What role cholesterol medication?

A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.

Supplement Mania!

Ever hear of "polypharmacy"? That's when someone takes too many medicines. People will have lists of 15-20 prescription medicines, for instance, with crazy interactions and oodles of side-effects.

Well, how about "poly-supplments"? That's when someone takes a large number of nutritional supplements.

Let me tell you about a 45 year old man I met.

In an effort to rid himself of risk for heart disease that he felt was likely shared with his family (brother and father diagnosed with heart attacks in their late 40s), Steve followed a program of nutritional supplementation. You name it, he took it: hawthorne, anti-oxidant mixtures, vitamins C, E, B-complex, saw palmetto, 7-keto DHEA, velvet deer antler, gingko biloba, policosanol, chronium picolinate, green tea, pine bark extract, St. John's Wort, CoEnzyme Q10, papain and other digestive enzymes...He became a distributor for a nutritional supplement company to allow him to afford his own extraordinary program.

To satisfy himself that he had indeed "cured" himself of heart disease, he got himself a CT heart scan. His score: 470, in th 99th percentile. Steve's heart attack risk based on this score was around 10% per year. High risk, no question.

For weeks after his scan, Steve admitted walking around in a daze, not knowing what to do. Years of telling himself that he had effectively dealt with his heart disease risk, now all down the drain.

When we met, I persuaded him that to think that this collection of supplements would reverse heart disease was magical thinking. We trimmed his list down to the essentials and got him on the right track.

Heart disease is controllable and reversible, but not this way. Don't fool yourself into thinking that some collection of supplements will be enough to stamp out your heart disease risk. Just like taking an antibiotic when you don't have an infection achieves nothing, so does taking the wrong supplements.

What does heart scanning mean to you?

CT heart scans can mean different things to different people.


What does a heart scan mean to you? There are several possibilities:

1) A way of reducing uncertainty in your future.

2) A tool to crystallize your commitment to health.

3) A device to help you track how successful your heart disease prevention program is.

4) A trick to get you in the hospital.

5) A moneymaking tool for unscrupulous physicians hoping to profit from "downstream" testing, particularly heart catheterizations.


Like anything, heart scans can be used for both good and evil. How can you be sure that your heart scan is put to proper use--for your benefit and not someone else's profit?

Simple: Get educated. Understand the issues, be armed with informed questions.

If, for instance, you're a 55-year old female with a heart scan score of 90, active without symptoms, and you're told to have a heart catheterization right off the bat---run the other way. This is bad advice. A heart procedure like catheterization at this score in an asymptomatic woman is very rarely necessary. That decision can only be made after a step-by-step series of decisions are made by a truly interested, unbiased party. (A stress test is almost always required in this situation before the decision can be made to proceed with a catheterization.)

Unfortunately, in 2006, getting unbiased advice from your doctor is still a struggle. That's why we started Track Your Plaque---unbiased information, uncolored by drug or device company support, with an interest in the truth.

Coronary disease is drying up!

I had an interesting conversation with a device representative this morning. He was a sales representative for a major medical manufacturer of stents, defibrillators, and other such devices for heart disease.

Since I'm still involved with hospital heart care and cardiac catheterization laboratories, this representative asked me if I was interested in getting involved with some of the new cardiac devices making it to market over the next year or two. "The coronary market is drying up, what with coated stents and such. We've got to find new profit sources."

Well, doesn't that sum it up? If you haven't already had this epiphany, here it is:

HEART DISEASE IS A PROFITABLE BUSINESS!

Why else can hospitals afford billboards, $10 million dollar annual ad campaigns, etc.? They do it for PROFIT. Likewise, device and drug manufacturers see the tremendous profit in heart disease.

The representative's comments about the market "drying up" simply means that the use of coated stents has cut back on the need for repeat procedures. It does NOT mean that coronary disease is on the way out. On the contrary, for the people and institutions who stand to profit from heart care, there's lots of opportunity.

