AHA: Doctors don't have time for prevention

Doctors "don't have enough time to educate their patients and to stop and think about what measures the patient really needs," says Dr. Raymond Gibbons, new head of the American Heart Association.

Dr. Gibbons highlighted how the system reimburses generously for performing procedures, but reimburses relatively little (often just a few dollars) for providing preventive counseling. He claims to have several ideas for solutions.

Good for Dr. Gibbons. There's no doubt that the lack of truly effective preventive information and counseling is a systemic, built-in flaw in the current medical environment. It is especially true in heart disease.

Another problem: "If a doctor didn't say it, it must not be true." That's the attitude of many of my colleagues. Despite their broad and systematic failure to provide preventive counseling, most physicians (my colleagues the cardiologists especially) pooh-pooh information that comes from other sources. Yet, it's my prediction that much of healthcare will go the way of optometry--direct access to care, often delivered in non-healthcare settings like a store or mall. People are hungry for truly self-empowering health information. Too many physicians can't or won't provide it. You've got to turn elsewhere for it.

That's one of the main reasons I set up the Track Your Plaque program. It's direct access to self-empowering information. A flaw: You still require the assistance of a physician to obtain lab values, lipoproteins, and to monitor certain treatments (e.g., niacin at higher doses). If I knew of a way around this, I'd tell you. But right now I don't. We remain constrained by legal and moral obligations.

Nonetheless, phenomena like CT heart scanning and the Track Your Plaque program are just a taste of things to come.
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Niacin scams

Niacin scams

As most of you know, niacin (vitamin B3) is an important tool for many in the Track Your Plaque program.

Niacin:

--raises HDL cholesterol
--reduces small LDL
--reduces lipoprotein(a)

And it's the most potent agent we have for all three patterns, despite just being a vitamin. Niacin also reduces LDL cholesterol, VLDL, IDL, triglycerides; reduces heart attack risk dramatically either alone or in combination with other agents.

Unfortunately, some people who are either afraid of the "hot flush" side effect, or experience excessive degrees of it, have resorted to two preparations sold in stores that have none of these effects.

Most notorious is "No-flush" niacin, also known as inositol hexaniacinate. This compound is an inositol sugar molecule complexed with 6 ("hexa-") niacin molecules. Unfortunately, it exerts none of niacin's effects in the human body. No-flush niacin has no effect on HDL, small LDL, or Lp(a), nor on LDL or heart attack.

In short, no-flush niacin is a scam. It's also not cheap. I've met people who have spent hundreds of dollars on this agent before they realize that nothing is happening, including a flush.

Likewise, nicotinamide does not work. It sounds awfully close to the other name for niacin, nicotinic acid. But they are two different things. Like no-flush niacin, nicotinamide has no effect on HDL, small LDL, Lp(a), etc.

Though I've discussed this issue in past, somehow these two "supplements" seem to sneak back into people's consciousness. You walk down the health food store aisle and spy that bottle of X-brand No-flush niacin, promising all the benefits of niacin with none of the bother. Then you remember that rough night you spent a few months back when the hot flush lasted longer than usual. That's when some people end up buying this agent making extravagant--and false--promises.

For now, for all its imperfections, niacin is still a pretty darn good agent for these patterns. Remember that the best strategy to minimize the hot flush effect is to drink plenty of water. We generally recommend taking the dose at dinner along with water. If the hot flush occurs, drink two large glasses of water (total volume 16-24 oz). Nine times out of ten, the flush is gone. It also dissipates the longer you take niacin.

Comments (11) -

  • auntulna

    1/12/2009 11:06:00 PM |

    I've been taking Slo-niacin for more than six months, and about three times it must have broken down too fast. That is an intense hot pins and needles rush! Anyone else had that happen?

  • Grandma S.

    1/13/2009 2:37:00 PM |

    Dr. Davis,
    I do appreciate your blog and the information you provide. I am switching to SloNiacin!

  • stern

    1/13/2009 7:54:00 PM |

    it appears to me that the only    final decisive enemy for the heart is the LA sort LDL,all other are the indicators that your body inclines forward to get that enemy .all other encompassess high tryglicerides ,high ldl,low small hdl,c reactive proyien ,am i wright ?

  • Anonymous

    1/13/2009 9:46:00 PM |

    Niamax is also a slow release niacin.

    Is Niamax acceptable or does it also fall into the scam group?

  • Anonymous

    1/14/2009 12:27:00 AM |

    Please comment on a niacin product I have been using for years by Endurance Products,a sustained form of nicotinic acid that causes no flush (1000 mg daily) plus their regular version of immediate release (250 mg daily). Thanks...

  • martha

    2/4/2009 4:06:00 PM |

    Hi—
    My name is Martha and I am  a  writer working on a story about niacin for Better Homes & Gardens' Heart-Healthy Living magazine. I hope to interview Dr. Davis but also wanted to talk to people who are taking niacin for my story. If you are interested, please email me at marthajmiller@hotmail.com. My deadline is Feb. 16. Thanks
    -martha miller

  • IggyDalrymple

    2/28/2009 2:37:00 AM |

    My VA doc has been prodding me for years to take statins for my bad LDL/HDL ratio.  I finally took Dr Davis' advice and starting taking niacin and it worked.  My doc is now happy.

  • SES

    3/3/2009 10:29:00 PM |

    There are so many people commenting on the side effects of statins I wonder if there are side effects to something like Niaspan. Hot flashes are not what I am talking about.

  • Mary P

    4/28/2009 6:23:00 AM |

    I was talking to a dietitian friend about your strong feelings about no-flush niacin. I'm confused because she pointed me towards a recent European Food Standards Agency report that states that inositol hexanicotinate is bioavailable to humans and a source of niacin (they say, on average, 70% of an oral dose is absorbed into the blood stream).

  • buy jeans

    11/2/2010 7:40:15 PM |

    Nicotinamide--Also called niacinamide. While the nicotinamide/niacinamide forms of vitamin B3 can be used to treat B3 deficiency ("pellagra"), they do not reproduce the lipid and lipoprotein effects of niacin. For our purposes, they are useless.

  • Troy Honaker

    1/4/2011 5:00:05 AM |

    Niacin does have a tendency to have a prickly flushing effect on the skin.  This is normal to my knowledge.  It's not really a "side effect," it's just niacin doing its job.  I have never known it to be dangerous.  It is temporary.

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Factory hospitals

Factory hospitals

Twenty years ago, the American farming industry experienced a dilemma: How to grow more soybeans, corn, or wheat from a limited amount of farmland, raise more cattle and hogs in a shorter period of time, fatter and ready for slaughter within months rather than years?













(Image courtesy Wikipedia)

The solution: Synthetically fertilize farmland for greater crop yield; “factory farms” for livestock in which chickens or pigs are crammed into tiny cages that leave no room to turn, cattle packed tightly into manure-filled paddocks. As author Michael Pollan put it in his candid look at American health and eating, The Omnivore’s Dilemma:


To visit a modern Concentrated Animal Feeding Operation (CAFO) is to enter a world that for all its technological sophistication is still designed on seventeenth-century Cartesian principles: Animals are treated as machines—“production units”—incapable of feeling pain. Since no thinking person can possibly believe this anymore, industrial animal agriculture depends on a suspension of disbelief on the part of the people who operate it and a willingness to avert one’s eyes on the part of everyone else. . .


