Comments (3) -

  • Lori Miller

    12/25/2010 4:57:28 PM |

    If you have a small pumpkin, you can use that instead of the canned goop. Stab the pumpkin a few times and roast it for about an hour at 350, or until it's spongy. Scoop out the seeds (save them for roasting) and mash the flesh.

  • Anonymous

    12/25/2010 9:27:08 PM |

    Love this, thank you! We need these recipes so much!
    Penny

  • kellgy

    12/26/2010 3:18:52 AM |

    I think I will make this treat with a small pumpkin (thanks Lori) and I will use my trusty pressure cooker to shorten the cook time and maybe add a little vanilla like Richard A. suggested.
    I typically avoided the wheat biscuits and breads today along with the 90% sweets-laden party spread. The only non-sugar items on the table were a salad and veggie plate.  (I think I was the only one who noticed the huge disparity.)
    I suppose this bread can also be concocted with yams or acorn squash as an alternative to pumpkin if desired. I am going to have to experiment with the different flavors.

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Low HDL makes Dr. Friedewald a liar

Low HDL makes Dr. Friedewald a liar

There's a $22 billion industry based on treating LDL cholesterol, a fictitious number.

LDL cholesterol is calculated from the following equation:

LDL cholesterol = Total cholesterol - HDL cholesterol - triglycerides/5

So when your doctor tells you that your LDL cholesterol is X, 99% of the time it has been calculated. This is based on the empiric calculation developed by Dr. Friedwald in the 1960s. Back then, it was a reasonable solution, just like bacon and eggs was a reasonable breakfast and a '62 Rambler was a reasonable automobile.

One of the problems with Dr. Friedewald's calculation is that the lower HDL cholesterol, the less accurate LDL cholesterol becomes. If it were just a few points, so what? But what if it were commonly 50 to 100 mg/dl inaccurate? In other words, your doctor tells you that your LDL is 120 mg/dl, but the real number is somewhere between 170 and 220 mg/dl. Does this happen?

You bet it does. In my experience, it is an everyday event. In fact, I'm actually surprised when the Friedewald calculated LDL closely approximates true LDL--it's the exception.

Dr. Friedewald would likely have explained that, when applied to a large population of, say, 10,000 people, calculated LDL is a good representation of true LDL. However, just like saying that the average weight for an American woman is 176 lbs (that's true, by the way), does that mean if you weigh 125 lbs that you are "off" by 41 lbs? No, but it shows how you cannot apply the statistical observations made in large populations to a single individual.

The lower HDL goes, the more inaccurate LDL becomes. This would be acceptable if most HDLs still permitted reasonable estimation of LDL--but it does not. LDL begins to become significantly inaccurate with HDL below 60 mg/dl.

How to get around this antiquated formula? In order of most accurate to least accurate:

--LDL particle number (NMR)--the most accurate by far.

--Apoprotein B--available in most laboratories.

--"Direct" LDL

--Non-HDL--i.e., the calculation of total cholesterol minus HDL. But it's still a calculated with built-in flaws.

--LDL by Friedewald calculation.

My personal view: you need to get an NMR if you want to know what your LDL truly is. A month of Lipitor costs around $80-120. A basic NMR costs less than $90. It's a relative bargain.

Comments (5) -

  • Mike

    3/18/2007 1:52:00 AM |

    What is shocking is that enormous prescriptions for statins are written based on the calculated LDL.

  • Dr. Davis

    3/18/2007 1:16:00 PM |

    Yes, $22 billion last year, in fact. All prescribed for a number that is a crude estimate, sometimes a complete fiction. Imagine your state trooper ticketed you because his radar device said you were doing 60 mph when you were really doing 35 mph.

  • Anonymous

    2/6/2008 1:37:00 AM |

    Why NMR over the other tests Berkeley Heart Lab or VAP?

  • Anonymous

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

    I don't understand.  If in this example, the doctor (wrongly) thinks the LDL number is 120mg/dl, how does that cause the prescription of Lipitor? Unless I'm reading it backwards, and the doctor is actually telling the patient their LDL is 170mg-220mg, but unwittingly, it's actually 120mg/dl.

    And, if a low HDL causes the LDL number to be inaccurate, does that also cause the total cholesterol number to be inaccurate too?