Track Your Plaque is trying to battle this trend. Heart disease should NOT be profitable. For the vast majority of us, it is a preventable process, much like house fires and dental cavities.

Mammogram for your heart

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.

Is your doctor using "leeches"?

What if you went to your doctor for a problem and he/she promptly placed leeches on your body?

Yeccchhhh! Would you go back? I'd bet that you'd run the other way as fast as your bleeding legs could take you. Outdated health practices like "bleeding" are outdated for good reason.

Then why would you allow your doctor to approach your heart disease prevention program by checking cholesterol and then waiting for symptoms to appear? That miserable approach leads to tragedy and death all too often--ask Bill Clinton! He might as well have had leeches!

Don't allow your doctor's ignorance or disinterest impede your prevention program. Get your coronary plaque measured, then attack it from all sides by knowing all causes, hidden and obvious. That's why Track Your Plaque is such an effective program.

I often wonder why more doctors aren't using this unbelievably powerful approach to deal with heart disease. But when I see colleagues implanting stents, defibrillators, and the like for many thousands of dollars per patient, the answers are obvious. Given a choice of a rational, effective program of prevention that pays the doctor a few hundred dollars for his time, versus $2000 to $10,000 for a procedure, you can see that the temptation is irresistible for many physicians.

All in the family--What to do if there's heart disease in your family

What should you do if a close relative of yours is diagnosed with coronary disease?
This question came up recently with a patient of mine. The patient--a strapping, 47 year old businessman who looked the absolute picture of health--was undergoing bypass surgery. Although I'd met him for the purposes of plaque reversal, he was already having symptoms and his stress test was flagrantly abnormal, all discovered after a heart scan score of 765. On the day after the patient's bypass, the patient's brother came to me. Understandably concerned about his own health, he asked what he should do. The answer: get a heart scan.
Measure the disease with the easiest test available. If his heart scan score is zero, great--he's at exceptionally low (near zero) risk for heart attack. A modest program of long-term prevention is all that's necessary. What if his score is like his brother, should he get in line for his bypass? No, absolutely not! But he will need two things: 1) a stress test to ascertain whether or not he's safe (60% likelihood a stress test would be normal), and 2) an effort to determine how the heck he got so much plaque. (We favor lipoprotein testing, of course, for greatest diagnostic certainty.)
Message: Learn from the lessons your own family provides. Don't let this valuable information go to waste.
Spontaneous combustion, vampires, and goitrogens

Spontaneous combustion, vampires, and goitrogens

What do the following have in common:

Lima beans
Flaxseed
Broccoli
Cabbage
Kale
Soy
Millet
Sorghum?

They are all classified as goitrogens, or foods that have been shown to trigger goiter, or thyroid gland enlargement. Most of them do this either by blocking iodine uptake in the thyroid gland or by blocking the enzyme, thyroid peroxidase. This effect can lead to reduction in thyroid hormone output by the thyroid gland, which then triggers increased thyroid stimulating hormone (TSH) by the pituitary; increased TSH acts as a growth factor on the thyroid, thus goiter.

Add to this list of goitrogens the flavonoid, quercertin, found in abundance in red wine, grapes, apples, capers, tomatoes, cherries, raspberries, teas, and onions. Most of us obtain around 30 mg per day from our diet. Quercetin, often touted as a healthy flavonoid alongside resveratrol (e.g., Yang JY et al 2008), has been shown to be associated with reduced risk for heart disease and cancer. Many people even take quercetin as a nutritional supplement.

Quercetin has also been identified as a goitrogen (Giuliani C et al 2008).

What to make of all this?

Most of these observations have been made in in vitro ("test tube") preparations or in mice. Rabbits who consume a cabbage-only diet can develop goiter.

How about humans? The few trials conducted in humans have shown little or no effect. In most instances, the adverse effects of goitrogens have been eliminated with supplemental iodine. In other words, goitrogens seem to exert their ill thyroid effects when iodine deficiency is present. Restore iodine . . . no more goitrogens (with rare exceptions).

