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.
Creatine: Not just for muscle heads

Creatine: Not just for muscle heads

Even if you’re not interested in building big muscles like a bodybuilder, there are health benefits to increasing muscle mass: increased bone density, better balance, and fewer injuries. Greater muscle mass means higher metabolic rate, improved insulin responsiveness, lower blood sugar. The inevitable loss of muscle mass of aging can lead to frailty, an increasingly common situation for the elderly. Muscle loss be reversed, health improved as a result.

Since its introduction in 1994, creatine has exploded in popularity, particularly among bodybuilders and athletes interested in gaining muscle mass and strength. But creatine is not just for young weight lifters. If you are just interested in increasing muscle mass for its health benefits, then creatine is something to consider.

A study of creatine supplementation in men, average age 70 years, demonstrated that, when creatine was combined with strength training, it increased muscle mass 250% better than placebo (7.26 lb muscle vs 2.86 lb muscle), along with improved leg strength and endurance. The same group also demonstrated 3.2% increased bone density (measured using dual energy X-ray absorptiometry) after 12 weeks in participants taking creatine with strength training, while the control (no strength training, no creatine) group decreased by 1.0%.

Benefits are not confined to men. Similar results were observed in another study that included women (age 65 and older), with outcomes in females comparable to males. This is especially important for females, given the common development of osteopenia and osteoporosis in postmenopausal females.

Other studies have shown that benefits are maintained after stopping creatine supplementation.

The most popular form of creatine is the monohydrate, generally taken as a “loading” phase of 15-20 grams per day (generally split into 3-4 doses of 5 grams) for 5-7 days, followed by weeks to months of 2-5 grams per day.

An alternative form, polyethylene glycosylated creatine (PEG-creatine) provides similar effects at one-fourth to one-half the dose of creatine, i.e., 1.25-2.5 grams per day.

Despite previous concerns about kidney toxicity with prolonged use, another study showed that athletes taking creatine for up to 21 months have shown no adverse effects on kidney function, lipid (cholesterol) values, or other basic health measures.

Having healthy muscle mass doesn't make you bulge like a bodybuilder. With modest efforts at strength training, augmented with creatine supplementation, you have a wonderful tool to feel better, reduce injury, increase bone density, and combat abnormal insulin resistance, not to mention accelerate weight loss, since lean muscle mass consumes energy.

Comments (29) -

  • Chris

    7/5/2009 7:57:53 PM |

    I go thorugh phases of taking creatine every now and again and it does make me feel stronger and look better....but it also makes me get cramps and urinate a lot and I am not sure if that is healthy?

  • Lena

    7/5/2009 10:00:12 PM |

    There is also good evidence that for people who have kidney disease and are on a low-protein diet, supplementing with carnitine, amino acids and keto acids significantly improves health and slows kidney function decline. Some nephrologists had been recommending against a low-protein diet for kidney patients as on its own it decreases health basically due to wasting, but with the supplements this risk is removed and overall health improves.

    There is an American doctor working in Malaysia with people who can barely afford dialysis who is a big advocate of this approach, since the supplements are cheap and can delay the start of dialysis by years.

    http://jasn.asnjournals.org/cgi/reprint/2/7/1178.pdf

    http://www.pkdiet.com/pdf/SavingFailingKidneys.pdf

  • Lynn M.

    7/5/2009 10:32:19 PM |

    Too bad there wasn't a control group of strength training but no creatine to separate out the effects of strength training vs. creatine.

  • Anonymous

    7/5/2009 10:58:21 PM |

    My husband gained massively in strength and size by taking creatine and weightlifting so I'm convinced that it works. However, he says that it takes a lot glucose to activate it and since I was low carbing with the hopes that it might improve my Crohn's,  I wanted to avoid drinking all the juice, a pint or more, that he disolves the creatine in when he takes it.

    Karen

  • Fitness-Diet-Info!

    7/5/2009 11:15:36 PM |

    Nice looking blog. Great article on Creatine. www.Fitness-Diet-Info.blogspot.com

  • kris

    7/6/2009 1:46:49 AM |

    I wonder if any positive/negative effects for hypo/hyper thyroid?