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Heart Scan Frustration

Heart Scan Frustration

Ideally, you get a heart scan and your doctor sits down with you and provides a rational, insightful discussion on what the results mean.

Is heart attack in your future? If so, when? Are blockages present? What is the role of other tests like stress tests and heart catheterizations? Do CT coronary angiograms add any important information? What is the role of cholesterol? Can diet or nutritional supplements impact on heart scan score?

But what happens if you are unable to get the answers you desire? What if you get brusque responses, or your doctor just doesn't know? Or what if there is a clear conflict of interest or the possibility of financially-tainted advice? ("You need a heart catheterization right away or you'll die of a heart attack!")

One example of this process was posted by a frustrated Member of Track Your Plaque who found that answers were virtually unobtainable from his/her doctors:

I underwent a heart scan a few weeks ago, based on a recommendation from a doctor. I assumed that, since I was paying for it, and I requested it, the results would be fully explained to me.

Late on a Friday afternoon, the radiologist who intrepreted it called me and said I would be receiving a report, and so would the doctor. I asked that she explain them to me. She said their policy was to give the report to the doctor and let him explain them. She did say I was in the 90th percentile for my age--and that 10% had a worse score. I asked where do we go from here, and she said, if you're not having symptoms, maybe lifestyle changes, but YOUR DOCTOR will let you know. I asked for a copy of the films and reports, and was told YOUR DOCTOR can request them. I called back a little later and she was gone. It was starting to sink in that I must have a terrible score. In the meantime, I did what I should have done before I went for the scan---looked up information on the internet, and read about calcium scoring. This website [Track Your Plaque] hadn't showed up in my Google search, so a lot of the information was useless.

I did manage to get the score of 186, with the breakdown per artery from someone at the clinic, but only after I insisted I paid for the test, I have a right to the information. 'Course having a score per artery didn't really help---what did it mean? ie: if a 72, how did that correlate to any blockages? Was it a big lump...or spread along the wall throughout the artery.

I had an appt. the following Tuesday with THE DOCTOR---a very busy doctor. After an hour and 1/2 wait in a crowded waiting room, I got to see him. We discussed briefly another issue, and he started walking out. I followed him out and said I wanted my full l5 minutes of time allotted in their scheduling, which seemed to irritate him.

I followed him into his office and said, WHAT ABOUT THE HEART SCAN? What do the numbers mean? He responded that he didn't know, he'd have to see the films, but don't worry--you're probably ok, and I should get a thallium stress test anyway. He said he couldn't intrepret the numbers, or give an opinion on where the plaque was or how it was configured.

I then went to the interventional cardiologist that afternoon and the thallium stress test was scheduled. I asked about the HEART SCAN, and again, no acknowledgment. I asked if he would get the films and explain the results, and again no acknowledment as he was walking out the door.

After this lengthy saga.....MY QUESTION IS....since this is a test you can order yourself (literature at center made mention of the tests you can get without a doctors request)......WHO IS THEIR FIDUCIARY RESPONSIBILITY TO WHEN IT COMES TO EXPLAINING THE RESULTS?

I learned more on this website [Track Your Plaque], and the emailed book then I did dealing with two doctors and the center itself. Thinking back, there was nothing but a brochure on the test at the center. No "Track your Plaque" stuff.




Day 2
I called the scanning center and relayed my dilemma. I was put in touch with another radiologist--a very informative one, who appeared passionate about heart scans as a preventive test. He compared them to mammograms. He hadn't heard about the "Track Your Plaque" program but was going to check it out. He said people varied in their responses to the test results, as well as doctors/cardiologists as to the next step. (ie: lifestyle changes..the next test, etc). He seemed to feel blockages of more than 50% for many cardiologists would indicated angioplasty and stenting.

I'm going back to review the films with him later this week. He wasn't that concerned with the 101 reading on the right artery. The 72 on the left he had concerns with and indicated the CAT test [CT angiography] would offer more as far as how much was there, and approx. blockage, and could be a baseline to compare to in the future. He said some cardiologists would go right to angioplasty...some to a CAT which is more conservative...some might watch and encourage lifestyle changes. He said the Heart Scan doesn't show soft plaque. He also said the internist who referred me was one of only a few in the city that felt strongly about the heart scan---and probably used it to take further action via a referral, and just didn't have time to discuss it, with the way medicine is run these days.