Pollan goes on to argue that the cultural distance inserted between the brutal factory farm existence of livestock and your dinner table permits this to continue:


“. . .the life of the pig has moved out of view; when’s the last time you saw a pig in person? Meat comes from the grocery store, where it is cut and packaged to look as little like parts of animals as possible. The disappearance of animals from our lives has opened a space in which there’s no reality check on the sentiment or the brutality . . .”


The same disconnect has occurred in healthcare for the heart. The emotional distance thrust between the hospital-employed primary care physician, the procedure-driven cardiologist, the crammed-into-a-niche electrophysiologist (heart rhythm specialist) or cardiothoracic surgeon whose principal concerns are procedures—with an eye always towards litigation risk—mimics factory farms that now litter the landscape of the Midwest. The hospitals and doctors who deliver the process see us less as human beings and more as the next profit opportunity.

The “factory hospital” has allowed the subjugation of humans into the service of procedural volume, all in the name of fattening revenues. Never mind that people are not (usually) killed outright but subjected to a succession of life-disrupting procedures over many years. But whether livestock in a factory farm or humans in a factory hospital, the net result to the people controlling the process is identical: increased profits.

The system doesn’t grow to meet market demand, but to grow profits. The myth that allows this growth is perpetuated by the participants who stand to gain from that growth.

See hospitals for what they are: businesses. Despite most hospitals retaining "Saint" in their name, there is no longer anything saintly or charitable about these commercial operations. They are ever bit as profit-seeking as GE, Enron, or Mobil.

Comments (8) -

  • Jenny

    11/9/2008 2:48:00 PM |

    Dr. Davis,

    Have you read the book, Hippocrates' Shadow? You have a lot in common with the physician who wrote it and I think it would be very productive for you to contact him and discuss strategies together.

    I blogged about the book in detail at my Diabetes Update Blog a few days ago.

    We patients can't do much about this, but physicians working together could.

  • Zbigniew

    11/9/2008 8:43:00 PM |

    adequate analogy Smile, but what we get here is a gloomy picture with little hope - while thanks to blogs like yours we may be more lucky than those poor animals.

    So the punchline should be something like "educate, read, b/c if everyone takes care of themselves then everyone will be taken care of"

    best regards,

  • steve

    11/10/2008 2:35:00 PM |

    would be interested in your views of Crestor study, and statins in general: when should they be used, etc?

    thank you

  • Anonymous

    11/11/2008 12:31:00 AM |

    Thanks Jenny, for mentioning the book, Hippocrates'Shadow. This sounds very interesting and I can hardly wait to find a copy.  
    Another great book is "How Doctor's Think, by Jerome Groopman,M.D.
    Dr. Davis, I appreciate this wonderful blog and your excellent advice. You restore some of my lost confidence in the medical profession.

  • puddle

    11/11/2008 3:30:00 AM |

    Thank you, again.  And again.

  • [...] (11)  http://www.newsobserver.com/2012/04/22/2016905/north-carolinas-urban-hospitals.html (12)  http://blog.trackyourplaque.com/2008/11/factory-hospitals.html  (13)  http://online.wsj.com/article/SB10001424127887323829104578623720451833006.html (14) [...]

  • [...] (11)  http://www.newsobserver.com/2012/04/22/2016905/north-carolinas-urban-hospitals.html (12)  http://blog.trackyourplaque.com/2008/11/factory-hospitals.html (13)  http://online.wsj.com/article/SB10001424127887323829104578623720451833006.html (14) [...]

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Cranberry Sauce

Cranberry Sauce

Happy Thanksgiving 2012, everyone, from all the staff at Track Your Plaque!

Here’s a zesty version of traditional cranberry sauce, minus the sugar. The orange, cinnamon, and other spices, along with the crunch of walnuts, make this one of my favorite holiday side dishes.

There are 31.5 grams total “net” carbohydrates in this entire recipe, or 5.25 grams per serving (serves 6). To further reduce carbs, you can leave out the orange juice and, optionally, use more zest.

1 cup water
12 ounces fresh whole cranberries
Sweetener equivalent to 1 cup sugar (I used 6 tablespoons Truvía)
1 tablespoon orange zest + juice of half an orange
½ cup chopped walnuts
1 teaspoon ground cinnamon
½ teaspoon ground nutmeg
¼ teaspoon ground cloves

In small to medium saucepan, bring water to boil. Turn heat down and add cranberries. Cover and cook at low-heat for 10 minutes or until all cranberries have popped. Stir in sweetener. Remove from heat.

Stir in orange zest and juice, walnuts, cinnamon, nutmeg, and cloves.

Transfer mixture to bowl, cool, and serve.


Comments (3) -

  • Kathryn

    12/1/2012 9:01:14 PM |

    Wow, sounds good but that is a LOT of Truvia.  The same amount of real stevia would render that inedible.  I've never tried Truvia, so maybe it isn't as sweet as the real stuff.  I like KAL brand stevia.

    BTW, i was excited to learn that you're going to be on Oz on Monday.  Smile  I think your message should be carried to all the Land.  i hope it does get thru (i know TV shows have a tendency to edit so that the message gets diluted or even lost).  Best wishes!  (Well, i suppose it has already been filmed, still.)

  • JT

    1/6/2013 2:25:40 PM |

    Ah Christ, it seems I ate to much fiber yesterday!  Not to take the lords name in vain this Sunday morning just the fiber rich foods have me run down this morning.  But with that said, I think the defective gut will be alright.  That's a nice change!  The gut will thump and pulsate, and make all kinds of fussing through out the day I'm sure, but the typical sickness I would experience seems to be fading on the latest diet.  Kind of nice, to say the least.  Figure eventually fiber foods will be possible for me to eat again.  Not that I'm all that excited about this, a carrot or cucumber doesn't excite, but it would be oh so nice to broaden the monotone diet a bit more from what it currently is.  

    Congrats on the success of the books!  Very nice and wonderful that word is making its way out to "alternative" ideas to improve ones health, particular with the problems that wheat can have on ones health.  Alterative might not be the correct word to use anymore.  These ideas seem to be becoming more mainstream.  There are a good number of unhealthy people out there, that want help, and are motivated to try new ideas.  As can  be seen with your book, many are finding relief from condition they were all to often told by other health care professionals that their condition could not be treated and must be dealt with for life.  For me personally a big motivation for why I spread the word to others about dietary ideas to address heart disease, and now other health issues, was desperation.  I can remember how very sick I was at one time, home bound largely, in a great deal of pain, and desperate for relief.  Back in the internet days often times I would finding myself not wanting to approach others with dietary information to help with conditions.  It was information that would seem foreign to them.  Then simply I would often think of what I've gone through, how sick I had been, and believe maybe this information can help.    

    Well, it's time for me to move on to new pastures.  With being slightly healthier and having more energy here of late, there are other items on the mind.  I've had people seem to suggest ways to make a living continuing this work/hobby, but to be honest I do not believe that possible.  I never have carried much for the attention.  And there are safer hobbies to participate in.  Possibly I can get into cloths tailoring, making my own cloths.  That would be fun I would have to imagine.  

