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.
Is pomegranate juice healthy?

Is pomegranate juice healthy?


Pomegranate juice, 8 oz:

Sugars, total 31.50 g

Sucrose 0.00 g

Glucose (dextrose) 15.64 g

Fructose 15.86 g




In your quest to increase the flavonoids in your diet, do you overexpose yourself to fructose?

Remember: Fructose increases LDL cholesterol, apoprotein B, small LDL, triglycerides, and substantially increases deposition of visceral fat (fructose belly?). How about a slice of whole grain bread with that glass of pomegranate juice? The Heart Association says it's all low-fat!


(Coming on the Track Your Plaque website: A full in-depth Special Report on fructose in all its glorious forms and whether this is truly an issue for your health. Fructose tables and the scientific data to establish a safe "threshold" value will be included.)

Image courtesy Wikipedia

Comments (20) -

  • Anonymous

    7/19/2009 1:45:42 PM |

    all should keep in mind that 4 grams of sugar is equal to one teaspoon.  31 grams is 7 teaspoons plus; not exactly what one would think in what is promoted to be a healthful product!

  • John

    7/19/2009 2:15:04 PM |

    Like most juices, pomegranate juice just has too much sugar.  There is a reason why a juice glass is very small!

    I don't buy pomgrante juice anymore, and when I did I would water it down.  100% is very expensive too.

    Another thing about pomegranate juice, people might be surprised to find that many of them are not 100% pomegranate, but a blend of several juices.

  • Andrew

    7/19/2009 3:59:34 PM |

    At what point do the positive health benefits of pomegranate outweigh the bad parts of fructose?

  • Tom

    7/19/2009 4:20:58 PM |

    Thanks for your great blog! Your information on wheat and sugar is a must read for anyone serious about their health. I like your blog so much, I added a link to it at my blog at http://eatingandfasting.blogspot.com/

  • Anonymous

    7/19/2009 6:07:12 PM |

    Dr. Davis,

    Are you implying that there is no difference between a glass of Kool-ade and a glass of fresh Orange Juice?

    IMO, the problem is not fructose. The problem is highly refined sugar sources that are isolated from their highly complex natural matrix of fiber, vitamins, minerals, flavanoids, antioxidants, enzymes, amino acids--all which act in synergy together.

    That's why PJ reduced atherosclerosis by 35% compared to control group, lowered BP by 20%, increased antioxidant status, and did not raise blood sugar.

    (FYI, I happen to have heterozygous FH and drink daily one full glass of PJ along with one full glass of concord grape juice, and 97% of my LDL particle size remains large, my blood sugar is perfect, and my apo B is not too high. I do avoid refined sugars and carbs, however.)

    So please, Dr. Davis, don't compare an apple with a candy bar.

  • AJ

    7/20/2009 4:52:14 AM |

    Guava juice used to be my particular poison - literally speaking. But it's just not worth the hit to my metabolism. It's been awhile since I last drank any fruit juice and it will be never before I drink it again.

    It's an uphill battle to get people to realise the dangers of fructose, particularly when food manufacturers are allowed to put "No sugar added" on the label. Have them put the grammes of sugars the whole bottle contains on the front of the container in large bright type. It won't stop everyone, but it may help a few people make healthier choices.

  • JC

    7/20/2009 10:55:48 AM |

    Pomegranate juice more than triples PSA doubling time.Is that significant?

  • Peter

    7/20/2009 1:56:43 PM |

    I like to dilute the pomegranate juice with vodka.  That way I only use a couple of ounces of juice at a time, minimizing the fructose but still getting some flavanoids.  Of course once the long term study on this regimen comes out I may have to revise my view.

  • Dr. William Davis

    7/21/2009 3:28:52 AM |

    It's the same flawed logic of "healthy whole grains": If it contains something good (B vitamins, fiber), then it must be good. And it must be even better when consumed in greater quantities.

    Just because it contains one or two desirable ingredients doesn't mean that the entire "package" is desirable,

  • niner

    7/21/2009 5:00:09 AM |

    There's always pomegranate extracts.  You can get the polyphenols in a pill without all the sugar.  I'd be interested in what Dr. D thinks about this form of "sugar-free pomegranate".

  • JC

    7/21/2009 11:19:40 AM |

    Dr Davis,What about the research on pomegranate juice and PSA doubling time?

    Can you also comment on the reported benefits of cranberry juice in preventing urinary infection?

    Thanks,JC

  • Jonathan Byron

    7/21/2009 3:12:18 PM |

    You are absolutely right that fruit can contain large amounts of fruit sugar, and that large amounts of fructose can have serious consequences. The idea that fruit juice must be good (in any quantity) is not supported by the evidence.

