Dr. Dwight Lundell on omega-3s and CLA



An interview with Dr. Dwight Lundell, cardiac surgeon and author of the new book, "The Cure for Heart Disease."


Dr. Lundell comes to us with a unique pedigree. He is a cardiothoracic surgeon practicing in the Phoenix, Arizona, area. Despite having performed thousands of coronary bypass operations, including numerous "off-pump" procedures earning him a place in the Beating Heart Hall of Fame and a listing in Phoenix Magazine’s Top Doctors for 10 years, more recently Dr. Lundell has turned his attentions away from traditional surgical treatment and towards prevention of heart disease and.

In particular, Dr. Lundell is a vocal advocate for omega-3 fatty acids from fish oil and conjugated linoleic acid, or CLA.

When I heard about Dr. Lundell’s unique perspectives, I asked him if he’d like to tell us a little more about his ideas. Here follows a brief interview with Dr. Lundell.



You’re a vocal advocate of the role of omega-3 fatty acids from fish oil in heart disease prevention. Can you tell us how you use it?

In my book, I recommend 3 g of fish oil daily. This would normally yield about 1000 mg of EPA and DHA depending on the concentration of the supplement. This is approximately the dose that reduced sudden cardiac death by 50%, and all cause death, by 25% in patients with previous heart attack.

In patients with signs of chronic inflammation such as heart disease, obesity, arthritis, metabolic syndrome or depression or in those patients with elevation of CRP, I would recommend higher doses, 2000 to 3000 mg per day of EPA and DHA. The FDA has approved up to 3400 mg for treating patients with severely elevated triglycerides.

I personally take a 2000 mg EPA and DHA per day because I have calcium in my coronary arteries.




Of course, in the Track Your Plaque program we track coronary calcium scores. Do you track any measures of atherosclerosis in your patients to chart progression or regression?

Carotid ultrasound with measurement of IMT [intimal-medial thickness] has been shown to be a good surrogate marker for coronary disease, as has vascular reactivity in the arm. CT scanning with calcium scoring is a direct marker of coronary disease. CT does not differentiate between stable or unstable plaque but there is no good noninvasive way of doing this.

The dramatic value of CT scan calcium scoring is to demonstrate to people that they actually do have coronary disease and to motivate them to make the necessary lifestyle and nutritional changes to reduce it. CT scan with calcium scoring is a direct way to measure the progression or regression of coronary artery disease. If there is a choice between a direct measurement and indirect measurement, always choose the direct method.

Every patient treated with CLA in my clinic, experienced significant reductions in C-reactive protein. These patients were also on a weight-loss program, so I can't prove whether it was the CLA or the weight-loss that improved their inflammatory markers. In the animal model for arteriosclerosis, CLA has a dramatic effect of reducing and preventing plaque. This has not yet been proven in humans.

Normally, when people lose weight 20% or more of the loss is lean body mass (muscle) this lowers the metabolic rate and frustrates further weight-loss. My patient, from teenagers to retirees, lost no lean body mass and continued to have satisfactory weight-loss when CLA was used as part of the plan.



In reading your book, your use of conjugated linoleic acid (CLA) as a principal ingredient struck me. Can you elaborate on why you choose to have your patients take CLA?

My enthusiasm for CLA is based on:

1) Safety?this is of paramount importance. Animal toxicity studies have been done, as well as multiple parameters measured in human studies, both of these are well reviewed recently in the American Journal of Clinical Nutrition (2004:79(suppl)1132s). CLA, a naturally-occurring substance, is not toxic or harmful to animals or humans. The only negative report is by Riserus in Circulation (2002), where he found an elevated c- reactive protein; however, he used a preparation that is not commercially available and not found in nature as a single isomer.

2) Effectiveness?also critically important. A recent meta-analysis [a reanalysis of compiled data] in the American Journal of Clinical Nutrition (2007; 85:1203-1211) demonstrated the effectiveness of CLA in causing loss of body fat in humans. The study also reconfirmed the safety of CLA.

