hyper-knowledgeable society.

In past, when a health problem turned up, you'd turn to your doctor first. I predict that,in the next few years, we will use the doctor as a place of last resort, the person we turn to when all else has failed, after you've exhausted your information sources.

I hope that the Track Your Plaque process will become one of the engines of change, an information resource that provides empowering tools that don't replace your doctor, but provide many information tools that are superior and may minimize your reliance on a health care provider.


Copyright 2007 William Davis, MD

Comments (5) -

  • traderfran2001

    9/28/2007 2:16:00 AM |

    Ditto on having to struggle with Doctors to order tests. My Doctor thought that my lipid profile showed I was not in great danger until I showed him the results of my CT scan.He simply refuses to order tests like vit d levels. I have given up trying and simply get the tests myself.

  • Anne

    9/30/2007 3:23:00 AM |

    Ditto to having difficulty getting my PCP to run tests. I was low in Vitamin D and got it up by the end of last summer. I asked for a check after last winter and he refused because my vitamin D is now "good". In the summer I was getting some sunlight. I wanted to know if it had dropped during the winter months.

    There are online places that offer all the blood tests. I guess that is one alternative when the doctor refuses.

  • Dr. Davis

    9/30/2007 3:33:00 AM |

    Anne-

    You echo a repeated complaint we get: It is a frequent stumbling block  requesting laboratory tests (or other test, for that matter) that are clearly beneficial, but beyond the comprehension of your doctor.

    We are searching for solutions. Our collective efforts will, given sufficient time and inventiveness, lead us all to a practical answer.

  • Anna

    1/21/2008 8:40:00 PM |

    I think you have hit the nail on the head.  I used to think I was fairly well informed on health and that my doctor was giving me excellent care.  But over a few years I realized I had a lot of "not sick but annoying" health problems.  My *former* primary care doctor (I had seen her for a decade) was willing to prescribe for some of the symptoms but didn't seem interested in the "big picture" and even dismissed my theories.  She missed or dismissed so many things (hyperglycemia, hypothyroidism, relaxed pelvic ligaments), even when I asked about these conditions.  It was a rude awakening for me and I found other doctors who treated me with the appropriate treatments (rather than just Rx for symptoms) or at least listened to my ideas and I am much improved.  Now I am a much more informed patient and I don't hesitate to question, re-question, and learn on my own.  

    And while I don't like the idea of "shopping around" for a "puppet" doctor who will just do as I say, I have learned it is a good idea to get additional opinions (even if it means paying out of pocket) or try a new PCP, even within the same network (my HMO lets me see any PCP in the same network).   I made a huge mistake thinking that my former doctor couldn't have been wrong or that a long history with a doctor was better than starting all over with a new PCP.   I now realize that I am part of the team for my healthcare, even the leader sometimes, not just a passive observer.

  • Anna

    1/24/2008 12:14:00 AM |

    I think you have hit the nail on the head.  I used to think I was fairly well informed on health and that my doctor was giving me excellent care.  But over a few years I realized I had a lot of "not sick but annoying" health problems.  My *former* primary care doctor (I had seen her for a decade) was willing to prescribe for some of the symptoms but didn't seem interested in the "big picture" and even dismissed my theories.  She missed or dismissed so many things (hyperglycemia, hypothyroidism, relaxed pelvic ligaments), even when I asked about these conditions.  It was a rude awakening for me so I found other doctors who treated me with the appropriate treatments (rather than just Rx for symptoms) or at least listened to my ideas; two years later and I am much improved.  Now I am a much more informed patient and I don't hesitate to question, re-question, and learn on my own.  

    And while I don't like the idea of "shopping around" for a "puppet" doctor who will just do as I say, I have learned it is a good idea to get additional opinions (even if it means paying out of pocket) or try a new PCP, even within the same network (I now know my HMO insurance lets me see any PCP in the same network).   I made a huge mistake thinking that my former doctor couldn't have been wrong or overlooking anything or that a long history with a doctor was better than starting all over with a new PCP.  

    Now I am part of the team for my healthcare, even the leader sometimes, not just a passive observer.

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Actos, Avandia, and vitamin D

Actos, Avandia, and vitamin D

Up until a few years ago, if a patient showed signs of the metabolic syndrome/pre-diabetes, or early diabetes, I would often prescribe one of the drugs, Actos (pioglitazone) or Avandia (rosiglitazone), known as the thiazolidinediones, or TZD's for short. Although I do not manage diabetes, I was witnessing a flood of patients with pre-diabetic patterns that inhibited correction of lipoprotein patterns. So I saw the TZD's as a means of potentially assisting with correction of these abnormalities.

My rationale back then was that many people with metabolic syndrome struggled to raise HDL cholesterol, reduce triglycerides, reduce small LDL, reduce the inflammatory measure c-reactive protein (CRP), as well as reduce blood sugars towards the normal range. The TZD's partially corrected these phenomena.

But over the last 2 1/2 years, I haven't written a single prescription for these agents since I've added vitamin D to the regimen.

