Fortune teller

25. November 2006 William Davis (0)
Whenever your doctor uses your cholesterol values--total, LDL, HDL, triglycerides--to judge your heart disease risk, he/she is trying to act as your fortune teller.

In some states, fortune telling is illegal, a misdemeanor. The New York State lawbooks say:

A person is guilty of fortune telling when, for a fee or compensation which he directly or indirectly solicits or receives, he claims or pretends to tell fortunes, or holds himself out as being able, by claimed or pretended use of occult powers, to answer questions or give advice on personal matters or to exorcise, influence or affect evil spirits or curses; except that this section does not apply to a person who engages in the aforedescribed conduct as part of a show or exhibition solely for the purpose of entertainment or amusement.
(Source : Wikipedia)

Rather than occult powers, your physician claims to use "medical judgement" to tell your fortune. Except for that distinction, it might be construed as a misdemeanor.


Let's take three typical examples:

58-year old Laura has a high LDL of 195 mg/dl. Her HDL is 52 mg/dl, triglycerides 197 mg/dl. Does she have heart disease?

51-year old Jonathan has an LDL of 174 mg/dl, HDL 34 mg/dl, triglycerides 156 mg/dl. Does Jonathan have heart disease?

71-year old Marian has an LDL cholesterol of 135 mg/dl, HDL 84 mg/dl, triglycerides of 67 mg/dl.

None of the three have symptoms. They all feel well. Nobody is taking a statin cholesterol drug or other agent that would modify the numbers. Jonathan is around 30 lbs overweight. Nobody has an impressive family history of heart disease.

Can you tell who has heart disease and who doesn't? If you can, you're smarter than I am, because I certainly can't tell. But your doctor tries to divine your future by looking at these numbers.

Do they know something that we don't know? No. It's a crude odds game, a guessing game. A guessing game that frequently comes up on the losing end.

These are three real people. Laura, despite her high LDL, has no identifiable coronary heart disease. Jonathan has advanced coronary disease. These were his numbers just prior to his stent. Marian has a moderate quantity revealed by a CT heart scan score of 419.

Don't even try predicting your future from your cholesterol numbers--it simply can't be done. Every day, I see patients and physicians beating their heads over this dilemma. Telling your fortune using pretended occult powers is illegal. Telling your fortune using cholesterol numbers should be, too.

If you want to know if you have coronary plaque, that's the role of the CT heart scan. Plain and simple.
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Are there still unexplored causes of heart disease?

Are there still unexplored causes of heart disease?

23. August 2006 William Davis (0)
I met a woman today. She had her first heart attack at age 37. She just had her 2nd heart attack this morning, at age 40.

Several issues are surprising about her story. First, she's pre-menopausal. Heart attacks before menopause are unusual. We'll occasionally see women have a heart attack before or during menopausal years only if they're heavy smokers and/or they have had diabetes (either type I or type II) for many years. But this young woman had neither. She is slender and has never smoked.

Even more surprising are her basic lipid values: LDL cholesterol 35 mg/dl, HDL 150 mg/dl, triglycerides 317 mg/dl. This is a very unusual pattern.

Unfortunately, this is all developing acutely in the hospital. (I've just met her today--she's not a Track Your Plaquer!) Lipoprotein analysis would be extremely interesting. In particular, I'd like to see whether she has any other markers besides elevated triglycerides of a "post-prandial" abnormality, i.e., persistence of abnormal particles after eating. The high triglycerides make this quite likely.

If this proves true, the omega-3 fatty acids from fish oil will be a lifesaving treatment for her, since they dramatically reduce both triglycerides as well as persistent postprandial particles like intermediate-density lipoprotein (IDL). (Track Your Plaque Members: See the Special Report on Postprandial Abnormalities on the present home page at www.cureality.com for a more in-depth discussion of this fascinating collection of patterns that is just started to be explored.)