Since we now know that atherosclerosis is an inflammatory disorder, any strategy that reduces low-grade inflammation without significant side effects would seem to be beneficial in the treatment and prevention of atherosclerosis. CLA not only has antioxidant properties, but it modulates inflammatory cascade at multiple points. CLA reduces PGE2 (in much the same way as omega-3) CLA also has been shown to reduce IL-2, tumor necrosis factor-alpha and Cox–2. It reduces platelet deposition and macrophage accumulation in plaques. It also has some beneficial effect in the PPAR [peroxisome proliferator-activated receptors, important for lipid and inflammatory-mediator metabolism] area.

Part of the effect of CLA may be because it reduces fat mass and thus the amount of pro-inflammatory cytokines produced by fat cells.

I reiterate and fully admit that CLA has not been shown to have any effect on atherosclerosis in human beings. However, the results in the standard animal models for atherosclerosis (rabbits, hamsters,APO-E knockout mice) are very dramatic.

From all I know, it appears that the effective dose for weight loss and the animal studies in atherosclerosis would be equal to about 3 g of CLA per day. The anti-inflammatory properties of CLA seem to work better in the presence of adequate blood levels of omega-3.



I’m curious how and why a busy cardiothoracic surgeon would transform his practice so dramatically. Was there a specific event that triggered your change?

The transition from a very busy surgical practice to writing and speaking about the prevention of coronary disease has not been particularly easy, but it has been very interesting. I can't really point to any specific epiphany, it was a general feeling of frustration that we were not making any progress in curing heart disease, which is what I thought I was doing when I began my medical career.

Of course, I enjoyed the technical advances, the dramatic life-saving things that you do and I did on a daily basis. American medicine is spectacularly good at managing crises and spectacularly horrible at preventing those crises.

The lipid hypothesis is old and tired, even the most aggressive statin therapy reduces risk of heart attack by about 30% in a relatively small subset of people. It's interesting that we're now looking at statins as an anti-inflammatory agent.


Thanks, Dr. Lundell. We look forward to future conversations as your experience with CLA and heart disease prevention and reversal develops!


More about Dr. Lundell's book, The Cure for Heart Disease can be found at http://www.thecureforheartdisease.net.


Note: We are planning a full Special Report on CLA for the Track Your Plaque website in future.

Comments (15) -

  • Anonymous

    9/6/2007 8:46:00 PM |

    Do you know much about the diet he recommends to decrease inflammation and heart disease?
    Thanks!

  • Dr. Davis

    9/6/2007 9:56:00 PM |

    He uses a low processed carbohydrate diet. I'm afraid I did not get too far into that aspect of things with him.

  • Anonymous

    9/6/2007 11:22:00 PM |

    Thanks for the reply. I assume by "low-processed" you mean whole grains?
    Greg

  • Dr. Davis

    9/7/2007 1:45:00 AM |

    Although I read Dr. lundell's book, I remain unsure about how tightly he advises processed carbohydrate control. He is clear on minimizing sugars and sugar-equivalents like sodas and fruit drinks. However, on questions like some grains, I remain unclear.

  • Anonymous

    9/7/2007 10:20:00 PM |

    I was under the impression that CLAs only exist in animal products and that beef is particularly rich in CLAs.  I also understood that CLAs are a form of transfat, although perhaps a beneficial form, if there is such a thing.  Do you think that adding CLA is helpful for regression of plaque?  Does TYP recommend doing so?  If so, should the CLA be via a supplement and what dosage is typical?

  • Dr. Davis

    9/8/2007 1:07:00 AM |

    We are putting together a clinical trial to examine this issue. I don't have any preconceived notions over whether CLA will work or not. The animal data for reversal of atherosclerosis is fabulous, almost too good to believe.

    The human data on weight loss is, in aggregate, modestly promising. But will it reverse atherosclerosis in humans? We're going to try and find out.

  • Jill Doss

    6/5/2008 12:40:00 AM |

    It is my understanding that CLAs are a derivative of Parent Omega 6. I have read that the correct proportions are two parts omega 6 to one part omega 3.  This is referred to as Essential Fatty Acids (EFAs).  Lack of EFAs impede the use of oxygen and oxygenation is crucial to the miochondria of a cell.  I'm interested to see what your comments are on EFAs.