Vitamin D in my experience in the Track Your Plaque approach:

--Raises HDL--far more than the TZD's ever did.

--Reduces small LDL

--Reduces triglycerides

--Reduces c-reactive protein

--Reduces blood pressure

--Reduces blood sugar

In other words, vitamin D appears to not only reproduce many of the effects of the TZD's, but exceeds the effects. The effects are often so wonderful that I've taken many people off their TZD's.

Vitamin D, of course, also provides numerous benefits for bone health, reduction of cancer risk, and other health benefits that the TZD's simply cannot compete with. Vitamin D also lacks the quite substantial side-effects of TZD's: water retention and weight gain (around 8 lbs in the first year of treatment), possible increase in risk for heart attack (Avandia), definite increased likelihood of congestive heart failure in those prone to it.

How about cost? Actos goes for about $2 per pill (30 mg tablet). Vitamin D in the gelcap form (the only form we use) costs around $0.05 per capsule--5 cents. That's a 40-fold difference in price for what I would regard as an inferior--substantially inferior--product.

Throw into the mix a dramatic reduction or elimination of wheat products and other high-glycemic index foods, and all the phenomena of the metabolic syndrome and its associated lipoprotein patterns show even more improvement or full reversal.

In fact, with this approach we are seeing record-setting magnitudes of correction of these parameters every day. Getting HDL, for instance, into the 60 mg/dl or 70 mg/dl range has never been so easy.

Comments (16) -

  • Bob

    2/22/2008 5:01:00 PM |

    Dr. Davis,
    Enjoy reading your insights as what works and what doesn't in terms of prevention. On average, what is the starting HDL value of the individuals who are raising their HDL to the 60-70 range?

    Thanks.

    Bob

  • Anonymous

    2/22/2008 6:21:00 PM |

    Wow, great timing, I was just talking with my wonderful barber about vitamin D3 and how much you have found it to help your patients that have pre-diabetes, along with heart health issues. She has a prescription for her condition and was complaining of water retention also.  

    She wrote everything down so hope she reads your blog today.

  • stephen_b

    2/22/2008 8:35:00 PM |

    Any concern about a decrease in serotonin levels with a low carb diet? Perhaps it's only an issue with people having lower serotonin to begin with. I've started taking the occasional 500 mg of l-tryptophan (with B6 and vitamin C) at night before bed.

    Stephen

  • Anonymous

    2/23/2008 12:05:00 AM |

    I saw my endocrinologist this week and told her about my addition of Vitamin D to my diet. She recently starting taking it herself and totally supported it.  But she didn't offer an opinion on the amount - and had never heard of the gel cap advantage.  
    On a positive note; she suggested adding the Vitamin D to the lab tests.

  • moblogs

    2/23/2008 12:19:00 AM |

    Does the reduction of small LDL contribute to overall LDL reduction? Just wondering. I know that more HDL trumps LDL in general anyway.

    Your admission that nature's cheap system trumps those drugs is exciting. At the same time it's not surprising. While I don't dispute all pharmaceutical products (I can think of many that I see no alternative for right now) it makes you wonder just how many other safe and cheaper, natural answers to problems exist within nature that are yet to be found.

  • Anonymous

    2/23/2008 3:32:00 AM |

    So what do you say regarding a diabetic patient who is taking a prescription level Vit. D (once a week) but has a blood sugar spike after taking the Vit. D? This has been reported to me by a family caretaker - I am baffled!

  • mike V

    2/23/2008 4:22:00 AM |

    Eggs can help!

    http://www.nutritionandmetabolism.
    com/content/5/1/6/abstract

    Eggs modulate the inflammatory response to carbohydrate restricted diets in overweight men.
    Joseph C Ratliff , Gisella Mutungi , Michael J Puglisi , Jeff S Volek  and Maria Luz Fernandez

    Nutrition & Metabolism 2008, 5:6doi:10.1186/1743-7075-5-6

    Published: 20 February 2008
    Abstract (provisional)

    Background
    Carbohydrate restricted diets (CRD) consistently lower glucose and insulin levels and improve atherogenic dyslipidemia [decreasing triglycerides and increasing HDL cholesterol (HDL-C)]. We have previously shown that male subjects following a CRD experienced significant increases in HDL-C only if they were consuming a higher intake of cholesterol provided by eggs compared to those individuals who were taking lower concentrations of dietary cholesterol. Here, as a follow up of our previous study, we examined the effects of eggs (a source of both dietary cholesterol and lutein) on adiponectin, a marker of insulin sensitivity, and on inflammatory markers in the context of a CRD.

    Methods
    Twenty eight overweight men [body mass index (BMI) 26-37 kg/m2] aged 40-70 y consumed an ad libitum CRD (% energy from CHO:fat:protein = 17:57:26) for 12 wk. Subjects were matched by age and BMI and randomly assigned to consume eggs (EGG, n=15) (640 mg additional cholesterol/day provided by eggs) or placebo (SUB, n=13) (no additional dietary cholesterol). Fasting blood samples were drawn before and after the intervention to assess plasma lipids, insulin, adiponectin and markers of inflammation including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-I+/-), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1(VCAM-1).