In the real world, especially acute care medicine, there's always a kicker: she speaks no English. Unfortunately, communicating the intricacies of a powerful program like ours that aims to identify all causes of heart disease, then corrects then and aims for coronary plaque regression, is difficult if not impossible.

I also do occasionally worry that, given this woman's extraordinary risk at a young age, and overall very unusual lipid patterns (HDL 150?!), if there are causes presently beyond our reach. We have to make use of the tools available to us for now.
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Wheat-free and still fat

Wheat-free and still fat

15. February 2008 William Davis (14)
Readers of The Heart Scan Blog know that I preach a diet that contains foods with low glycemic index to control weight, raise HDL, and reduce triglycerides, blood sugar, and small LDL.

A crucial aspect of a low glycemic index approach is to sharply reduce, preferably eliminate, wheat products.

I pick on wheat specifically because it has come to dominate the American diet. Look at the shelves in the supermarket: aisle after aisle of processed wheat products. The bread shelves alone in some of the grocery stores in my neighborhood are 40 feet long, six shelves high. There's also breakfast cereals, granola products, cookies, cakes, baking products, pretzels, crackers, pasta, and on and on.

Wheat products like these are tasty and they're addicting--literally. Test animals given processed wheat will eat more and gain more weight. Wheat fails to trigger satiety. So laboratory mice--and you and I--eat and eat, because eating wheat stimulates appetite, creates a hunger for more wheat, and a vicious cycle ensues. Eliminating wheat, on the other hand, results in dramatic drop in appetite, substantial weight loss, followed by correction of the metabolic disruptions it created.


A quick Google search for "gluten-free" turns up a startling array of wheat-free, gluten-free, yet high glycemic index products. The breakfast cereal pictured, for instance, can do as much damage as most wheat containing products--though it won't cause gluten enteropathy (also known as "celiac disease").




The product shown contains:

Brown rice flakes, rice bran, evaporated cane juice, brown rice syrup, raisins, cinnamon, gum arabic, vanilla, molasses, ground flaxseed, rosemary extract.

A 1/2-cup serving contains:
Total Carbohydrate 31g
Dietary Fiber 5g
Sugars 8g

And I'll bet that most people eat a lot more than a half-cup serving.

But you and I are not laboratory mice. If deprived of wheat, many people will then seek out processed rice products (rice cakes, Rice Krispies), processed cornstarch or cornmeal products (tacos, cornbread, many processed foods using these products for texture or thickness), or other products labeled "gluten-free."

Going wheat-free for our purposes is not about avoiding the gluten in wheat. It is about seizing control of appetite, eliminating a food that disrupts insulin responses, reduces HDL, raises triglycerides, and creates small LDL particles. But this applies to processed corn, rice, and other high glycemic index foods, as well.

So, occasionally, someone will declare, "I've eliminated wheat! Now I only eat rice, corn, and I've discovered all the gluten-free alternatives!"

Unfortunately, they've traded one evil for another. So it's not just about wheat. It's really about reducing or minimizing foods that mess up metabolic responses and lead to coronary plaque growth. Wheat is the biggest culprit and so I focus on it. However, you could easily transfer far less popular rice and corn products into center stage and allow them to wreak all the health damage of wheat.

Going wheat-free for our atherosclerotic plaque-control purposes is not the same as going gluten-free. So be careful of the distinction.


Wheat-free gummi bears:


Contents:
Organic dehydrated cane juice, organic corn malt syrup, organic juice concentrates (may contain organic apple, organic apricot, organic aronia, organic carrot, organic cranberry, organic elderberry, organic lemon or organic red beet), organic spinach powder, organic apple pectin, citric acid, natural fruit flavors.

Virtually pure sugar--yet wheat-free.