  • Anonymous

    1/8/2009 12:56:00 AM |

    Are you aware Dr. Lundell's medical license was revoked in 2008 by the Arizona Medical Board?  Go here to read about him: www.azmd.gov

  • David

    4/20/2009 1:08:00 PM |

    It's true.
    http://azmd.gov/GLSuiteWeb/Repository/0/0/1/4/97d47a09-71b9-4f30-8bfe-78428be876c4.pdf

  • Jim

    8/18/2009 4:38:47 PM |

    @anon & David,

    I didn't read the whole report of the deliberations, but from reading the first one, several observations can be made:
    -Dr Lundell had retired from thoracic surgery at the time of the hearings.
    -The hearings concerned complaints about certain high risk surgeries done by Dr Lundell, as they are done by all thoracic surgeons.
    -None of this has anything to do with a nutritional approach to halting and reducing CVD.

  • Anonymous

    1/9/2010 8:48:17 PM |

    Hi! How about fresh juiced carrots? It's hec of carbo thing but is it slow, fast, should I just eat vegetables and fruits and not juice them?

  • buy jeans

    11/4/2010 5:14:15 PM |

    In my book, I recommend 3 g of fish oil daily. This would normally yield about 1000 mg of EPA and DHA depending on the concentration of the supplement. This is approximately the dose that reduced sudden cardiac death by 50%, and all cause death, by 25% in patients with previous heart attack.

  • pammi

    11/9/2010 9:50:34 AM |

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

  • MIKE

    8/11/2011 6:39:19 AM |

    I've been taking fish oil since 2005.Went to a cardioligist who wrote me out a script for lipitor after my cholesterol test was a little high.Being skeptical i then went hom and researched this horrible medication and realized i could take a much healthier,cheaper and much better alternative.Well that alternative was fish oil and i'm so glad i did my research first before blindly accepting my fate.

  • Brian

    11/24/2011 11:59:44 PM |

    Given the blood-thinning properties of fish oil, is it advisable to take it along with blood thinners such as Plavix or Coumadin?

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Can CRP be reduced?

Can CRP be reduced?

The JUPITER study has sparked a lot of discussion about c-reactive protein, or CRP.

If we follow the line of reasoning that prompted this study, reducing CRP may correlate with reduction of cardiovascular events. Thus, in the JUPITER study, Crestor 20 mg per day reduced cardiovascular events by nearly half.

From a CRP perspective, starting values were 4.2 mg/dl in the Crestor group of the trial, 4.3 mg/dl in the placebo group. After 24 months, CRP in the Crestor group was 2.2 mg/dl, 3.5 mg/dl in the placebo group, representing a 37% reduction.

Now, in our Track Your Plaque program--an experience that has yielded the virtual ELIMINATION of cardiovascular events--we aim for a CRP level of 1.0 mg/dl or less, ideally 0.5 mg/dl or less. The majority of people achieve these ambitious levels. In fact, it is a rare person who does not.

How do we achieve dramatic reductions in CRP? We use:

--Weight loss through elimination of wheat and cornstarch--This yields impressive reductions.

--Vitamin D--I have no doubt whatsoever of vitamin D's capacity to exert potent anti-inflammatory effects. I am not entirely sure why this happens (enhanced sensitivity to insulin, reduced expression of tissue inflammatory proteins like matrix metalloproteinase and others, etc.), but the effect is profound.

--Elimination of junk foods--like candies, cookies, pretzels, rice cakes, potato chips, etc.

--Exercise--Amplifies the benefits of diet on CRP reduction.

--Not allowing saturated fats to dominate--Yes, yes, I know. The demonization of saturated fat conversation has been largely replaced by the Taubesian saturated fat has not been confidently linked to heart disease conversation. But controlled feeding studies, in which a single component of diet is manipulated (e.g., saturated vs. monounsaturated vs. polyunsaturated fat) have clearly shown that saturated fats do activate several factors in the inflammatory response.

--Fish oil--Though I am a firm believer in the huge benefits of omega-3 fatty acid supplementation/restoration, the anti-inflammatory effect is modest from a CRP perspective. However, there are anti-inflammatory benefits beyond that of simple CRP (via normalization of eicosanoid metabolism and other pathways).

