Throw away total cholesterol!

17. May 2006 William Davis (1)
Richard's total cholesterol without treatment was 186 mg/dl. "That's great!" his doctor declared, referring to the conventional dictum that total cholesterols less than 200 carry low risk. Several fingersticks in a mall kiosk set up by a local hospital to check total cholesterols confirmed Richard's low number.

But after Richard's unexpected hospitalization and two stents for severe coronary blockages, he demanded better answers.

Tragically, the answer was there all along: Despite a "favorable" total cholesterol, his HDL ("good") cholesterol was a miserable 32 mg (ideal >60 mg).

Total cholesterol is actually the sum total of HDL cholesterol, LDL cholesterol, with a contribution from triglycerides. That's why a low total cholesterol can conceal a low HDL.

This situation is quite common. And low HDL is accompanied by a constellation of other undesirable causes of heart disease, most notably small LDL.

Don't accept total cholesterol as your sole measure of risk. It's nearly worthless. If you live in Bangladesh or a third world country, well perhaps that's the best you can get. But if you live in the U.S. or developed world, it's absurd to rely on total cholesterol.

Smart Start not so smart

15. May 2006 William Davis (2)



Kellogg's has crafted a campaign to support the American Heart Association featuring acress Sela Ward. Her attractive face, familiar to many TV and movie viewers, does add a comforting face to their efforts.

What's in this cereal made by the manufacturers of Pop-Tarts, Cheez-It, Rice Krispies, and Chips Deluxe cookies?

There are, indeed, some healthy ingredients: oat bran, potassium; you can even get a version made with soy protein. But there's sugar listed as the second ingredient. High-fructose corn syrup is also listed prominently. (Remember this issue? High-fructose corn syrup causes overwhelming sugar cravings, causes your triglycerides to skyrocket, and is probably among the principal food ingredients that make you obese.)

Upon detailed questioning of my patients struggling to lose weight, this and products like it are often among the "healthy" foods they've gravitated towards. We spend a great deal of time dissuading them of this idea.

A one-cup serving of Smart Start is low in fat (1 gram) but contains 43 grams of carbohydates, of which there are 14 grams of sugar. There are a meager 3 grams of fiber. To me, this sounds like a cupcake.

The Kellogg's people are exceptionally clever marketers. Partner with the American Heart Association and movie stars? Brilliant!

You should trust food manufacturer advertising about as much as you trust drug manufacturer advertising, which is to say not at all.

Kellogg's sold $10 billion dollars of food products last year. They are the world's leading producer of breakfast cereals. They are a leading producer of convenience foods: cookies, crackers, cereal bars, and frozen waffles under the brands Keebler, Pop-Tarts, Eggo, Cheez-It, Nutri-Grain, Rice Krispies, Famous Amos, and Kashi.

Can they cash in on healthy trends? They'll certainly try.

Does anybody have a normal vitamin D level?

15. May 2006 William Davis (0)
We now routinely check everyone's vitamin D blood level at the start of the program. (The measure to obtain is 25-OH-Vitamin D3. This is not to be confused with 1,25-OH2-vitamin D3, which is a kidney function measure.)

Of the 10 people with levels drawn today, none were even close to normal levels (which we define as 50 ng/ml)--not a single one.

The majority were in the range of severe deficiency (<20 ng/ml). Only two had levels in the 30s. None had higher. (Remember: I'm talking about people in Wisconsin, a terribly sunlight-deprived area much of the year. This might not apply quite as vigorously to Florida residents or others in sun-exposed regions.)

Curiously, I've also seen several people this week who had extraordinary quantities of coronary plaque on their heart scans (scores >1000), all of whom had extremely low vitamin D levels. One of these people had fairly unimpressive lipoproteins, with very minimal abnormalities identified. (This is quite unusual, by the way.) It makes you wonder if a profound deficiency of vitamin D is sufficient to act on its own as an instigator of coronary plaque.

The more we examine the issue of vitamin D deficiency, the more fascinating it gets. I suspect we've just scratched the surface and there's a lot more to learn about this tremendously interesting nutrient. Nonetheless, with what we're seeing in our experience, I'm urging everyone to get a blood vitamin D level.

Don't believe your LDL cholesterol!

14. May 2006 William Davis (0)
Harry's case is typical. For years, his doctor told him his LDL cholesterol of 123 mg was okay. But a heart scan score of 490 (90th percentile at age 52) made him question just where his coronary plaque came from.

Lipoprotein analysis told a very different story: His LDL particle number was 2400 nmol, meaning his trueLDL was more like 240 mg, nearly double the value of LDL obtained through his doctor. Harry had other sources of risk, too, but the LDL particle number was a clear stand-out.

Why does this happen? How can LDL cholesterol be so terribly inaccurate?

LDL cholesterols obtained in virtually all labs are not measured, they're calculated. The calculation was developed in the 1960s by Dr. Friedewald at the National Institutes of Health and therefore goes by his name (the Friedewald calculation). Dr. Friedewald derived this simple calculation to permit doctors across the U.S. to obtain LDL cholesterols, which were technically difficult to measure in those days by using measured HDL, total cholesterol and triglycerides.

