Blast triglycerides

15. May 2009 William Davis (0)
The conventional answers to high triglycerides levels are generally: low-fat diet, a fibrate drug (Tricor, Lopid), a statin drug, and--most recently--prescription fish oil.

This is the regimen to take if you want the drug industry to get even richer and more powerful than they already are. After all, what CEO of a pharmaceutical company can stand to have his salary and benefits slashed to below $200 million this year? It's outrageous!

If you really want to blast the heck out of your triglycerides and achieve numbers like 50 mg/dl, then the regimen to consider consists of:

--Elimination of sugars, wheat, and cornstarch
--Fish oil--Sam's Club would do fine at $8 for 350 capsules, or the high-potency at $14.99 for 180 capsules (at 680 mg EPA +DHA, nearly the same potency as prescription Lovaza at 842 mg)
--Vitamin D supplementation sufficient to achieve normal blood levels (60-70 ng/ml)

Those three strategies alone can reduce triglycerides far more than any drug combination. In fact, it is rare for someone with triglycerides as high as 900 mg/dl to not reduce them to the <100 mg/dl range.

Cheerios: Prescription required?

13. May 2009 William Davis (15)
Followers of The Heart Scan Blog know my feelings about Cheerios:


Can you say "sugar"?

Cheerios and heart health


There's an interesting tussle going on between the makers of Cheerios, General Mills, and the FDA.

The FDA says that the Cheerios' package claims of:

• "you can Lower Your Cholesterol 4% in 6 weeks"
• "Did you know that in just 6 weeks Cheerios can reduce bad cholesterol by an average of 4 percent? Cheerios is ... clinically proven to lower cholesterol. A clinical study showed that eating two 1 1/2 cup servings daily of Cheerios cereal reduced bad cholesterol when eaten as part of a diet low in saturated fat and cholesterol."

constitute a medical claim, i.e., trying to promote Cheerios as a drug.

I'm glad that the FDA has come down on General Mills. But I find this entire episode laughable: The debate is over the purported health benefits of what I would regard as pure junk food, no better in my view than claiming that a cupcake has health benefits, or a carton of ice cream.

In my experience, Cheerios does not 1) reduce risk for heart disease, nor 2) reduce cholesterol.

It does, however, cause blood sugar to skyrocket and increase the small type of LDL--you know, the type that causes heart disease.

"Placebos are frequently of value"

12. May 2009 William Davis (1)
The treatment of angina pectoris, generally speaking, is unsatisfactory.

Any procedure that relieves mental tension is valuable. Since patients suffer particularly during the winter, I encourage winter vacations in a southern climate.

I insist that obese patients lose weight, and have found small doses of benzedrine, 10 to 20 mg. daily, helpful in curbing the appetite.

I generally forbid smoking. This is a particularly disturbing task for many patients to carry out. In such cases, I suggest that 3 or 4 cigarettes be smoked daily, knowing full well that regardless of what I say or recommend, the patients is going to continue to smoke.

Innumerable drugs, most of which are of questionable value, have been used to prevent attacks of angina pectoris. In fact, placebos are frequently of value.

Testosterone--The male sex hormone has been effective in my experience. Whether it acts as a vasodilator or merely by promoting a sense of well-being is not known.

Alcohol--Alcohol (whiskey, brandy, rum) has been used for many years in the treatment of angina pectoris. I have prescribed it in moderate quantity--an ounce several times a day--and while I have not made alcoholics of any of my patients, I also have not cured any of them with it. Preparations, such as creme de menthe, are of value in relieving "gas" of which so many patients complain.


From Heart Disease Diagnosis and Treatment
Emanuel Goldberger, MD
1951

Iodine is not salt

12. May 2009 William Davis (3)
I've noticed a point of confusion recently, something I hadn't noticed in my patients before: Because of the public health advice from the FDA, American Heart Association, and Surgeon General's office to reduce sodium/salt intake, people have thought this meant reducing iodine, too.

I believe that people have drawn an equation in their minds:


Sodium = iodine


Of course, they are two entirely unrelated things.

Recall that the only reason iodine is added to many (not all) salt products is because it was a public health solution to solve the substantial nationwide iodine deficiency prevalent during the 20th century. But it was a solution conceived in 1924, when the FDA thought this was the best way to get iodine into Americans. And it worked.

Unfortunately, sodium does indeed present adverse effects in some people. As a result, "get your iodine from salt" has evolved into "reduce your sodium intake." Everyone forgot about the iodine: They forgot about the large disfiguring goiters, the poor school performance in iodine-deficient schoolchildren, the mentally-impaired offspring of iodine-deficient mothers.

So don't confuse sodium with iodine. You may need less of the former, but more of the latter.

For more on this, see "Help keep your family goiter free."

"You can't reduce coronary plaque"

10. May 2009 William Davis (9)
"I told my cardiologst that I stumbled on a program called 'Track Your Plaque' that claims to be able to help reduce your coronary calcium score.