    Oh, I guess to mention too, someday you might hear about me again.  If I do recover there is a good chance I'll write a book, pamphlet, web sight, what have you, detailing about how I solved my stomach issues and hopfully heart plaque also.  It's a shame that from my experience hospitals seem to care so little about dietary ideas.  It isn't strictly correct, but often times I feel as if I've had to invent the wheel for addressing my gut condition.  In an ideal world, that shouldn't have been the case.

  • Helen Howes

    3/27/2013 10:36:53 PM |

    Has this blog died?  It used to be interesting. the last few entries seem just to be over-sweet recipes..
    Sad, really..

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Wheat five times a day

Wheat five times a day

Terri couldn't understand why her weight wouldn't drop.

At 5'3", 208 lbs., she had the typical mid-abdominal excess weight that went with small LDL, low HDL, high triglycerides, a post-prandial (after-eating) fat clearance disorder, high blood sugar, increased c-reactive protein, and high blood pressure.

She claimed to have tried every diet and all had failed. So we reviewed her current "strict" diet:

"For breakfast, I had Shredded Wheat cereal in skim milk. No sugar, just some cinnamon and a little Splenda. For lunch, I had low-fat turkey breast sandwich--no mayonnaise--on whole wheat bread. For snacks, I had pretzels between breakfast and lunch, and a whole wheat bagel with nothing on it before dinner. For dinner, we had whole wheat pasta with tomato sauce and a salad. While we watched TV, I did have a couple of whole wheat crackers.

"I don't get it. I didn't butter anything, I didn't sneak any sweets, cakes, I didn't even touch cookies. And I love cookies!"

Did you see the pattern? I pointed out to Terri that what she was doing, in effect, was eating sugar 5 or more times a day. Many of her meals, of course, contained no sugar. All were low fat. But the excessive wheat content yielded quick conversion to sugar--glucose--immediately after ingestion.

Repeated surges of blood sugar like this trigger the excessive insulin response that yields low HDL, higher triglycerides, small LDL, etc., everything that Terri had.

Terri was skeptical when I suggested that she attempt an "experiment": Try a four week period of being entirely wheat-free. This meant more raw nuts and seeds, more lean proteins like low-fat yogurt and cottage cheese, chicken, fish, lean red meats, more vegetables and fruits.

After only two weeks, Terri dropped 5 1/2 lbs. She also reported that the mood swings she had suffered, afternoon sleepiness, and uncontrollable hunger pangs had all disappeared. The mental cloudiness that she had experienced chronically for years had lifted.

What happened was that the load of sugar from wheat products, followed by an insulin surge then a precipitous drop in sugar, and finally fogginess, irritability, and cravings for food all disappeared. With it, the entire panel of downstream phenomena (small LDL, CRP, etc.) all faded.

Though she started out intending to complete a four week trial, I believe that, having seen the light, she will continue to be wheat-free, or nearly so, for a lifetime.

Comments (3) -

  • Anonymous

    4/27/2007 9:20:00 PM |

    This description fits me to a 'tee' - including the unsuccessful attempts at dieting.

    I was a low-fat vegetarian with a wheat-heavy diet for 12 years.  I was convinced of the healthiness of my eating plan, despite the slow weight gain, ever-higher blood pressure, tryglicerides and cholosterol numbers.  It wasn't until my doctor shocked me with a diagnosis of Type 2 Diabetes that I realized the problem was how I was eating.

    After 9 months of a wheat-free and starch-free diet, a re-introduction of animal proteins from free-range poultry and wild seafoods, and much organic produce and nuts and seeds, I have shed 60 pounds - almost effortlessly.  My waist circumference is back to normal as are all my 'numbers'.  Without any medication.

    But no one could have convinced me prior to the diagnosis shock:  I was that successfully brainwashed by the conventional low-fat wisdom.

  • Dr. Davis

    4/28/2007 2:22:00 AM |

    Eloquently said.

    I fear that there's an entire nation that would concur, if they were aware. Sound the alarm!

  • Jonathan Byron

    4/22/2009 1:41:00 PM |

    You have repeatedly mentioned wheat and corn starch as culprits in a wide variety of disease factors. How much of this is specifically those two foods, and how much is the carb content (and the fact that these are so widely consumed in the west)? Our household is wheat-free (hashimoto's disease in one member), but we eat corn chips, corn tortillas and and corn noodles. Would switching from corn to rice be a logical next step, or would a low-carb diet with fewer grains of all types be better??

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Wacky statin effects

Wacky statin effects

In general, I try to exhaust possibilities before resorting to the statin drugs. But we still do use them, both in general practice and the Track Your Plaque program.

There are indeed a number of ways to reduce, minimize, or eliminate the need for these drugs. For instance, if your LDL is 150 mg/dl but comprised of 90% small particles, then a reduction in wheat and other high-glycemic index foods, weight loss, fish oil, and niacin can yield big drops in LDL.

But sometimes we need them. Say LDL is 225 mg/dl and is a mix of large and small. Exercise, weight loss, niacin, oat bran, ground flaxseed, Benecol, etc. and LDL: 198 mg/dl. Alright, that's when statins may be unavoidable. There's also many people who are not as motivated as all of us trying to reverse heart disease. Some just want the easy way out. Statins do indeed provide that option in some people.

So in truth, we end up using these drugs fairly regularly. How common are muscle aches and fatigue? In my experience, they are universal . If taken long enough, or if high doses are used, muscle complaints are inevitable. Most of the time, thankfully, they're modest and often relieved with a change in drug or with coenzyme Q10 supplementation.












But there's more to statin side effects than muscle aches. Among the wacky effects that I have witnessed with statin drugs:

--Insomnia-especially with simvastatin (Zocor and Vytorin). Insomnia can be quite severe, in fact, with difficulty sleeping more than 3-4 hours a night.

--Bone aches--I don't know why this happens, unless it's somehow related to muscle aches. I've seen this with all the statins, but more commonly with Crestor.

--Memory impairment--a la Dr. Duane Graveline's wacky book, Lipitor: Thief of Memory. I've seen this with Lipitor, though it's uncommon, and less commonly with simvastatin (Zocor, Vytorin).

--Diarrhea--More common with Zetia and Vytorin (which contains Zetia), because of the inhibition of bile acid reabsorption.

--Migraine headaches--This I certainly do not understand, but the cause-effect relationship is undoubtedly true in an occasional person.

--Low libido--In men more than women, though it may be more due to men being more willing to admit to it.

--Increased appetite--Rare, though I've seen dramatic instances.

--Tinnitus--Ringing in the ears. I've only seen it with Lipitor and Zocor.


In their defense (and in general I am no defender of the drug manufacturers), most people do fine with statin drugs, though the majority do eventually require coenzyme Q10 in my experience. By the way, coenzyme Q10 can be an indispensable aid to help tolerate statin agents.

I'd love to hear about your wacky experiences.