Wheat-free rice bread


Ingredients:
White rice flour, water, honey, soy oil, natural gum, salt, yeast, natural gum














Copyright 2008 William Davis, MD
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Comments (14) -

  • Anne

    2/15/2008 8:59:00 AM |

    Two years ago when I discovered I was intolerant to them, rather than go "wheat free" I went "grain free", I cut out all the grains. I don't miss grains at all, and doing a test with my blood glucose meter after a piece of bread was final confirmation of how bad they are ! When we go to friends for a meal it's so much easier to say I don't eat any grains at all than to say I'm intolerant to this one or that one or to gluten. Dh has also virtually cut out grains but it's obviously an addiction because he can't completely cut them out and has the occasional rice cake :-( You can tell grains are a cheap way of feeding people though as our food bill has gone up a lot since I stopped eating them and replaced them with lots of fresh veggies. I didn't know how much it would help my HDL, that's nice to know...mine is 2.4 (93).

    Anne

  • Anonymous

    2/15/2008 11:23:00 AM |

    Celiacs today are lucky, depending on how you look at it.  There are just so many ready made foods for them to choose from these days.  Additionally food manufactures now label if their food has wheat in it - some even volunteer to label if gluten is present!  There is a health food grocery store a few blocks from our place and one whole isle is dedicated to only gluten free foods!!  I'm jealous because I used to have a grumpy gut 20 to 15 or so years ago and different doctors would suggest I try eating gluten free.  Back then plain old Quaker rice cakes was about as tasty as it got when it came to a quick meal.

    Thanks for the wonderful blog Dr Davis.  I enjoy e-mailing it out to friends and family.  As I tell them, your blog wittings are too good to keep to myself.  Received two e-mails yesterday from others wanting to learn more about TYP.  Primrose

  • Anne

    2/15/2008 12:36:00 PM |

    I have non-celiac gluten sensitivity. I have to eliminate gluten 100% in order to feel well. I found out very quickly, if I want feel my best, I must avoid all the processed gluten free(GF) foods too.

    As more and more people get diagnosed with celiac disease/gluten sensitivity, more and more processed GF products are showing up on the grocery shelves. You are right to point out that a GF diet is not always a healthy diet. That is a common misconception. Yesterday I spoke with a doctor who said she was going to eat GF in order to lose weight. When I told her Snickers and Coke were GF, she was surprised.

    By sticking with whole foods and eliminating all grains, I regained my health.
    Anne

  • Anonymous

    2/15/2008 3:08:00 PM |

    I am in complete agreement with your stance that refined/processed sources of wheat should be avoided. But are moderate glycemic load whole grain foods such as bulgur wheat, kasha, brown rice, and 100% whole wheat bread, which are important sources of fiber and B vitamins, truly "evil"  when CONSUMED in moderation? I may be somewhat unusual because I do not need to lose weight or decrease my blood sugar (or, for that matter, reduce TG's or raise HDL) but I have the "dreaded combination" of genetically induced Lp(a) and small LDL. Do I actually have to feel that I am "doing damage" to myself by eating a few whole grain products a few times a week?

  • Anonymous

    2/15/2008 4:58:00 PM |

    So where does a highly processed product like Bran Buds (wheat bran, sugar, psyllium seed husk, oat fiber, high fructose corn syrup... uh oh!) come out?  Lots people eat this one for a fiber boost, but is it really just another Frankenstein food, masquerading as "healthy"?

    1/3 cup serving has 70 cals., 1 gm fat; 200 mgs. sodium; 300mgs. potassium; 24 gms. carbs of which 8 gms are sugars; 13 gms fiber, of which 3 gms are soluble and 10 gms are insoluble fiber; 2 gms protein

    I may have answered my own question.

    Thanks for the great blogs, Dr. Davis.

    madcook
    Cypress, TX

  • Anonymous

    2/15/2008 5:20:00 PM |

    I've been reading about coconut flour, which is supposedly lower on the glycemic scale, and is high in fiber -- according to the sites promoting coconut flour.

    Do you think baked items made from 100% coconut flour would be ok for blood sugars, and not causing increases in LDL and triglycerides, if eaten in moderation?