Should we as humans adopt a diet that avoids apples, grapes, tomatoes, red wine, tea, onions, soy etc. on the small chance that we will develop goiter?

I believe that we should avoid these common food-sourced goitrogens with as much enthusiasm as we should be worried about spontaneous combustion of humans or the appearance of vampires on our front porches. We are as likely to suffer low thyroid activity from quercetin or other "goitrogens" as we are to experience the "mitochondrial explosions" that are purported to set innocent people afire.

Comments (17) -

  • Lena

    5/27/2009 12:12:26 AM |

    The advice given by thyroid docs, at least the kind that understand more about it than average and are willing to prescribe Armour, etc, is that you should reduce goitrogen intake while you are first starting treatment for hypothyroidism and/or iodine deficiency, then they're OK to have more of in your diet. The goitrogenic effect of most of them is minimised or negated by cooking anyway. Mine did advise that soy could be a bit more problematic and you should avoid consuming any within four hours of taking your thyroid medication, if you swallow the medication instead of taking it sublingually.

  • maxthedog

    5/27/2009 6:19:28 PM |

    Very interesting!  I was hoping you would follow up your iodine/goiter posts with something about goitrogens.  I'd like to read up on the human trials, if there's anything more than abstracts available.  Any urls handy?  Also, just wanted to say I really appreciate your blog, and thank you.

  • flit

    5/28/2009 2:34:37 AM |

    I have Hashimoto's thyroiditis and my endocrinologist (who is fantastic; she titrates my dose to my symptoms, and has me on Armor) has suggested that I want to take the following two precautions around goitrogens:

    a) Don't eat the "biggies" such as soy within four hours of taking my thyroid medication.

    b) Eat them moderately and fairly steadily; a serious pig-out on raw broccoli or edamame after weeks without may cause a swing, but a normal diet that includes them is no big deal.  This means that I actively want to include these things in my diet (which is good, because I both like them and they are good for me.)  If I keep the amount steady then we can just balance my dose against any goitrogenic effect they might have.

  • pooti

    5/28/2009 12:59:23 PM |

    My understanding of the cruciferous vegetable family is that their goitrogenic effect is negated or at least minimized by cooking or fermentation.

  • Anonymous

    5/28/2009 6:22:31 PM |

    Hi Dr Davis,

    FYI - in case you are not aware, the home testing kit shopping area is not working.  At least I've tried ordering with two different computers with out luck.

  • Dr. William Davis

    5/29/2009 1:24:18 AM |

    Flit--

    Thanks for your comments.

    I like option "b", the most practical and logical.

  • Dr. William Davis

    5/29/2009 1:26:01 AM |

    Anon--

    I believe that the lab test area should be working now.

    We are in the process of transferring all files over to a new website and servers. There may therefore be momentary glitches that shouldn't last more than a few minutes while the programmers make the switch.

    On the bright side, the new website will be more user-friendly.

  • Dr. William Davis

    5/29/2009 1:27:39 AM |

    Max--

    The easiest way is to just go to PubMed.gov and enter the relevant search terms.

    You will find oodles of studies, many in mice or in vitro preparations, a few in humans. You can specify which--mouse vs. human, for instance, in your choice of search terms.

  • kris

    5/29/2009 12:59:49 PM |

    The researchers claim that the findings provide little evidence that "in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function."
    The researchers also stated that "there remains a theoretical concern based on in vitro and animal data that in individuals with compromised thyroid function and/or whose iodine intake is marginal soy foods may increase risk of developing clinical hypothyroidism. Therefore, it is important for soy food consumers to make sure their intake of iodine is adequate." They also claim that "some evidence suggests that soy foods, by inhibiting absorption, may increase the dose of thyroid hormone required by hypothyroid patients."