Comments (18) -

  • Anonymous

    9/23/2007 2:26:00 PM |

    It was the craziest thing, my elbows felt like they needed to pop but couldn't.  I was taking 20mgs of Zocor, and the first couple of months the elbows were fine, but one day I realized they hurt and wouldn't pop.  I enjoy tennis and will occasionally shoot baskets with the boys - working elbows are a requirement for both sports.  I told my doctor the problem and he said to stop taking Zocor, and after two weeks he will have me try a different statin.  Avoiding Zocor brought relief.  After a week of being statin free the elbows stopped aching.    

    I havn't gone back to my doctor to receive a prescription for that new statin.  After learning more about heart disease prevention from this sight and others, my starting LDL was low to begin with right around 80, and so decided to take a different natural approach to lower my LDL and more importantly for me raise HDL.  I cleaned up my diet and began taking nutritional supplements.  It worked, today cholesterol levels are great, and I have working elbows.

  • DietKing2

    9/23/2007 3:27:00 PM |

    When I first started on Lipitor 20mgs a few months back I suffered from 'Lipitor Leg'; that dull, annoying pain that plays hide-and-seek in and about the calf and thigh muscle.  And of course, only one leg, too.  Weird, nu? But it went away when I doubled my intake of CoEnzyme Q10 from 150mgs to 300mgs daily. (yeah, I don't like taking chances on being stingy)
    I could easily blame the Lipitor I'm taking for my short-term memory issues, but I'm hesitant to pass absolute judgment as of yet, only because of the tremendous amount of reading/researching I do daily combined with the fact that I sometimes have my head up my ass, and it causes me to forget stuff.  I'll keep you posted.
    And you keep posting this fantastic stuff, too!
    AdamWink

  • JoeEO

    9/23/2007 4:21:00 PM |

    I have experienced the muscle aches, absent mindedness and what I believe to be severe GERD. The GERD symptoms where so severe that I stopped taking Lipitor (20 MG) a month ago.

    Dr Davis - have you tried Q.O.D. administration of longer acting statin? There is a cardiologist in Hartford CT (PD Thompson) who  
    has found that Q.O.D.  administration of statins "significantly improves serum lipid levels" (PUB MED ID 16230873)

    Peace,

    Joe E O

  • Dr. Davis

    9/23/2007 5:49:00 PM |

    Hi, Joe-

    No, I didn't know that!

    Sounds like an interesting strategy. I think it's worth a try.

  • Anonymous

    9/24/2007 5:00:00 PM |

    After taking Lipitor 10mg for a few days I developed an occasional pain in the back of my right eye.  Since I had never had a pain like that before I stopped taking it and the pain disappeared a few days later, never to return.  Although my cardiologist said he had never heard of anything like that, I found several people on the internet who reported having varying types of vision-related reactions.  It's fairly obvious that some people do have strange reactions.  Years ago, when it was a prescription drug, I once took Claritin and thought I was going to die when my airway started to close down.  Now (don't laugh) I'll only take a new drug in the parking lot of the hospital!  Thinking you won't be able to breathe might do that for you.  Fortunately I don't really have to take any drugs   ...   yet.
            TYP member:  the164club

  • Dr. Davis

    9/24/2007 10:39:00 PM |

    Add another wacky side-effect to the list!

  • Cindy Moore

    9/25/2007 4:23:00 AM |

    Wacky? Well, I'm not sure how memory loss, muscle and bone pain, and debilitating diarrhea can be considered "wacky", but yea, I had them and more...how about severe depression? For the first time in my life I would cry at the least thing and had to force myself out of bed and do anything!!

    I'm sorry. Wacky? That isn't a term I'd use for the side effects that I and many others experienced.

    For those of us that have had severe reactions to these drugs it is very difficult to get your doc to understand and believe. My doc actually laughed at me!! Many are ignored when they complain about muscle and bone pain....then when it gets unbearable they sometimes will quit the drug. Others have what appears to be permanent peripheral neuropathy as a result of statins and their effect being ignored. Having a physician, and an apparently fairly well known one, call these side effects "wacky" minimizes what many have gone thru and makes it harder for others to convince their docs!

  • Tom

    11/17/2007 3:50:00 AM |

    Two weeks after I started 10mg/day of Lipitor I developed tinnitus.  I had never noticed a ringing in my ears before and now all of a sudden it was LOUD.  After three months I saw my doctor for a cholesterol retest (it went way down) and complained of the tinnitus.  He said he hadn't heard of this side effect, but I told him the web said 2% complain of it.  He suggested I go to 5mg/day to see if it helped.  I tried this for a few months, then went totally off for a few weeks, and the tinnitus got better, but never went away.  I'm still on a 5mg dose after 9 months and I still have tinnitus.  My fear is that the damage is done and the tinnitus will never go away.

  • Anonymous

    3/13/2008 2:45:00 AM |

    Other bloggers: you might have something about the tinnitus. I had been plagued by tinnitus a few years ago - unrelated to statins - eventually it went away. I suspect medications. However, six days ago I began 5 mg simvastatin and the tinnitus came back, same sort of noise, same annoying level or volume. Dr. Davis mentioned tinnitus and Zocor in his "wacky" side effects posting. Maybe not so wacky, huh?

  • Veedubmom

    4/6/2008 1:50:00 AM |

    I got sun sensitivity from taking Simvastatin.  Wherever my skin is exposed to the sun, it turns red and starts itching intensely and my skin looks like giant hives.  I have to wear long sleeves, gloves, turtlenecks, etc.  

    Has anyone else ever had this side effect?

    Veedubmom

  • jegan

    1/25/2009 4:26:00 AM |

    I was on Lipitor, but as a result of teh recent study, asked to go on Simvastatin. I too have never suffered tinnitus until taking statins. I perceive it most at night. It sounds either like e pure high pitched white noise, or often like being stuck in an aviary with a million high pitched birds. I did not suffer any pains, but I clearly am more forgetful. I also feel depressed, and really don;t care about anything.. Paying bills, family, cleaning, you name it. Also, my rosacea seems to act up a lot more.

  • Brian

    2/27/2009 1:02:00 PM |

    I started Zocor 2 weeks ago and have ringing in right ear. Somtimes irs loud. I also had dizzyness and feeling of confusion the 1st week. Insomnia too.

  • UrbaneGorilla

    2/28/2009 4:00:00 AM |

    I don't know why there is no real documentation on these type of statin side effects. I'm guessing that there is too much money behind the labeled products.

    To sum up:

    I started taking statins a couple of years ago. A friend told me that he heard that they caused altzheimers-like symptoms. I didn't think that I exhibeted any effects like that, so I pretty much ignored it, except to raise the issue with my doctor.

    During the last two years, I gradually lost interest in pretty much everything. It wasn't that I was forgetful, I just didn't much care about anything. Didn't care about my hobbies, quit my job, only paid bills when I felt like it, left a rental property vacant for 1 1/2 years and other similar issues.

    I am normally a pretty active person with lots of pursuits. When I spoke to my doctor about my 'lack of interest and motivation', she suggested putting me on testosterone and later a mood enhancer. (I'm 60 and I lost my wife to breast cancer about 3 years ago, so I guess the thinking was either that I was going through male menopause or just depressed over her passing.)