    Glycemic Index of Coconut Flour Products in Normal and Diabetic Subjects

    S

  • Zute

    2/15/2008 5:31:00 PM |

    I always thought you picked on wheat because of something in particular about wheat.  However, I have found that all grains definitely play havoc with my blood sugar and ultimately lead me to getting fat(ter) and unhealthier.  

    Since I've gone "Paleo" and eliminated all grains and dairy products I found a lot of strange health issues that I can trace directly to removing them from my diet (and their subsequent reappearance when I add them back) disappeared like:

    Terrible IBS (wheat)
    Low blood sugar feelings (grains)
    Brain fog and memory problems (wheat)
    Insomnia maybe lack of D3 (wheat)
    Arthritis (wheat)
    Sinus problems (dairy)
    Muscle spasms (dairy)
    Acne (dairy)
    Constipation (dairy)

    Anyway, wheat is the worst for me but the other grains are right behind it.

  • Ross

    2/15/2008 11:41:00 PM |

    Absolutely correct in my experience.  My body composition didn't start to change until I cut out grains and starchy vegetables entirely (except for one weekly cheat meal).

    Wheat may be the worst of the bunch, but it's the carbs within the wheat that are really the problem, and those carbs are found in lots of places.

    One thing that's really suprised me are how many "low-carb" foods are also low-fat.  What's left?  I don't want a high-protein diet, I want a high-fat diet with fats from natural animal and vegetable sources.  It's frustrating that it's so difficult to find healthy food in the grocery store these days.  I'm really looking forward to the day when the era of "low-fat = healthy" is broadly regarded as an embarassing lapse of judgement by an entire culture.

  • Mike

    2/15/2008 11:59:00 PM |

    But the Gummi Bears are Organic! They must be healthy. I'm wondering if I can get some organic arsenic.

  • Cindy Moore

    2/16/2008 2:01:00 AM |

    Many low carbers eliminate all grains, not just wheat. There certainly isn't any reason why we should be eating grains!

    Personally I think wheat, corn and soy should all be eliminated....and one or more is in almost every processed food in some way.

  • Anonymous

    2/17/2008 7:40:00 PM |

    No one explicitly mentioned oats.   I try not to eat many grains, but I do feel better with a bowl of Scottish oatmeal for breakfast and it is mostly soluble fiber which is good for your digestion.  I'm really not much of an "egg person" and get really tired of them everyday.

    Noreen

  • migraineur

    2/18/2008 10:30:00 PM |

    I just tell people I'm allergic to grains.  Since most desserts also have flour in them, that covers me on 95% of anything people might try to serve me as a main dish or dessert.  The last 5% would be potatoes or legumes, and those are usually served as a side dish, so I can just avoid them.

  • Anna

    2/19/2008 4:08:00 AM |

    With rare exceptions, we don't eat grains very often at our house anymore.  I still do get some sprouted wheat bread for my son, but I have to freeze it because he eats it so slowly.  I do add some very small amounts of quinoa to stews and soups, or sprout it to add to salads, but even that is minimal.

    Another commenter mentioned coconut flour.  Last year I started baking again, using recipes from a coconut flour cookbook (Fife).  Be aware, that without gluten, 100% coconut flour (as opposed to a flour blend) requires a lot of binder, usually eggs, or else the item will fall apart.   I also have to watch my blood sugar with a low carb diet, and if consumed sensibly, low sugar coconut flour  cookies fit in well.

  • Anonymous

    2/22/2008 12:08:00 PM |

    @ Anna re: Coconut flour

    Thanks for the feedback about coconut flour; I''m going to give it a try for the occasional baked goods replacement.

    I was aware that without gluten, extra binder would be needed. I originally thought about what the celiacs use, guar or xanthum, but Gluten A Go Go has been using ground flax or chia as her binder for her celiac baked goods. So I'll play around with those too.