  • Anonymous

    7/6/2009 2:43:57 AM |

    Dr. D,

    I think you made a typo in paragraph 6. I believe you meant to say grams (not milligrams).

    Also, I think you left out the word, "can" in the last sentence of your first paragraph.

    Keep up the good work!

    JohnM

    P.S. I hope someday you will share a story if any of your patients have ever reversed their scan all the way down to zero. I know you have mentioned big reductions, but I am assuming those are people with pretty big scores to begin with. I was always curious if any of them ever made it all the way back down to zero..

  • dr j

    7/6/2009 12:17:03 PM |

    I maybe am wrong....
    read this loading as
    0.3-g Cr.kg(-1) body weight per day for the first week
    for a 70 kg male, 70x0.3=21 g per day
    could someone correct me pls?

  • Anonymous

    7/6/2009 3:35:47 PM |

    Dr Davis:
    Thought that Creatine needed to be taken with carbs/sugar.  what is the corect way to take it

  • Joe E O

    7/6/2009 3:36:04 PM |

    Dr Davis,
    I can't agree more. Not taking creatine while strength training (especially for folks over the age of 40 who may be taking a statin ) is like going out in the the rain without an umbrella.

    Personally - I would put strength training while using creatine right up there with the normalization of Vitamin D as far as improving my quality of life.

    Peace

    Joe E O

  • Anonymous

    7/6/2009 3:48:23 PM |

    Typos: In the monohydrate paragraph, you say mg where you mean grams.

  • karl

    7/6/2009 3:52:40 PM |

    Yes - I think your units are off -- should be g - not mg.

  • Dr. William Davis

    7/6/2009 4:15:07 PM |

    Thanks for catching the typos.

    Yes: Creatine doses should be in grams, not milligrams.

  • pmpctek

    7/6/2009 6:45:52 PM |

    To those asking if creatine must be taken with carbs, in one word, no.

    Yes, creatine taken w/simple carbs has proven to cause faster and more complete absorption. But, when we're talking 15-20 grams/d during the loading phase, we're going to maximize our body's stores within an extra day or two anyway, without having to spike our insulin.

    My only concern with creatine is that it causes initial weight gain to be almost entirely due to increased water volume within the muscles and blood vessels.  That may be concerning for people trying to lower their blood pressure. The studies I've read have proven it does not increase bp.  But I have also read anecdotal reports that it may have caused acute elevated bp in some people after starting creatine.

  • Dr. William Davis

    7/6/2009 10:39:26 PM |

    By the way, I've also written a full-length article for Life Extension Magazine called Superhuman that will detail creatine use, along with HMB, BCAA, and other performance-enhancing supplements for non-bodybuilders.

  • darnoconrad

    7/7/2009 5:29:46 AM |

    Dr. William Davis,

    Does the increased production of creatinine cause concern?

    There was a product created to subvert the production of Creatinine called Kre-Alkalyn which fused ash with creatine-monohydrate in order to produce a pH balanced Creatine product which would not breakdown into Creatinine in the body. The pH of Kre-Alkalyn is at around 14. According to the company that holds the patent, as little as only 1-3g is needed in place of the 15-20g of creatine-monohydrate. According to studies posted on their own site, the Kre-Alkalyn users out perform the creatine-monohydrate users.

    I would like you to comment critically or share any information that you have on these subjects please.

    Thank You!

  • Zach

    7/8/2009 2:03:06 AM |

    Dr. Mike,
    I had kidney stones last year.  I am on the paleo diet/EF diet.  Once a week or so, in addition to supplements of a multivitamin, antioxidants, and vitamin D I take some ginger extract, which really makes my whole kidney area feel cleaned out.  I'm going to have to try out the creatine.
    Best Regards,
    Zach

  • Andrew

    7/8/2009 7:39:14 AM |

    Two comments as an avid creatine user:

    It's not necessary to load creatine.  All the loading phase does is saturate your body more quickly.  However, many people, myself included find the loading phase not only annoying, but also causes a significant amount of bloat.  IMO, you can just take it in 5g doses to start and kind of ease into it.  There's no real reason not to do it this way, as loading is just faster, not better.