    Although I never had the muscle aches or liver problems that are considered the side effects of statins, gradually, I began to feel weaker (not uncommon at 60) and more lackadaisical in my approach to bills and  responsibilities. I also began suffering continual intense tinnitus and insomnia. I became crankier and more vehement in my dealings with other people and dangerously aggressive while driving.

    Oddly enough, my lack of concern with paying bills led to the pharmacist telling me that Blue Shield had canceled me. Although I could easily have called the doctor for a prescription for $5 statins through KMart, I just couldn't be bothered, so I discontinued my medication.

    It's been about 2 1/2 weeks since my prescription ran out. Within 4 days I began feeling better and my thinking became clearer. I no longer have tinnitus, my good mood has returned and I **actually** accept  life's small annoyances again. Finally, I feel better physically and am more motivated. (Unfortunately, now I have to clean up all the financial garbage I've accumulated in the last year or so.)

    If you take statins and begin to suffer any of the symptoms that I've noted above. **Tell** your doctor to take you off for a month. If your symptoms improve, you'll know why.

    Although I no longer have medical insurance, one requirement of the coverage was that my cholesterol be controllable with statins. I'd rather have a heart attack or stroke and die than to go back to being the useless walking zombie that I was.

    John B. Egan
    Grass Valley,CA

  • UrbaneGorilla

    2/28/2009 4:05:00 AM |

    Just want to add that I've changed my screen name. This post was an update to my prior January 24, 2009 post as jegan.

    What can i say. I feel more inventive these days.

    jegan aka Urbanegorilla. Wink

  • Anonymous

    1/4/2010 9:44:00 PM |

    My father has been on Lipitor for close to two years now.  He's getting almost daily "light-headed" symptoms (sometimes several times a day) where he explains that he becomes disoriented.  He'll ask me what day of the week it is.  Or completely forget a conversation we would just have.  It all comes back after a few minutes; but still very scary. As one commenter said, I too have been having trouble convincing people of his symptoms.  Doctors downplay it (and they shouldn't.  No matter how small the group experiencing this).  I'm trying to convince him to get off the statins and instead adopt a strict diet (no wheat/sugar etc. and lots of fish oil). He wont listen.  Does anyone know if this side effect can worsen with continued use? Can I have him take something (CoQ10)that may help lessen symptoms?

    -concerned son

  • UrbaneGorilla

    1/4/2010 10:58:43 PM |

    In response to anonymous who's father is suffering mental issues.. My doctors had no idea that depression, memory problems, unusual spontaneous anger and lack of interest could be caused by statins. My opinion is that pharma is not interested in publishing these matters. Why would they? They make a ton of money selling the products.

    If I hadn't forgotten to pay my Blue Cross bill I would never have known the difference as I was truly in a daze. Not only did I forget to pay the bill, but I couldn't develop enough interest to call either Blue Cross, or my doctor for a new prescription so I could go buy statins at KMart for $4.

    Tell your dad's doctor to take him off the drugs for 2 weeks..See how he feels after that time. He won't have a heart attack in that period but he may well recover as I did.

    Having said that, I still only feel partly improved but considerably so over my fugue state.

  • buy jeans

    11/2/2010 9:15:00 PM |

    In their defense (and in general I am no defender of the drug manufacturers), most people do fine with statin drugs, though the majority do eventually require coenzyme Q10 in my experience. By the way, coenzyme Q10 can be an indispensable aid to help tolerate statin agents.

  • simvastatin side effects

    5/8/2011 8:18:45 AM |

    As we all know, statins reduce the problem of people suffering from high cholesterol level. Some side effects of this drug may be eliminated with the help of coenzymes.

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Supermarkets and buggy whips

Supermarkets and buggy whips

Will supermarkets eventually phase out, joining the history books as a phenomenon of the past? Or are supermarkets here to stay, an emblem of the industrialization of our food--easy access to foods that are convenient, suit the undiscriminating masses, stripped of nutritional value despite the prominent health claim on the package front?

Anna left an insightful comment on the last Heart Scan Blog post, Sterols should be outlawed, along with some useful advice on how to avoid this trap for poor health called a supermarket:


I rarely shop in regular supermarkets anymore (farm subscription for veggies, meat bought in bulk for the freezer, eggs from a local individual, fish from a fish market, freshly roasted coffee from a local coffee place, etc.). What little else I need comes from quirky Trader Joe's (dark chocolate!), the fish market, farmer's markets, a small natural foods store, or mail order.

When I do need to go into one of the many huge supermarkets near me, not being a regular shopper there, I never know where anything is, so I have to ramble a bit around the aisles before I find what I'm looking for (and I almost always can grab a hand basket, instead of a trolley cart).

It's almost like being on another planet! There's always so many new products (most of them I hesitate to even call food). It's really a shock to the senses now to see how much stuff supermarkets sell that I wouldn't even pick up to read the label, let alone put in a cart or want to taste. I'm not even tempted by 99% of the tasting samples handed out by the sweet senior ladies in at Costco anymore (only thing I remember tasting at Costco in at least 6 mos was the Kerrygold Irish cheese, because I know their cows have pasture access and it's real food).

What's really shocking to me is how large some sections of the markets have become in recent years. While Americans got larger, so did some sections of the supermarket (hint - good idea to limit the consumption of products from those areas). Meat and seafood counters have shrunk, though. Produce areas seem to be about the same size as always (but more of it is pre-prepped and RTE in packaging.

But the chilled juice section is h-u-g-e! And no, I don't think there is a Florida orange grove behind the cases. Come on, how much juice do people need? Juice glasses used to be teeny tiny, for a good reason. To me it looks like a long wall stocked full of sugar water. Avoiding that section will put a nice dent in the grocery expenses.

The yogurt case is also e-n-o-r-m-o-u-s! Your 115 yo Bulgarian "grandmother" wouldn't know what to make of all these "pseudo-yogurts"! Chock full of every possible variety, but very little fit to eat. The only yogurts I'll look at are made with plain whole milk, without added gums, emulsifiers, or non-fat milk solids, and live cultures (I mostly buy yogurt now and then to refresh my starter culture at home). I can flavor them at home if needed. The sterols are showing up in processed yogurts, too, along with patented new strains of probiotic cultures (I'll stick to my old fashioned, but time-proven homemade lacto-cultured veggies and yogurt instead).

I found the same "cooler spread" in the butter & "spread" section. The spread options were just grotesque sounding. Actually, the butter options weren't much better, as many were blended with other ingredients to increase spreadability, reduce calories or cholesterol/saturated fat, etc. A few plain butters were enhanced with "butter flavor" - say what? And on no package could it be determined if the butter came from cows that were naturally fed on pasture or on grain in confined pens.



Well said, Anna.

There's a huge supermarket about 1 mile away from my house similar to the one Anna describes with aisle after aisle of eye-catching cellophane-wrapped foods. I go there about every 3 or 4 months, and then I only go to get something I need in a pinch. Every time I go, I too am reminded just how many products there are that look more like junk food than real food.

But there's no real money in real food. Who gets rich off of selling green peppers, tomatoes, and eggs?

Supermarkets sell these modern industrial foods because people buy it: Look around you. You don't get to be a 250 lb 5 ft 2 inch-woman by eating too many cucumbers.