"My cardiologist said, 'That's impossible. You cannot reduce coronary plaque. I've never seen anyone reduce a heart scan score."

Who's right here?

The commenter is right; the cardiologist is wrong.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Quantify and work to reduce the atherosclerotic plaque? No way! That's work, requires thinking, some sophisticated testing (like lipoprotein testing), even some new ideas like vitamin D. "They didn't teach that to me in medical school (back in 1980)!"

Welcome to the new age.

Atherosclerotic plaque is 1) measurable, 2) trackable, and 3) can be reduced.

We do it all the time. (Amy still holds our record: 63% reduction in plaque/heart scan score.)

Though I pooh-pooh the value of statin drug studies, there's even data from the conventional statin world documenting coronary plaque reversal. The ASTEROID Trial of rosuvastatin (Crestor), 40 mg per day for one year, demonstrated 7% reduction of atherosclerotic plaque using intracoronary ultrasound.

I have NEVER seen a heart attack or appearance of heart symptoms (angina, unstable angina) in a person who has reversed coronary plaque (unless, of course, they pitched the whole effort and returned to bad habits--that has happened). Stick to the program and coronary risk, for all practical purposes, been eliminated.

A heart scan score is not a death sentence. It is simply a tool to empower your prevention program, a measuring stick to gauge plaque progression, stabilization, or regression. Don't accept anything less.

Lethal lipids

8. May 2009 William Davis (15)
There's a specific combination of lipids/lipoproteins that confers especially high risk for heart disease. That combination is:

Low HDL--generally less than 50 mg/dl

Small LDL--especially if 50% or more of total LDL

Lipoprotein(a)--an aggressive risk factor by itself


This combination is a virtual guarantee for heart disease, often at a young age. It's not clear whether each risk factor exerts its own brand of undesirable effect, or whether the combined presence of each cause some adverse interaction.

For instance, lipoprotein(a), or Lp(a), by itself is the most aggressive risk factor known (that nobody's heard about--there's no blockbuster revenue-generating drug for it). Each Lp(a) molecule is a combination of an LDL cholesterol molecule with a specific genetically-determined protein, apoprotein(a). If the LDL component of Lp(a) is small, then the combination of Lp(a) with small LDL is somehow much worse, kind of like the two neighborhood kids who are naughty on their own, but really bad when they're together.

Interestingly, the evil trio responds as a whole to many of the same corrective treatments:

Niacin--increases HDL, reduces small LDL, and reduces Lp(a)

Elimination of wheat, cornstarch, and sugars--Best for reducing small LDL; less potent for Lp(a) reduction.

High-fat intake--Like niacin, effective for all three.

High-dose fish oil--Higher doses of EPA + DHA north of 3000 mg per day also can positively affect all three, especially Lp(a).


If you have this combination, it ought to be taken very seriously. Don't let anybody tell you that it is uncorrectable--just because there may be no big revenue-generating drug to treat it on TV does not mean that there aren't effective treatments for it. In fact, some of our biggest successes in reducing heart scan scores have had this precise combination.

"Get regressive"

6. May 2009 William Davis (0)
This caught my eye:



Niaspan, prescription niacin, now sold by Abbott Laboratories, is now promoting its advantages in regressing coronary plaque:



In patients with a history of coronary artery disease (CAD) and hypercholesetgerolemia, Niaspan (niacin), in combination with a bile acid-binding resin, is indicated to slow progression or promote regression of atherosclerotic disease.



And the new slogan: "Get regressive."



Interestingly, the new marketing campaign is based on relatively old data. They base this new claim on 3 studies:



1) Cholesterol-Lowering Atherosclerosis Study (CLAS)--a 1987

CRP House of Cards

4. May 2009 William Davis (15)
Lew has coronary plaque with a heart scan score of 393. At age 53, that's in the 90th percentile (higher score than 90% of men in his age group).

On our search for causes of his coronary plaque, we identify low HDL of 41 mg/dl, high triglycerides of 202 mg/dl, small LDL (83% of total), calculated LDL of 133 mg/dl, and severe vitamin D deficiency with a starting blood level of 25-hydroxy vitamin D of 19 ng/ml.

His c-reactive protein: 4.1 mg/dl--above the cut-off of 2.0 mg/dl that the pharmaceutical industry is targeting as a mandate for statin therapy, particularly given the JUPITER data.

Lew instead eliminates wheat and other small LDL-provoking foods and, as a result, loses 28 lbs in 3 months; adds omega-3 fatty acids from fish oil; supplements vitamin D sufficient to increase his blood level to 70 ng/ml.

Along with dramatic correction of his starting abnormalities, his c-reactive protein: 0.4 mg/dl--no statin drug.

In my view, increased CRP is nothing more than a surrogate for the inflammatory phenomena that arise from high-carbohydrate diets, overweight, and small LDL. Correct those and CRP drops off a cliff. In fact, it is exceptionally rare for CRP to not drop to very low levels following this formula.