Doctors were told that the only time that the Friedewald calculated LDL was inaccurate was when triglycerides exceeded 400 mg. So most family practitioners and internists still believe that calculated LDL's are, for the most part, quite accurate.

Nothing could be further from the truth. When LDL's are actually meaured, you find that LDL is rarely accurate. In fact, in our experience, inaccuracy of 30-50% is the rule, sometimes 100%. The one telltale hint that calculated LDL is wrong is when HDL is <50 mg--that's nearly everybody.

So what's your LDL? You won't really know unless it's measured. Our preferred method is NMR (LipoScience) LDL particle number, probably the most accurate of all. Second best: apoprotein B, direct measured LDL, and non-HDL. (We'll cover this issue much more extensively in an upcoming report on the www.cureality.com website in an extensive Special Report.)

Are you the exception?

14. May 2006 William Davis (0)

I read about 40 heart scans this morning. In the stack was a 41-year old man with a heart scan score of 841.

That's terribly high for anyone, let alone a 41-year old person. He's lucky to find out about this before catastrophe strikes.

People like this worry me. In general, we advise men to consider a heart scan age 40 and older; women 50 and older. If there's anything exceptional about your family history or your own history, then you might notch these numbers down another 5-10 years. For instance, if your Dad had a heart attack at age 43, you might consider a scan at age 35. Or, if you've had diabetes for several years and you're a 42-year old woman, you might think about a scan. (Men tend to develop measurable plaque by heart scans 10 years before women.)

There are no hard and fast rules. It's unusual for a male to have a score >0 before age 40. Likewise, it's very uncommon for a woman to have a score >0 before age 50. But there are occasional exceptions--but they can be very important exceptions.

Our 41-year old man with the score of 841, for instance, probably had a high score since his mid-30s. I've seen several women without any obvious risk factors with scores in the several hundred range in their early 40s.

My rule: When in doubt, opt for safety. Every day, I still read about people in their 30s, 40s, and 50s dying of heart attacks. It shouldn't happen.

When in doubt, get the heart scan. The most you'll lose is the cost of the scan and a modest exposure to radiation. If your score is zero, you know you're safe for the next 5 or more years. But if you have an exceptional score at a young age, take preventive action.

Self-empowerment in health: The new wave in health care

12. May 2006 William Davis (0)
Track Your Plaque is just one facet of the broad and powerful emerging wave of self-empowerment in health.

Hospitals, drug and device manufacturers, and the medical establishment don't like this idea. People managing their own health? That's ridiculous! Dangerous! But mostly unprofitable.

Self-empowerment means having easy access to simple, safe, and inexpensive diagnostic tests like heart scans, carotid scans, bone densitometry (for osteoporosis), cholesterol tests, abdominal ultrasound, even brain scans (e.g., CT or MRI) for people with a family history of brain aneurysm.

Opponents of this idea worry about the "false-positives" that come about with broad testing, i.e, detection of abnormalities that are artifactual. Our experience is that false-positives are only an occasional problem with any test. Instead, we find that most people have many true-positives. In CT heart scanning, for example, we find many unsuspected enlarged aortas (potential future aneurysms), valve disorders, and aortic calcium. These are all important in a preventive program. Unfortunately, your doctor's definition of false-positive often means that no corrective procedure or operation is required.

Other evidence that self-empowerment in health is growing:

--The nutritional supplement movement. What better example of power in managing your own health is there than the fabulous array of nutritional supplements available?

--Medications moving to over-the-counter status. Gradually, more and more medications are trickling into availability for you to obtain without a doctor's prescription.

--What I call "retail imaging", i.e. screening ultrasound, heart scans, full body scans, etc. that are available in most states without a doctor's order.

--The Internet. The rapidity and depth of information available on the Internet today is mind-boggling. It will fuel the self-empowerment movement by providing sophisticated information to the health care consumer previously available only through your physician.

--High-deductible health insurance plans. If health care consumers will bear more and more of the costs of health care, they will seize greater responsibility for early identification and prevention to minimize long-term costs.

There are more. But the movement is powerful and broad--and unstoppable. Let the establishment with vested interests in preserving the status quo fuss and complain, just like horse and buggy manufacturers did in the early 1900's when the autmobile came along.

Vitamin D deficiency is rampant

12. May 2006 William Davis (0)
Today alone I've seen several people with severe deficiencies of vitamin D.

We're now checking everyone's blood vitamin D level at the start of the program. The measure that most accurately reflects your vitamin D status is 25-OH-vitamin D3. This is very confusing to many physicians, who traditionally have thought of 1,25-di-Hydroxy vitamin D3 as the standard test to measure. What they're failing to recognize is that this second measure is a kidney product, not a reflection of vitamin D status.

Using 25-OH-vitamin D3, several people today alone had levels of <10 ng/ml, clearly in the category of severe deficiency (generally regarded as <20ng/ml).