Like Anna, I drive an additional several miles to Trader Joes', buy at farmers' markets whenever possible, buy some odds and ends like wine and cheese and raw nuts at specialty stores. I grow my own basil in a big pot I keep in the kitchen and we are just about to start turning over the soil in the back yard for our vegetable garden. I don't need nor do I miss having the choice among 40 different chips, 25 brands of ready-made microwavable dinners, an entire aisle of breakfast cereasl (all of which are virtually the same with different names and labels), or 75 varieties of salad dressing.

The supermarket for me--and I hope for many of you--has become a place rarely frequented, and only for the odd forgotten item. Oh, I forgot the dog chewies the grocery does have--my dogs love them. So perhaps they are good for something after all.

Comments (17) -

  • Anonymous

    3/17/2009 1:15:00 PM |

    A nice thought, to demodernize and go back to the days of a different shop and source for every grocery item, but even when trying to live clean, supermarkets can still win out budget-wise during these troubled times.  I'm mostly living off of frozen vegetables and lots of canned salmon etc.  The food *ideal*?  No.  But it's not trash, either.

    Don't throw out the baby with the bath water!

  • Brock Cusick

    3/17/2009 1:56:00 PM |

    The first and most important problem with grocery stores is that they're allowed to take bribes from the food vendors. That means they really work for the food vendors with the greatest degree of vertical integration, organization & bargaining leverage (e.g., Coca-Cola, Kellogs, the Florida Orange Growers Association, etc.) and not for the customers that shop the aisles.  This perverse incentive explains almost everything that's wrong with supermarkets today.

    The second biggest problem is that those same parties I mentioned above have taken control of the political process that governs nutritional disclosure, creating barriers of ignorance between "customers" at the grocery stores and truly useful information.

  • JPB

    3/17/2009 4:07:00 PM |

    Comment to Brock:  Your comment could also apply directly to the medical profession with a little editing!

  • Anonymous

    3/17/2009 5:37:00 PM |

    Anna is lucky to be able to find all these natural, organic, pasture raised produce, but some of us are not lucky enough to afford or find space for large freezers in our tiny apartment sized fridges. It's still winter here so no markets with fresh produce, no free range hens grazing in the snow and below zero temperatures. However, I do frequent the halal and polish meat markets whenever possible. We don't have a trader joe's and the 2 organic markets here may as well post a sign on the door "only millionaires can afford to shop here." Supermarkets are ok if you know what sections to shop in and what to buy. They are also starting to stock organic products like cheese made with raw milk (which is banned in Canada btw).

    Sorry about the rant but not everyone is as fortunate as others.

  • Lola

    3/17/2009 10:00:00 PM |

    Supermarkets will exist as long as there are people who are simply too busy or don't have the energy to get to all those different stores. In the old days when "main street" could still be counted on, you could go to the grocer, butcher, fishmonger, baker etc all within a short distance of each other. Now you often have to drive, bus, walk all over town to get to them.  For most low income people, this is not an option. Working two minimum wage jobs doesn't leave much time or energy except to get in and out of a supermarket as quickly as possible. A disabled person may not even have good access to some of these places. [When my hypothyroidism was at the height of its untreated awfulness, going to more than one store in a day was unthinkable.] Bear in mind also that many low-income people live in areas where the only food stores are a crappy supermarket and fast food outlets and no other places will open because they know nobody can afford it.

    If we *really* want to improve peoples' health, then we need to work on eradicating the causes and effects of poverty. It's no good if we get an organic market to open in the ghetto or rural town if people can't afford to go there or aren't able to get there. Perhaps instead of all the food subsidies going to Big Farming, we could subsidise business owners that wanted to open in low-income areas. But somehow when the government uses money that will help the poor it's Evil Pinko Commie Welfare but when giving the same money to big business it's fine and dandy. That's why I don't think the government (and it doesn't matter whether Democrat or Republican) doesn't actually care about health despite all the bleating about obeeeeeesity.

  • baldsue

    3/17/2009 10:53:00 PM |

    Nope, I didn't slim down from size 14 to size 2 by walking the aisles of my local supermarket.  Instead I rode my bike to the farm down yonder for my fruits and veggies and I hopped into my car to drive to Trader Joes and Whole Foods for the rest of my nutrients.  And that's the way it's going to stay for me.

  • vin

    3/18/2009 10:55:00 AM |

    I buy all my fresh greens, fruits, fish and nuts from my supermarket. Frozen and canned foods are useful in the winter months.

    Rest of the food asiles are simply not interesting.

    Local green grocer's shop has usually little choice and very often unripe food.

    Just look around in the supermarket and you can find almost everything you need to stay healthy.

  • Kipper

    3/18/2009 11:35:00 AM |

    Supermarkets are to some extent what you make of them. I end up at Safeway fairly often due to my schedule, but I couldn't tell you what was in most of the interior aisles or freezer cases.

  • Anne

    3/18/2009 1:08:00 PM |

    There's no fishmongers or butchers which sell organic produce near me, and no greengrocers which sell organic produce either, nor farmer's markets, but I hardly ever set foot in a supermarket ! Instead I shop online in the comfort of my living room from them ! I buy organic meat, fish, fruit and veggies, tea and coffee, and household items, from my supermarket, but because I buy online I don't have to pass shelves and shelves of junk food and get a headache from the bad atmosphere there. The prices are the same whether online or in store and there's no delivery charge because I get my shopping mid week - it's a fantastic deal which saves stress, time and money Smile

    Anne

  • Anonymous

    3/18/2009 2:37:00 PM |

    Good points made in the above comments!

    I would LOVE a Trader Joe's or a farmers market, or even a Whole Foods market in my area... they aren't here in the suburbs where I live... all are 20 miles away in the city, or simply non-existent here.

    It just doesn't make sense to drive that far for my food (utilizing some of the outlets quoted by Dr. Davis in his blog post), and only patronizing some of these type outlets frankly sounds a bit elitist... and quite expensive, too.

    Rather, the commitment to good health requires some resourcefulness... I'm into figuring out what I CAN healthfully eat from Randall's (Safeway), Kroger, H*E*B, and Costco... stores reasonably close.  I'm into planting my own fresh herbs, and a small "victory" garden of vegetables we enjoy... it's fun, challenging, and good exercise, too.

    But I am fortunate... I have a generous food budget, I live in a reasonably populated area, with excellent weather and growing conditions most of the year, and access to fresh produce and quality supermarket foods year round.  Just mostly stay away from the center of the supermarket, be knowledgeable and selective while there, and you will be fine... that's my advice... oh, and if people don't continue to buy junk, the "supers" won't be stocking it for very long.

    madcook

  • Gretchen

    3/18/2009 3:24:00 PM |

    I agree with some others that not everyone can afford to shop at upscale organic markets. Not everyone has access to locally produced farm produce.

    We have to work with what's available, and unfortunately, the people who need the most help nutritionally are the ones who can't afford fresh food.

    We need to educate people about how to find better food at a supermarket.