    Results
    Body weight, percent total body fat and trunk fat were reduced for all subjects after 12 wk (P < 0.0001). Increases in adiponectin were also observed (P < 0.01). Subjects in the EGG group had a 21% increase in this adipokine compared to a 7% increase in the SUB group (P < 0.05). Plasma CRP was significantly decreased only in the EGG group (P < 0.05). MCP-1 levels were decreased for the SUB group (P< 0.001), but unchanged in the EGG group. VCAM-1, ICAM-1, TNF-alpha and IL-8 were not modified by CRD or eggs.

    Conclusions
    A CRD with daily intake of eggs decreased plasma CRP and increased plasma adiponectin compared to a CRD without eggs. These findings indicate that eggs make a significant contribution to the anti-inflammatory effects of CRD, possibly due to the presence of cholesterol, which increases HDL-C and to the antioxidant lutein which modulates certain inflammatory responses.
    ***********************************



    The amazing thing to me is that the egg's cholesterol appears to be beneficial inraising HDL ald lowering CRP!
    Sadly the fat soluble vitamins A,D,K in egg yolk were not mentioned.

    MikeV

  • Anne

    2/23/2008 7:44:00 PM |

    Mike said "Eggs can help" - I downloaded the full study as I love eggs and eat a low carbohydrate diet. However, on page 18 of the study it says “The authors wish to thank the Egg Nutrition Center for funding this study”. I would hope the study wasn’t biased but I would guess it might be - sigh - unless I'm overly cynical.

    Anne

  • TedHutchinson

    2/23/2008 10:00:00 PM |

    stephen_b said...Any concern about a decrease in serotonin levels with a low carb diet? Perhaps it's only an issue with people having lower serotonin to begin with.

    Stephen may be reassured to read Dr McCleary's blog http://www.drmccleary.com/default,month,2008-02.aspx
    where he raises the possible serotonin elevating effects of a vitamin D rich diet,
    Remember also 4000iu/daily /D3 is associated with optimal feelings of wellbeing.
    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=506781

    The link between carbohydrate intake and poorer performance
    http://www.second-opinions.co.uk/feed_brain.html is also an interesting take on the issue.

  • Anonymous

    2/24/2008 11:42:00 PM |

    If your vitamine D is normal but your blood pressure is borderline and you have a small LDL and increasing calcium scores with time, is extra Vit D a good thing to try?

  • Anonymous

    2/25/2008 5:25:00 AM |

    Interestingly I have noticed over the past while my bg seem a bit higher than norm, have started 5000 units of Vit D about 3 to 4 months ago....am just thinking....hmmm... wonder if age is making me keep a higher bg as low carb diet hasn't changed.It crossed my mind if Vit D or omega 3 would contribute to this but I understood they should lower it....maybe a glitch as my body gets used to it....don't know what is happening.

  • Anonymous

    2/25/2008 7:02:00 PM |

    Dr. Davis just read an article in your local newspaper{The Milwaukee Journal Sentinal, feb. 24th} about a study of women who ate low fat milk products and high Vitamin D foods had lower blood pressure BUT vitamin D supplements didnt give the same results. Any comments?

  • Anonymous

    2/25/2008 10:46:00 PM |

    Came accross this reference to Vit D being immunosuppressive and may may disease worse.  Any comments?

    Autoimmunity Research Foundation (2008, January 27). Vitamin D Deficiency Study Raises New Questions About Disease And Supplements. ScienceDaily. Retrieved February 25, 2008, from http://www.sciencedaily.com­ /releases/2008/01/080125223302.htm

  • Anonymous

    3/30/2008 7:09:00 PM |

    Human beings evolved in sunshine.  Go back 10,000 years and people were living outside all the time.  Even in northern Europe they were getting an enormous amount of sun.  I live in Los Angeles, tan deeply and yet got a mild sunburn on the back of my neck while on an all-day hike in northern Scotland.  I suspect that (1) our Vitamin D requirements are much, much higher than commonly recognized, (2) many of the conditions of old age (diabetes, heart disease, cancer) are linked to long-term vitamin D deficiency, (3) what throws people off is that you can go for months or even years with minimal sun exposure and apparent minimal effect, but it eventually catches up to you after 20 or 30 years.

  • Actos

    11/3/2010 10:03:17 AM |

    Yap, better take more vitamins than pills Smile

  • buy jeans

    11/3/2010 6:54:18 PM |

    The “Arginine Paradox” is the name that some researchers in this field have given to the unusual property of l-arginine supplementation to “overpower” the blocking effects of ASDM. This is somewhat unusual in biologic systems in that an agent that blocks a receptor cannot usually be outmuscled by providing excess material for a reaction. Kind of like hoping that your car runs faster simply by topping up the gas tank.

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