This Member's frustrated post pretty much sums it up:

1) Doctors don't seem to have the time nor motivation to be bothered about offering advice that leads to prevention of disease.

2) The tendency is to always ask, "Are heart procedures necessary?", not "How did this happen?" or "What can we do about this to keep it from getting worse?" How about diet, supplements, and other tools to use at home?

The obvious uneasiness of the radiologist, the last physician this Member spoke with, can just as easily lead to boneheaded advice: Maybe getting a stent isn't such a bad idea. Maybe a CT angiogram is an absolute necessity.

I hear comments like this every day. It is the reason why I continue to plug away at this program and try to set things straight.

By the way, subscribers to our Track Your Plaque Newsletter just heard about our latest success story, Roy, who dropped his heart scan score over 500 points. If you are yet not a newsletter subscriber, click here.


Copyright 2008 William Davis, MD

Comments (4) -

  • Anonymous

    3/27/2008 12:23:00 AM |

    I wonder why this busy heart scan place doesn't make a movie about what each test score means, along with recommendations to correct abnormal scores. The patient could watch it before his follow up with the dr, then there'd be less questions using up busy doctors times.

    Each test segment could be recorded separately to make it easier on the dr in front of the camera, and for later on when different tests are added or removed from the heart scan, the movie could be re-compiled more easily with the different segments. Making movies on computers isn't nearly as difficult, or expensive, as a few years ago.

  • Anonymous

    3/27/2008 2:50:00 AM |

    Just wanted to say a rambling,  thanks for taking the time to write the blogs that you do and to have created the TYP web sight.  The program has made a difference for me, my family, and several friends who follow the TYP teachings.  

    In many ways you have a job that I used to say I wanted.  For many years I suffered from severe GI issues and was forced to go from doctor to doctor looking for a cure.  It was a miserable experience, as I was not only ill and tired, I also found myself all to often fighting doctors and nurses for information, and proper care.  
    I remember telling myself back then that if I ever found a cure for myself I was going to go back to college to try and become a doctor to help those with GI needs.  Not because I wanted to be a doctor, I didn't and now being close to 40 don't want to today, but because I knew what it was like to have GI issues, and what it was like to deal with the mainstream medical system.    

    You have a fan in me.  After what I had been through previous with hospitals, when I saw your TYP program it didn't take me long to realize what a wonderful system you have created.  I'm still surprised that as a doctor you are not afraid to recommend supplements.  After all the prescription drugs I had taken that helped very little and all to often had miserable side effects, if I have a choice I'd take natural supplements every time.  The only side effect I've had with them is feeling great.  No other doctor that I'd met was willing to recommend supplements even though i later figured out that fish oil was by far the best medicine for my gut issues.

    I enjoy promoting your proven to be successful heart program to others.  I don't know how successful I am at it, but want to see you succeed so do the little that I can.

  • moblogs

    3/27/2008 2:09:00 PM |

    I saw this today (British health site) and feel happy that the right path is being looked at: http://www.netdoctor.co.uk/interactive/news/theme_news_detail.php?id=18524357&tab_id=116

    On a non-heart note. I think England's (currently in America) Dr. Wakefield will one day get praise for outlining the MMR jab as a contributor to autism development. A D deficient body can't deal with mercury and severely D deficient bodies are now the norm with safe sun campaigns reached their peak in the mid 90s. What's more a D replete body may not need MMR...

  • Anonymous

    3/28/2008 6:17:00 AM |

    I can see where a testing center would be reluctant to share "Track Your Plaque" information since they serve a wide variety of doctors..cardiologists, and they don't want to step on their toes or interfere with their treatment plan.  

    The key is having a doctor--or better yet preventive cardiologist (how many of them are around?) that takes the necessary time to intrepret and counsel their patient on the significance of the heart scan, and makes alternatives available.  Of course that takes time...for some doctors it's easier to recommend the next test or referral and write out numerous prescriptions.  In my opinion, this is not good medicine and you should run as fast as you can from this type of fast medicine.

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