  • scall0way

    3/18/2009 3:47:00 PM |

    OK, I shop at a supermarket! But I'm mostly a "perimeter shopper" - produce, dairy, meats, etc. But it's convenient because I can buy things like paper goods, detergents, light bulbs, all those other non-food items that supermarkets carry. The place is only a little over a mile from my house. I save on gas and energy. I do love the local farmer's market - but it's only open June-November. I do love Trader Joe's - but there are none nearby. It's a haul to get to one, so I limit my trips. I love Whole Foods, but it's too expensive other than for certain special items.

    But I would not even give my *dogs* food or treats from a supermarket. We get our food and treats from a pet store whose philosophy gibes pretty well with my own. Founded to: "provide our customers with the healthiest foods, best products and highest quality of pet-animals ever assembled in one store...We believe that animals should eat what nature intended them to eat, along with a variety of natural supplements."

    LOL, not only is my own health better these days, but so is the health of my pets. Smile

  • Monica

    3/19/2009 8:44:00 PM |

    Pet snacks from the supermarket?!  Smile

    OK, I have to admit that made my eyebrows go up.  I happened upon healthy eating for myself by first figuring out what was healthy for my pets when the pet food scare happened a few years ago.  I doubt dog chewies contain melamine, and perhaps they aren't a routine in many households, but they're not an evolutionarily appropriate food for dogs.  The only pet snacks I get at the supermarket are the big chunks of raw meat that get thrown to my dog and cats daily... the food they were designed to eat.  (I can almost hear people exclaim how expensive this is but it's way cheaper because the meals themselves are treats because they take 15-30 minutes to eat.)

    90% of the stuff in the grocery store isn't fit for human consumption, that's true.  However, it's still very handy for many things.  You can completely avoid the unhealthy stuff with a little effort.  That's not even remotely possible in the pet aisle in which every single product is a derivative piece of frankenfood.  

    Throw your dog or cat a raw meaty bone and some organ meats now and then.  They will thank you with good health once they have been getting real food long enough.  You will never need a $300 tooth cleaning at the vet, that is for sure.

  • Rob

    3/19/2009 9:30:00 PM |

    From what I have seen of TJ's and Whole Foods, you can do yourself a lot of the same harm in the center of these stores as the local MegaMart.   Stick to the outsides no matter which store you shop in.  Although! I will say that I recognize most of the ingredients in JT's inner aisle food, not so true of the supermarket! And I like the sardines at TJ's.

  • Anna

    3/21/2009 7:48:00 AM |

    Great comments, everyone.  Yes, it's true, we all have different circumstances, different locations and climates, different food budgets, and different ways of coping with our food sourcing options.   The most important thing is to find what works best with the resources/options one has (assuming one knows all the resources).  But so many don't even ever consider looking "outside the box" or think about how to do it without relying on a supermarket.  I am continually amazed at how many terrific resources are out there, not just here in So Cal, but in many communities, practically in people's own backyards, but they don't know about it or take advantage.

    Even the 99 cents store has some good options, if one can avoid the minefields of cheap sugars, starches and processed foods.  That's were I go to shop for  my donations to the local food pantry, where they mainly want non-perishables in unbreakable packaging.  I buy canned and pouched salmon, sardines, and tuna there, because I know so few complete protein foods are donated.  

    I do think it's possible to eat pretty well from a supermarket *if* one is disciplined, truly informed and willing to forgo convenience for real food, but there are so many hazards at the supermarket that many can't easily avoid or don't know to avoid (especially if they are paying attention to mass media nutrition advice).  I'm sure it didn't save me any time to shop there way back when and it certainly wasn't very enjoyable.  I know I spent more money there for food that wasn't as good for us (I was too easily tempted and distracted too often), despite ironically trying very hard to pinch pennies with coupons, sale circulars, buyer's cards, and shopping around.  

    We *are* fortunate with our mild local climate and long growing season, but I know people in Madison, WI and upstate NY who have great produce from their CSAs, too, just in a shorter time frame (though many practice traditional food storage methods, like root cellaring and lacto-fermentation to extend the harvest).  Some CSAs allow for a trade of labor instead of payment, too.  My neighbor and I take turns on pickups for our biweekly CSA boxes, so I only have to make a 14 minute (round trip) drive once a month for most of my produce, a huge timesaver (I do understand there are transport issues for some people and I know I'm fortunate to have a car, but I *could* (but don't very often) ride a bike to get my food at stores or the CSA spot, too - I have two shopping baskets that easily detach from the rear rack).  My CSA pickup point is in the other direction of the stores, but only a tiny bit farther and in a somewhat rural, natural part of town, far more pleasant than the long cashier lines, parking lots,  and stop-& go traffic hazards near the stores.

    I'm probably going to host a new pickup point next quarter at my house, so now our community will then have east, west, *and* a central pickup location, making this CSA even more convenient for more people who want to join (there's a waiting list).  The CSA can to expand from 1500 to 2000 members if they add some new pickup spots.  New CSAs with slightly different membership models have started up in recent years offering even more choices for people, too.

    But is it more expensive?  My CSA's large biweekly box costs $30 (there are two sizes, with weekly or biweekly options and any number of boxes can be canceled in advance before the start of a quarter, with 2 allowed cancelations with notice during the quarter - so it's quite flexible).  Members pay for their boxes in advance for a quarter year (though if I host a weekly pickup spot in the future, I'll get a box for free); I think $15 a week for the generous amount of high quality, just picked produce is *very* competitive with any store of any caliber in my area (except maybe the super low prices at the 99 cent store are less, but even then it would be close in cost; the variety and quality of the 99 cent store produce doesn't even come close).  I know people who spend that much or more on a delivery pizza or takeout for one meal for their family (or dvd rentals for the weekend).  I think I could only do better if I grew it all myself (instead, I put my edible gardening efforts into "special" crops or lazy things like bananas, fig and citrus trees).

    We love eggs and consume a lot each week in many varied dishes.   The eggs I buy via my neighbor's co-worker are $1 cheaper per doz than the eggs I would buy in the store(thankfully my neighbor doesn't mind transporting several doz eggs once a week to me).   Prior to that, I had a "backyard" egg source that was even cheaper (half the store price), *and*  (maybe this is the elitist aspect) they delivered them to a cooler on my front porch because they were already delivering meat, eggs, and goat milk to a local alternative health institute (until the couple split up and ended their "backyard" farm business).  

    One of the few places I do get take-out now and then is the local, family owned (non-franchise) rotisserie chicken place.  I make salad and veggie sides at home, though.  Great chicken using marinade  ingredients I might use at home if I were roasting the chicken;  5 quarters (an extra leg) when you buy a whole chicken for $10 (it's the only thing I buy there, our family of three can eat off it for at least 2 meals, plus soup, and it doesn't have the chemical injections that the cheaper grocery store rotisserie chickens contain).   I watch other families spend $20-30 for a single meal every time I go there.  I often ask for 5 pieces to be legs because I know they always have lots legs (and they have more flavor and moisture), since nearly everyone else requests the "healthy" chicken breast combos.  Sometimes they have extra cooked whole chickens in their cooler for $4 (from earlier in the day or the night before), so I always get one or two extra when available.  And the old guy at the counter is always happy to make up a huge container of wings, backs, and meaty scraps for me, for my chicken broth; it makes really great mineral-rich flavorful broth.   So I have a cheap streak that wants to eke out everything but the cluck Wink.  I know families that throw away more food than my family eats.