    This study is suggesting that soy is safe -- unless you have a thyroid condition, or iodine deficiency. It also suggests that soy foods can inhibit absorption of thyroid medication.
    The study doesn't address the fact that it's estimated that as much as one-fourth of the U.S. population is now iodine deficient, and that the number is on the rise. At the same time, many millions of Americans also have undiagnosed autoimmune thyroid disease. At minimum, if you accept the premise of this study, that means that more than 75 million Americans with iodine deficiency may be at risk of thyroid problems from soy consumption. If you include the up to 60 million Americans who have a diagnosed or undiagnosed thyroid condition, almost half of all Americans could be at risk of soy-related thyroid problems.

    It's also troubling to note that the author of this study -- and several other recent studies claiming soy is not a danger to the thyroid, is Mark Messina, PhD. Messina, though not a medical doctor, also goes by the name "Dr. Soy." Messina had been in charge of grant funding at the National Institutes of Health (NIH), where he oversaw a $3 million grant for soy studies. Soon after he left NIH, he was hired to serve on the scientific advisory boards of both the United Soybean Board, and international soy agribusiness Archer Daniels Midland. He still serves on both scientific advisory boards as a paid advisor. In addition to his work on these advisory boards, Messina is a consultant to the United Soybean Board and editor of its soy-related newsletter, and serves as a paid speaker and consultant to promote the positive benefits of soy for the United Soybean Board's "Soy Connection.". Messina has also published a number of books promoting soy. The "Political Friendster" website, which tracks corporate influence, has documented the close relationship between Messina and the various corporate players in the soy industry.

    the full 5 page article can be read at.
    http://thyroid.about.com/cs/soyinfo/a/soy.htm?nl=1

  • Anonymous

    5/30/2009 1:51:56 AM |

    Help, I am so confused!

    I have a goiter and nodules diagnosed via an ultrasound screen. I have an appt with my MD to take the next step to do lab etc. I am hoping the goiter is caused by iodine deficiency and not Hashimotos. I have been reading about supplementing with iodine but some folks say take lots (12+ mgs) others say taking more will exacerbate a hypothyroid condition. I have been taking kelp capsules 4 daily supplying 1600 mcg. I have been tempted to up the dose but don't want to mess things up. Should I wait until test results come back, then if it is negative for Hashi's go ahead and do mega doses? or should I not be afraid to supplement?

    Thanks for this blog, and thanks for all the intelligent comments through-out. I have learned so much.

    Laura in Arizona

  • Anonymous

    6/2/2009 12:49:52 PM |

    Hi again Dr Davis,

    I was the one that wrote earlier about having troubles ordering testing kits.  The system still is having trouble - at least with my computers, at home and work.  Thought you might want to know.  
    The error occurs after pressing the submit order button.  

    Below is a cut and paste of what the error says.  Hope this helps!    

    Server Error in '/' Application.
    Retrieving the COM class factory for component with CLSID {17B9BE57-09EA-11D5-897B-0010B5759DED} failed due to the following error: 80040154.
    Description: An unhandled exception occurred during the execution of the current web request. Please review the stack trace for more information about the error and where it originated in the code.

    Exception Details: System.Runtime.InteropServices.COMException: Retrieving the COM class factory for component with CLSID {17B9BE57-09EA-11D5-897B-0010B5759DED} failed due to the following error: 80040154.

    Source Error:

    Line 146:
    Line 147:    Public Function ProcessCC(ByVal PaymentObject As PaymentObjCC) As ArrayList
    Line 148:        Dim pfpro As New PFPro
    Line 149:        Dim Response As String
    Line 150:        Dim pCtlx As Integer


    Source File: E:inetpubwwwrootTYPTYP_MainApp_CodePayflowProPFProProcessor.vb    Line: 148

    Stack Trace:

    [COMException (0x80040154): Retrieving the COM class factory for component with CLSID {17B9BE57-09EA-11D5-897B-0010B5759DED} failed due to the following error: 80040154.]
       PayFlowPro.PFPro..ctor() +13
       PFProProcessor.ProcessCC(PaymentObjCC PaymentObject) in E:inetpubwwwrootTYPTYP_MainApp_CodePayflowProPFProProcessor.vb:148
       Checkout.CompleteOrderCC() in E:inetpubwwwrootTYPTYP_MainproductsCheckout.aspx.vb:970
       Checkout.btnSubmitOrder_Click(Object sender, EventArgs e) in E:inetpubwwwrootTYPTYP_MainproductsCheckout.aspx.vb:1113
       System.Web.UI.WebControls.Button.OnClick(EventArgs e) +111
       System.Web.UI.WebControls.Button.RaisePostBackEvent(String eventArgument) +110
       System.Web.UI.WebControls.Button.System.Web.UI.IPostBackEventHandler.RaisePostBackEvent(String eventArgument) +10
       System.Web.UI.Page.RaisePostBackEvent(IPostBackEventHandler sourceControl, String eventArgument) +13
       System.Web.UI.Page.RaisePostBackEvent(NameValueCollection postData) +36
       System.Web.UI.Page.ProcessRequestMain(Boolean includeStagesBeforeAsyncPoint, Boolean includeStagesAfterAsyncPoint) +1565


    Version Information: Microsoft .NET Framework Version:2.0.50727.3082; ASP.NET Version:2.0.50727.3082

  • Anonymous

    1/8/2010 6:28:02 PM |

    What a great resource!

  • buy jeans

    11/3/2010 3:41:19 PM |

    How about humans? The few trials conducted in humans have shown little or no effect. In most instances, the adverse effects of goitrogens have been eliminated with supplemental iodine. In other words, goitrogens seem to exert their ill thyroid effects when iodine deficiency is present. Restore iodine . . . no more goitrogens (with rare exceptions).

  • Lena

    1/21/2011 6:06:50 PM |

    ABOUT THE QUESRCETIN has also been identified as a goitrogen (Giuliani C et al 2008).

    WOW, this is the most detailed information I have seen so far  online about the Resveratrol and flavonoids being goitrogenic,

    I have been searching and searching, as I just had read briefly of an experiment with rats that showed Resveratrol (red wine + grape seeds extract) was causing the thyroid gland to enlarge
    I really appreciate you posting this info

    I have hypothyroidism, I take small doses of Armour and it really works great for me, and was taking Resveratrol too, (which by the way, it seemed to help me a lot, especially with giving strength and gloss to my hair)
    So when i heard about this experiment i was shocked. Then I found out that even all kind of fruits are goitrogenic (as you point out) and tea and greens and garlic and onion and potatoes and beans, but above all, fruit and grapes.

    Is so hopeless, I in fact, by fear, suspended the resveratrol, and now, and is funny, as now I am experiencing some minor hair loss, I am sure due to that I stopped taking this amazing supplement which was helping my hair to grow strongly

    So I am so confused, my doctor as most of doctors, do not have a clue, as there is no enough info about all this and also no willingness to look into this research as well

    He told me to stop taking it
    But as you point out, then we should also stop eating then, as it seems that for one reason or another ,, all food is goitrogenic, soy, brassica greens, all greens, and veggies and fruit and also chickens and animals that seems are fed with goitrogenic grass and seeds
    So what choice do we have?
    ALSO I found this experiment on same PubMed which seems contradictory, I am not a doctor but it seems that it helps to add iodide (which is in iodine)  to the thyroid???

    IS there any MD on this site who might throw some light on this???

    or anyone here who has read more on this quercetin or Resveratrol? or knows about where to find more info about real evidence that flavonoids really work that way in humans????
    (by the way thank you for posting the Giuliani experiment, was that on humans or rats?)

    Does anyone knows of a good medical website or any that provides more information about this confusing subject?
    Please, help, let me know,
    Thank you
    Nella

  • Lena

    1/21/2011 6:09:52 PM |

    OOPS
    about the QUERCETIN

    here is that experiment URL
    http://www.ncbi.nlm.nih.gov/pubmed/20151827

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