    S

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Making Dr. Friedewald an honest man

Making Dr. Friedewald an honest man

28. August 2008 William Davis (3)
Colleen started with the usual discrepancy between conventional calculated LDL cholesterol of 121 mg/dl and the far more accurate LDL particle number (NMR) of 1927 nmol/L.

Those of you following this conversation or our many conversations on the Track Your Plaque Forum know that a useful and highly reliable rule-of-thumb for converting NMR LDL particle number to LDL is to drop the last digit: 1927 nmol/L becomes 192 mg/dl. (This is, admitttedly, arrived at empirically, not by design. However, it has held up through thousands of NMR analyses and plays out reasonably when you compare distributions of Friedewald LDL and LDL particle number on a population basis.)

In other words, by this simple manipulation, Colleen's Friedewald calculated LDL is off by 58%. This is very common, a phenomenon I witness several times every day.

By LDL particle size, 75% of all Colleen's LDL particle were abnormally small (small LDL particle number 1440 nmol/L). This is a moderately severe small LDL tendency.

So we took all the steps for reduction of small LDL/LDL, including elimination of wheat and cornstarch, exercise, weight loss (which happens inevitably when wheat and cornstarch are eliminated), fish oil, vitamin D, etc.

Another NMR lipoprotein panel showed an LDL particle number of 882 nmol/L and a Friedewald calculated LDL of 87 mg/dl. Using our rule-of-thumb, LDL by particle number is virtually the same as the calculated LDL. This time, small LDL numbered only 237 nmol/L, or 26.8% of the total, a marked reduction.

Isn't that interesting? As small LDL is corrected, the crude Friedwald calculated LDL approximates the more accurate LDL particle number.

It assumes that accuracy of the Friedewald calculation may be more likely to occur as LDL size approaches normal. However, when LDL size is abnormally small--a condition shared by at least 70% of people with coronary heart disease--then the Friedewald LDL becomes increasingly inaccurate.

The opposite can also happen: When all or nearly all LDL particles are large, Friedewald calculated LDL can markedly overestimate LDL particle number. Yesterday, for instance, a patient had a Friedewald calculated LDL of 183 mg/dl, but an NMR particle number of 1110 nmol/L--drop the zero . . . LDL 110 mg/dl. This woman was advised to take a statin drug by her primary care physician, based on the Friedewald LDL. Instead, she proved to have a far lower LDL. She would not have benefitted from taking a statin drug.

As I've warned many times before: Beware the Friedewald calculated LDL.
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Comments (3) -

  • Nancy LC

    8/27/2008 9:55:00 PM |

    Oooh, thanks for posting this!  On low carb diets we see people getting alarmed all the time because their LDL goes up (calculated, of course).  However their triglycerides are very, very low and their HDL usually is good, sometimes extremely high.

    But their doctors are all alarmed over their LDL and keep pushing them into using statins.  I'll let folks know that they should ask for an NMR test that directly counts their LDL particles before jumping onto statins.

    BTW: Have you ever run into people getting higher fasting blood glucose readings taking fish oil?  It seems to happen to me.  I was taking a high dose (8g) for my arthritis and my FBG went to over 100 at times, despite a low carb, no grain diet.

  • Jonathan

    8/31/2008 11:10:00 AM |

    "She would not have benefitted from taking a statin drug."  Isn't it true that women have never been shown to benefit from statins?  If I understand correctly, statins have only been shown to reduce total mortality for middle-aged (not elderly) men with full-blown heart disease.

  • Isaac

    11/11/2008 3:07:00 PM |

    Is it really that the Friedewald calculation is wrong, or just that the two tests are measuring different things? Standard panels report cholesterol components in mg/dl, a mass per volume. The NMR test reports nmol/L, a particle count per volume. If the particles are large then there are fewer particles but perhaps more mass.

    This doesn't say anything about which one is more accurately describing cardiovascular risk, but I don't see why the Friedewald calculations are necessarily incorrect; they're just measuring things differently than a NMR test does.

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