    So clearly, I don't think putting a priority on wholesome unconventionally sourced food is necessarily really expensive, nor is it "elitist" at all  - we don't drive fancy cars and make other decisions that allow eating good food easier (both my husband and I grew up in families where money was quite scarce for significant periods of time, but both our mothers were extremely resourceful when it came to nourishing, economical food - so we are *very* mindful of how fortunate we are).  The  "elitism" charge that often comes up in food issue discussions distracts from the real issues.  I'm not suggesting there aren't considerable barriers to eating well for some people, there are, and some are very hard to overcome.  I donate regularly to the local food pantry and am very aware of local "food insecurity" issues, which of course have worsened  lately.  I'm also aware of how difficult it is to get fresh, nutrient dense food into the hands of those most needing it.

    But not everyone is in that sort of position, and some non-supermarket options can sometimes actually work better for people with difficulties sourcing good food, though of course, that will vary to situation to situation.  I'm just suggesting that it can be worth looking for alternatives; there *are* other options "outside the box" in many, if not most places; it sometimes just takes the desire and creativity to find and access them.  And sometimes it requires shifting priorities, which can be hard to do (especially if lacking support from significant others).  Believe me, my husband and I have shifted some of our priorities (financial as well as lifestyle considerations) to accommodate good food (and sitting down to meals together most nights) being high on our list of priorities.  We want to eat well, but that doesn't necessarily mean extravagantly.

  • Dr. William Davis

    3/21/2009 5:55:00 PM |

    Thanks for the well-thought out description of your experience, Anna.

  • Trinkwasser

    3/21/2009 7:50:00 PM |

    A big AMEN!!! from over here. I treat most of the supermarket as a toxic waste dump. Mother likes it because it's cheap and the floor is level. The rest of the town is on a hill and she has difficulty with hills so I get the rest of the stuff from the local shops.

    Mind you, the Organic Shop is something of a toxic waste dump too if you're trying to avoid carbs. And the supermarket is better than many others I've used in the past (Co-Op), they have Fairtrade stuff and the veggies aren't that bad. When I worked full time it was nearly as good as shopping around, you traded quality for convenience to a degree but you need discipline to work one properly.

    Can't beat locally grown meat, fish and veggies for quality though and sometimes they're not that much more expensive and occasionally cheaper, plus the money goes to local businesses rather than to anonymous shareholders: don't forget that supermarkets get their low prices by screwing their suppliers.

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Roto Rooter for plaque

Roto Rooter for plaque




Joe, a machinist, was frightened and frustrated.

With a heart scan score of 1644 at age 61, his eyes bulged when I advised him that, if preventive efforts weren't instituted right away, his risk for heart attack was a high as 25% per year. Joe had "passed" a stress test, thus suggesting that, while coronary plaque was present--oodles of it, in fact--coronary blood flow was normal. Thus, there would be no benefit to inserting three stents, say, or a bypass operation.


(Illustration courtesy Wikipedia)

"I don't get it, doc. Why can't you just take it out? You know, like Roto-Rooter it out? Or give me something to dissolve it!"

Of course, if there were such a thing, I'd give it to him. But, of course, there is not. It doesn't mean that there haven't been efforts in this direction over the years. Among the various attempts made to "Roto-Rooter" atherosclerotic plaque have included:

Coronary endarterectomy
This is a drastic procedure rarely performed anymore but enjoyed some popularity in the 1980s and 1990s. Coronary endarterectomy was performed during coronary bypass surgery, but few thoracic surgeons performed it. Milwaukee's Dr. Dudley Johnson was the foremost practitioner of this procedure (retired a few years ago after his own bypass operation) with a mortality in excess of 25%. A very dangerous procedure, indeed. The technical hurdle, beyond the tedium and length of time required to remove plaque that had a tendency to fragment, was blood clot formation after tissue was exposed upon plaque removal. I saw many lengthy hospital stays and deaths following this procedure.

Coronary atherectomy
This is an angioplasty-type procedure that has gone through several variations over the years.

In the early 1990s, transluminal extraction atherectomy (TEC) was a technique involving low-rpm drill bits with a suction apparatus that was used to clear soft debris, usually from large coronary arteries or, more commonly, bypass grafts. Then came direction atherectomy, in which a steel housing contained a sharp drill bit that captured atherosclerotic plaque in an aperture along the housing length and stuffed it into a nosecone, retrieved once the device was removed.

Then came high-speed rotational atherectomy in which a diamond-tipped drill bit rotated up to 200,000 rpm and essentially pulverized plaque to flow downstream and, presumably, eventually captured by the liver for disposal. Rotational atherectomy is still in use on occasion. Laser angioplasty, usually using the excimer wavelength, vaporizes plaque. I did plenty of all of these back in the early and mid-1990s.

While all atherectomy procedures sound clever, they are all plagued by the same problem: vigorous return of plaque. Remove plaque, it grows back. There are few instances today in which atherectomy is still performed.

Chelation
This involves a metal-binding, or "chelating," agent like EDTA normally used in conventional practice for lead poisoning. Usually administered IV, some have also advocated oral use. People who use chelation also tend to believe in faith healing and other practices based on faith, not science. There is an international trial that is nearing completion that should provide the final word on whether there is any role to intravenous chelation.

There are numerous other oral treatments that claim a Roto-Rooter-like effect. Nattokinase, for example--an outright, unadulterated, and unqualified scam.

Unfortunately, the helpless, ignorant, and gullible are many. When frightened by the specter of heart disease, there are plenty of people who will willingly pay for the hope provided by clever ads, fast-talking salespeople, and unscrupulous practitioners.

So, Joe, there is no Roto-Rooter for coronary atherosclerotic plaque, at least one that is safe, doesn't involve a life-threatening effort, provides results that endure beyond a few months, and truly works.

The Track Your Plaque program may not be easy. There are obvious common hurdles to adhering to these concepts: obtaining lipoprotein testing, getting intelligent interepretation of the results, persuading your doctor to measure vitamin D blood levels, battling the onslaught of prevailing food propaganda that confuses and misleads. The Track Your Plaque program also requires time, at least a year.

But it's the best program there is. Do you know of anything better?

Comments (4) -

  • jpatti

    11/4/2007 8:32:00 PM |

    I find this post amusing because it was my exact question after my bypass... how do you *reduce* arterial blockages?  Looking for an answer to that question is what led me to this blog, your book, and the TYP site.

    Personally, modifying my diet and swallowing a few pills of fish oil, vitamin-D and niacin is a heck of a lot preferable to a bypass!  By my scale, this program is *easy*.

  • Anonymous

    11/5/2007 4:26:00 AM |

    Doc, would like your opinion on the efficacy of carotid IMT test measuring plaque?

  • Dr. Davis

    11/5/2007 4:33:00 AM |

    Please see numerous prior posts about this question.

  • buy jeans

    11/3/2010 2:30:52 PM |

    These red flags are not perfect. If you lack any of them, it doesn't necessarily rule out the possbility of having Lp(a). They simply serve as signs to suggest that Lp(a) may be lurking.

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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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