The majority of people we see in the office are Wisconsin residents. It's no wonder they're deficient. Although it's mid-May, we've seen the sun only a handful of days this year. And most of the days have been too chilly to wear short sleeves and shorts to permit sufficient surface area for UV exposure.

Living in a sunny climate, however, is no guarantee that you have sufficient blood vitamin D levels. Two recent studies have shown that 30-50% of the residents of sunny southern Florida and Hawaii are also deficient. (Why, I'm not sure.)

Although our experience thus far is anecdotal in several hundred people, my impression is that people who have normal blood levels of vitamin D (we regard normal as 45-50 ng/ml) have a far easier time of halting or regressing coronary plaque.

Vitamin D is among the most exciting nutritional tools we've come across in a long time. The conversation is making the media, which impresses me tremendously, given the fact that nobody stands to profit financially to any significant degree through vitamin D supplementation.

For a wonderful collection of discussions on vitamin D, go to Dr. John Cannell's website, www.vitaminDcouncil.com. You'll find a huge quantity of scientific background and conversation on the whole idea. I believe you will be thoroughly impressed with just how powerful the argument in favor of vitamin D has become.

What if wheat products were illegal?

11. May 2006 William Davis (3)
Imagine if anything made of wheat were illegal: bread, bagels, crackers, pasta, pretzels, donuts, Shredded Wheat cereal, Raisin Bran, pastry, cookies, cakes, cupcakes. . . Your grocery store would then be unable to carry any of these products.

How empty would the grocery store shelves be?

There would be very little. The stores would be filled instead with vegetables and fruits, meats, and dairy products. But aisle after aisle would be empty. There'd be no cereal aisle. There'd be no snack chip aisle. The ordinarily overcrowded bread shelves wouldn't be there.

Bakery? Nope, not there either. Pasta and noodles? Empty. How about cakes and pastries? Also gone.

Getting the picture? American groceries are dominated by wheat products. What would happen to your health and the health of your family if wheat were abruptly removed from your choices? Would you be less healthy?

No. In fact, your health would be hugely improved. You'd lose a significant quantity of weight. Extraordinary numbers of people would lose diabetic or pre-diabetic tendencies. Feelings of sluggishness, sleepiness, and moodiness would dissolve. Blood pressure would be reduced. The incidence of cancer, skin disease, and inflammatory diseases would plumet.

From a plaque control perspective, your HDL cholesterol would rise, triglycerides drop. Small LDL would improve dramatically.

The message: Slash wheat products from your diet. Yes, you'll miss the smell and taste of freshly baked bread. But you'll do it for many more healthy years. And you may do it without a 14 inch scar in your chest.

The sobering tale of small LDL

10. May 2006 William Davis (0)
Every day, I learn to respect small LDL more and more.

Small LDL particles, and its evil partner, low HDL, is among the most common reasons why someone fails to fully gain control of coronary plaque and heart disease risk.

Just yesterday, I saw a slender businessman (6 feet 1 inch in height, 186 lb.) whose small pattern persisted despite niacin, fish oil, oat bran, and raw almonds. We generally think of small LDL as an overweight person's pattern, but in some people the genetics are quite powerful and it can be expressed even in slender people.

The solution: More physical activity and exercise; cut back on processed carbohydrates, particularly wheat products like breads, pasta, crackers, breakfast cereals; think about magnesium (see our two recent reports on magnesium on the www.cureality.com membership website, the latest report to be posted this week); be sure sleep is adequate (gauge this by whether you're energetic during the day and don't fall asleep watching TV or movies). Lack of sufficient physical activity in people with sedentary jobs is probably among the most common reason the small LDL pattern persists.

Ignore small LDL and it can be like a hidden cancer in your body, growing and metastasizing (not literally, of course), fueling coronary plaque growth. Be sure your doctor assesses whether you have small LDL if you hope to gain control of your coronary risk.

Burn off the fat

9. May 2006 William Davis (0)

If you've ever wondered just how many calories you're burning with various activities like yard work, driving, climbing stairs, etc. go to this great website that will calculate it for you: http://www.caloriecontrol.org/exercalc.html.

Here are some examples:


Dancing for 30 minutes(fast, e.g., tango): 193 calories
Yoga for 30 minutes: 204 calories
Washing the car for 30 minutes: 173 calories
Vacuuming for 30 minutes: 88 calories

(All are for a 170 lb person.)

As you see, physical activity does not necessarily have to consist of exercise. It doesn't require fancy equipment or expensive outfits. But it does require you to keep moving. Sedentary work is among the most common reasons I see in my patients for failing to control weight and its associated lipoprotein patterns, like low HDL and small LDL.

If your work is sedentary, then a minimum of 60 minutes of physical activity per day is necessary to begin to correct weight-related patterns. If you gauge by calories burned, then a useful goal is 500 calories per day in physical activity--at a minimum.
Is pomegranate juice healthy?

Is pomegranate juice healthy?

19. July 2009 William Davis (20)

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
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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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