    There are a few forms of creatine.  I prefer supplements made with Creapure, as it seems to go down more smoothly.  I also use powder for quicker absorption, instead of pills.  I generally just put the creatine dose in my mouth and then chug some water.  Creatine doesn't have any taste, so it's really just a matter of texture if you can stand it.  The primary thing I aim for is about 1 gal of water per day.  This isn't as daunting as it sounds, as you should be drinking close to that amount, anyway.

    Dr. Davis - If possible, could you do a post about Beta Alanine?

  • Anonymous

    7/15/2009 5:39:18 PM |

    Supplementation with creatine greatly increases ones chances for developing rhabdomyolysis. Beware, especially if you are taking it in combination with a statin.

  • Anonymous

    7/16/2009 2:03:57 AM |

    quitting the statin for a few months is a good idea anyhow.  I am lucky to have the support of an enlightened PCPhys.  She provides guidance and support when I ask to make changes to my Statin or add a supplement.  I don't need her permission to stop taking it but in consultation, she will ask what my goal for the change is and tell me what to look out for.  Get y'rself one of these consultative Docs, they are true gems.

  • william Trumbower

    8/25/2009 9:01:40 PM |

    After reading your post I added creatine along with D-Ribose twice a day.  I do an Ultrafit work out twice weekly and was astonished at the increase in my strength.  I had no side effects at all.  I eat lowcarb-gluten free.

  • Anonymous

    12/5/2009 6:19:03 PM |

    Hey are you a professional journalist? This article is very well written, as compared to most other blogs i saw today….
    anyhow thanks for the good read!

  • Jolly

    2/16/2010 1:16:21 AM |

    Any idea when your Superhuman article will be published?

  • Anonymous

    4/1/2010 1:56:55 AM |

    The doc should compare kre-alkalyn to all studies compaired to creatine are very promising.

  • Anonymous

    7/22/2010 7:21:34 AM |

    Im 16 yrs old and i have osteoperosis. i go to a world class doctor who specializes in kidneys. i took a bone density test and 24hr urine test. i took creatine for weightlifting trying to get bigger. when he told me the results he said everything was normal except one thing. i was excreting too much calcium and not retaining too much citrate. (or something). this leads to kidney stones and other problems. creatine is horrible for you. it lowers bone density long term and puts stress on your kidneys. same with shakes. if you have a good diet thats enough protein already. when you take more protein it sits in your stomach waiting to be processed and is terrible for your kidneys. all this info is from my doctor.....just a heads up. i thought it was safe. but i was wrong.

  • Scott

    9/13/2010 6:28:50 PM |

    Good post.

    http://www.threeblendcreatine.co.uk

  • buy jeans

    11/3/2010 9:15:01 PM |

    Benefits are not confined to men. Similar results were observed in another study that included women (age 65 and older), with outcomes in females comparable to males. This is especially important for females, given the common development of osteopenia and osteoporosis in postmenopausal females.

  • David

    12/23/2010 6:38:46 PM |

    ATP is a long name for a phosphate that increases muscle contraction. Creatine in NO way is harmful, as you can find Creatine in red meats like the steak you eat after your workout. If taken properly (5mg a day), you will notice increases in size, power, as well as weight.

  • Harry

    12/28/2010 12:05:53 PM |

    I took a supplement containing creatine one evening and the next morning I woke up with chest pounding arrythmia. I went to the ER, was diagnosed with Atrial Fibrillation with rapid ventricular response and Rhabdomyolysis (creatine kinase 17000 u/L with a normal range 40-170 u/L) and got admitted to the hospital. The A-Fib lasted 24 hours and the rhabdomyolysis lasted 7 days. I had not associated the creatine with this episode, until a few months later I came across an article titled "Lone atrial fibrillation associated with creatine monohydrate supplementation"
    http://www.ncbi.nlm.nih.gov/pubmed/15899738
    So, before you supplement with creatinine, keep in mind the danger of atrial fibrillation.

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