--Weight loss--A BIG effect. Weight loss drops CRP like a stone. The CRP-reducing effect is especially large if achieved via carbohydrate reduction.

Of course, this is much more complicated than taking a pill. But it is effective to achieve health benefits outside of cardiovascular risk, is enormously useful as part of a weight loss effort, and doesn't cost $1400 per year like Crestor.

In short, if CRP reduction is the goal, it certainly does not have to involve Crestor.

Comments (17) -

  • stephen_b

    11/13/2008 7:23:00 PM |

    Here are a couple of data points:

    2007-10: Vit D 25-hydroxy: 34.7 ng/mL
    CRP: 0.33 mg/L

    2008-05: Vit D 25-hydroxy: 39.7 ng/mL
    CRP: 0.26 mg/L

    I don't know how significant it is, but increasing vitamin D levels for me resulted in a better CRP.

    StephenB

  • Anonymous

    11/13/2008 7:48:00 PM |

    Were the controlled feeding studies done on high carb diets?  Are there any studies like this on low carb diets?  I think Cassandra Forsythe studied the short term  difference between MUFA/omega 3 and saturated fat on a eucaloric low carb diet but I don't believe she has finished writing her thesis yet and I don't know if she checked CRP.  It seems to me that a high carb diet amounts to a high saturated fat diet since what the body does with the carbs is make it into saturated fat, no?  So eating a lot of saturated fat on a low carb diet may well amount to less saturated fat in the body than eating lots of carbs on a low fat/saturated fat diet.  Wait a minute, don't i remember hearing about a study like that?

  • Jenny

    11/13/2008 8:10:00 PM |

    Dr. Davis,

    Can't you extract data from cases from your files and publish in one of the journals?

    One problem I have always had with Dr. Atkins is that he made a lot of claims but never published a single study using data from the thousands of cases he claimed to have had.

    You have the credential to report your results to mainstream journals. I see plenty of doctor-published studies with tiny numbers of participants, as few as 10 (completely statistically meaningless!) If you have hundreds or thousands, why not analyze the data and publish. That way it goes from "anecdotal" to peer-reviewed.

    Yes, it is a lot of work, but that is the kind of work that helps everyone. You might be able to find a grad student in epidemiology or a related field to help you with the number crunching, too.

  • Anonymous

    11/13/2008 10:08:00 PM |

    How about getting dental/periodontal inflammation cleared up?

  • Jeff Consiglio

    11/13/2008 10:10:00 PM |

    "But controlled feeding studies, in which a single component of diet is manipulated (e.g., saturated vs. monounsaturated vs. polyunsaturated fat) have clearly shown that saturated fats do activate several factors in the inflammatory response."

    I tend to agree with you that animal based long-chain saturated fatty acids may not be quite as benign as some in the low-carb community assert. But was wondering if you had an opinion on the medium-chain saturated fatty acids in coconut oil?

  • Anonymous

    11/14/2008 12:50:00 AM |

    I absolutely agree with you, Dr. Davis. I am living proof that your wellness plan works.

  • Anne

    11/14/2008 1:00:00 AM |

    Years ago my hs-CRP was over 13. I tried taking 3 different statins and they all caused muscle pain.

    My hs-CRP has slowly fallen as I tried to optimize my health with lifestyle changes. It is now 3 - not perfect, but much better. I have lost about 25lbs. I have eliminated gluten(wheat, barley, rye) and rarely eat any grain. Junk food is out except for a small piece of dark chocolate. Trying to get my vitamin D to optimal. Through food choices I am keeping my blood glucose from spiking.  I take fish oil. I exercise....oops, I should say I still need get on an exercise program. Maybe exercise will bring down the CRP to <1.

    Yup, I agree, CRP can be decreased without statins. I wonder if decreasing CRP through lifestyle changes is more beneficial than reducing it with a pill? It would be nice to see such a study, but I don't think that will happen.

  • Anonymous

    11/14/2008 1:36:00 AM |

    I tried these measures and reduced my hs-CRP to less than 0.2. It works.