    But fruits are more than sugar and moderate amounts of fruits and fructose are not inherently bad - the question is what is reasonable. For those of us with fatty liver, certain patterns of dyslipidemia, or a GI fructose intolerance, the ideal amount is very low. For those who don't fall into that category, the ideal amount of fruit is somewhat greater (but probably less than most people assume).

  • Anna

    7/22/2009 10:22:04 PM |

    I can't remember the last time I saw someone outside my household drink juice from a small juice glass.  Most people I see drinking juice are consuming quantities of juice that practically rival a 7-Eleven Big Gulp.

    Many days I squeeze a half orange to make a couple ounces of OJ to mix with cod liver oil to make the CLO palatable for my young son.  

    To fill a 4 oz juice glass (with about 3-3.5 oz juice), it takes 1-2 oranges, which means that larger glasses of OJ contain the sugar of a whole lot of oranges!  Who would ever eat that many whole oranges in one sitting?

    Also, I know from using a glucose meter that OJ sugar is nearly instantly into my blood stream (and that isn't even measuring the affect of the fructose portion of sugars.  The glucose spikes an insulin response and later a nasty feeling low BG.  So I approach fruit juices with extreme caution and limitations on both quantity and frequency.  I eat whole lower sugar fruits in extreme moderation (avoiding higher sugar tropical fruits).  I focus more on non-starchy veggies rather than fruit, anyway, because veggies are high in the nutrients I want without the excess sugar that fruit has.        

    Not long ago I was in waiting in line at a Starbucks to order an Americano (lack of local coffee shops at that particular suburban area) and right next to me a dad was reading aloud to his young daughter the number of grams of sugar from her “fresh-squeezed 100% fruit juice” bottle label. He noted incredulously there were 30-something grams of sugars per serving and there were 2.5 servings per bottle. He said  â€œwow, that’s a lot of sugar in that bottle”. I thought to myself, wow, here’s a dad who is “getting it”, so I said to him, “there’s 4 grams of sugar to a teaspoon, so that’s at least 7-9 teaspoons of sugar per serving, very nearly the sugar content in soda.”

    His response was, “but it’s fruit sugar, and she doesn’t eat enough fruits and vegetables, so I guess that’s ok.” Sigh. I let it go, and ordered my Americano (unsweetened).

    I've had many interesting conversations with a glycobiologist colleague of my husband's.  He has confirmed I'd be wise to keep all sources of fructose intake to a minimum, as well as being especially wary of concentrated sources of fructose.    I'm sure he follows his own advice; he's looks at least 15 years younger than his 60 years - lack of AGEing, I guess.

  • trinkwasser

    7/29/2009 6:04:30 PM |

    Tell this stuff to a dietician and they won't believe you "but it's low fat!"

    My BG meter tells me fruit juice is an exceedingly toxic substance, and most of my once favourite fruits aren't much better.

    Fortunately it permits me to eat a few berries, but I'd rather get my bioflavinoids etc. from vegetables.

    IMO there's a balancing point between the beneficial and non-beneficial properties of many foods, we probably evolved to deal with small acute doses of toxins but fall apart with chronic exposure to high levels of the same stuff, and all the bioflavinoids and vitamins don't outweigh the damage.

    I just stuffed some strawberries in my face following my lamb chops and runner beans, but only a few, and I washed them down with a fine Bordeaux, that'll about achieve a balance.

  • Barrry

    2/22/2010 12:58:33 PM |

    i have been using Pomegranate juice for 3 years every day after i had 2 stents placed. i also had type 2 diabetes. It has worked very well for me and has not effected my A1c in the least. My cardilogical nuclear studies have been perfect. i am a believer my opinion this stuff can save your life.

  • EMR

    2/24/2010 1:33:43 PM |

    ink it should be avoided by sugar patients.It contains almost a spoon of sugar...though with wheat bread the whole effect of the meal is balanced.

  • Anonymous

    3/8/2010 3:03:37 PM |

    http://www.nutraingredients-usa.com/Research/Pomegranate-juice-shows-possible-diabetes-benefits

    Quit being sugar paranoid.

  • buy jeans

    11/3/2010 3:09:20 PM |

    Remember: Fructose increases LDL cholesterol, apoprotein B, small LDL, triglycerides, and substantially increases deposition of visceral fat (fructose belly?). How about a slice of whole grain bread with that glass of pomegranate juice? The Heart Association says it's all low-fat!

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