  • Anonymous

    11/14/2008 7:23:00 AM |

    Part of the confusion over saturated fats could be that UN-saturated fats have been shown to deaden our immune system, while saturated fats had no effect. [1][2]

    So any comparison of the two in patients with growing inflammation will appear to show greater inflammation with sat fats.

    Deadening our immune system can be helpful if for some reason we have chronic inflammation (like atherosclerosis) or an autoimmune disease, but deaden our immunity too much and cancer deadens us instead.

    I'd prefer to find the cause of the inflammation, address it, and keep my immune system at full strength with more sat fats.

    Saturated fats also convert our most dangerous LDL subclasses to the harmless varieties, resulting in very little of the dangerous LDL IIIa, IIIb, and IVb subclasses.  It also boosts our most helpful HDL subclass 2b.

    I'd guess the studies you referred to used hydrogenated saturated fats [they were STILL making that mistake even in 1994!] or fats from grain-fed animals which are high in omega-6. Both of those WILL raise inflammation. I like to stick to grass-fed meats and dairy whenever possible.

  • The Vitamin Tutor

    11/14/2008 7:46:00 AM |

    Let's not forget vitamin C. Cheap. Proven effective in multiple clinical studies. Safe.

    http://www.berkeley.edu/news/media/releases/2008/11/12_vitaminc.shtml

  • Olga

    11/14/2008 2:09:00 PM |

    Hi Dr. Davis:

    I was wondering if you read Michael Eades review of the Jupitor study.  It can be found on his protien power blog site at:

    http://www.proteinpower.com/drmike/cardiovascular-disease/1853/#more-1853

  • Olga

    11/14/2008 3:43:00 PM |

    Hi Dr. Davis:

    Have you come across a recent research paper which showed significant reduction of arterial calcification after administration of vitamin K to rats.  Very compeling research published in April 2007, by Dr. Cees Vermeer and his group.  Here is a link to a review of the paper with a link to the actual research paper.  Keep up the great work!

    yhttp://wholehealthsource.blogspot.com/2008/11/can-vitamin-k2-reverse-arterial.htmlou

  • Dr. Dwight Lundell

    11/16/2008 1:55:00 PM |

    Dr. Davis,
    The reduction in events was not 55% but O.O9% you continue to fall into the dishonest use of statistics by the statin makers. the number needed to treat to avoid one event is 120! The jupiter study and the
    Vytorin study should clearly show that LDL reduction has little benefit and is only a marker for a poor diet. The LDL theory is dead.
    That said your program is right on the mark, reduction of carbohydrate intake, exercise and fish  oil along with vitamin D will do more to save lives and prevent heart attack than all the statins on the world.

  • Anonymous

    11/16/2008 1:59:00 PM |

    I'm reading a new book from Ulf Ravnskov, Fat and Cholesterol is Healthy. Saturated fat seems to be harmless after Ulf's researh of all relevant studies.
    I've also read a lot on Weston A Price and it seems that saturated fat was dominating the fats in the food of the native americans (healty ones). In sweden, a doctor reviewed almost every study that said "saturated fat is bad" and came up with the conclusion that not a single study we're trusted. Also beacuse a lot of studies said the opposite.
    Wille, Sweden. Low Carb High Fat for 3 years.

  • Nancy LC

    11/24/2008 4:32:00 PM |

    This is tangentially related to your posting but I thought you might be able to comment on, or be interested in reading about, the types of fat found in "atherosclerotic plaques and xanthomas".  Here's a link to the abstract: http://www.jlr.org/cgi/content/abstract/24/10/1329

    Some interesting individual fats were palmitic (16:0) 12.7%, stearic (18:0) 1.5%, oleic (18:1) 25.5%, linoleic (18:2) 38.1%, arichidonic (20:4) 8.3%, EPA (20:5) 0.7%, and DHA (22:6) 0.6%

  • Research Papers Writing

    11/19/2009 6:40:23 AM |

    Many institutions limit access to their online information. Making this information available will be an asset to all.

  • buy jeans

    11/3/2010 2:33:17 PM |

    --Weight loss--A BIG effect. Weight loss drops CRP like a stone. The CRP-reducing effect is especially large if achieved via carbohydrate reduction.

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