I believe that CRP is one more item on the list of reasons--the house of cards--the pharmaceutical industry is building to persuade us to take more and more statin drugs. LDL not low enough? Take more statin. Diabetic with low cholesterol? Take a statin. Inflammation? Take a statin.

Enough already.

At-home blood tests

2. May 2009 William Davis (6)
Our at-home blood tests are proving a hit.

So far, vitamin D is the number one most popular test, no surprise.

Second--to my surprise--is DHEA. I would have predicted it would have been thyroid testing.

Our male and female hormone panels are also proving popular.

I've personally been using the thyroid and vitamin D testing to monitor my levels. I increased my Armour thyroid based on a low free T3 value, while my vitamin D was perfect at 77 ng/ml on 8000 units vitamin D3 (cholecalciferol) per day.

The process of performing the blood spots is straightforward. The finger pricks are virtually painless using the automatic spring-loaded finger stick devices:





The number of blots to make depends on how many tests you'd like. Just a vitamin D test requires 2 blots. If 6 or more tests are ordered at a time, then all 12 blots should be made. (Two spring-loaded lancets are provided in each kit.)





If you are interested in any of our at-home blood tests, go here.

Our own Heart Hawk has posted an editorial on about blood spot testing on Health Central:

Simple, affordable home blood testing is a real game-changer in the arena of informed, self-directed healthcare. For the first time broad access to home blood testing, on a scale similar to that enjoyed by persons who routinely test their blood sugar, is available to virtually everyone and it removes doctors as the gatekeepers of these tests. Even private insurance companies and Medicare are beginning to understand the potential for improving healthcare and decreasing costs and are slowly beginning to expand coverage of home blood testing much as they do for diabetics or persons taking anti-coagulants.

"Help keep your family goiter free"

1. May 2009 William Davis (10)
People ask, "If I need iodine, should I go back to iodized salt?"

First of all, how did this notion of iodized salt originate?

In 1924, J. Edgar Hoover was appointed head of the FBI, Marlon Brando and Doris Day were born, and Calvin Coolidge was elected President of the United States. Half of American households had a car, while 1 in 4 Americans were illiterate.



In the 1920s, cities were a fraction of their current size and a third of the U.S. population, or 36 million people, lived in small rural communities.

Goiters were also wildly prevalent in 1924. Up to a third of the population in some areas of the country, particularly the Midwest, suffered from goiters, thyroid glands that enlarged due to lack of iodine.

Goiters were not only unsightly, but sometimes grotesque, causing a visible bulge in the front of the neck. Occasionally, they would grow so big that it compressed adjacent structures, like the trachea, and would have to be surgically removed. Goiters were commonly associated with thyroid dysfunction, especially low thyoid or hypothyroidism, that resulted in low IQ's in schoolchildren, debilitation in adults. Women of childbearing age delivered retarded children.

So iodine deficiency in early 20th century America was a big problem. How to solve this enormous public health problem in a large nation without television, few radios, no internet, with a largely rural and often illiterate population?

Thus was iodized salt born, a simple, technologically available solution that could be implemented on a large scale nationwide at low cost. The FDA chose this route in 1924, figuring that it was the best way to ensure that most Americans could obtain sufficient iodine through liberal use of iodized salt. Public health officials urged Americans to use salt. Morton's salt label proudly bore the slogan "Help keep your family goiter free!"

It worked. Goiters largely became a thing of the past.

How about today? The American Heart Association recommends limiting salt, recently announcing that they would like to limit intake to 1500 mg per day. The American Medical Association has been lobbying the FDA to set lower salt limit guidelines. The FDA has been clamping down on food manufacturers to reduce the quantity of salt in processed foods.

Why limit salt? The concern is that there are segments of the population (not all) that are salt sensitive, particularly African Americans, people with certain genetic forms of high blood pressure, conditions that cause water retention, and any degree of heart or kidney failure. Salt in these peoplem, in fact, can be disastrous.
So adding iodine to salt was the solution to epidemic goiter. And it worked.

But salt is not a perfect solution, just one that served its purpose back in 1924. What we need is a 21st century solution.
You will find that in the various iodine supplements at your health food store. My favorite is kelp--inexpensive, available, and a form that mimics the way Japanese people obtain iodine (though by eating seaweed, rather than with tablets).


Image of kelp courtesy Wikipedia
All posts by william-davis

A new Track Your Plaque record: 63% reduction

14. juli 2007 William Davis (3)
Stress can booby-trap the best efforts at reducing your CT heart scan score.

But Amy, our newest Track Your Plaque record holder, defied the effects of an overwhelmingly life stress to drop her heart scan score from 117 to 43--an amazing 63% reduction.

Amy beat our previous record holder, Neal, who achieved a 51% reduction. Though Neal had dropped his score from 339 to 161, a drop of 178 and more than Amy's 74 point drop, on a percentage basis Amy holds the record.

I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!

Amy's complete story can be found in our latest Track Your Plaque Newsletter to be released later this week, as well as an upcoming feature on the www.cureality.com website. (We've got to toot our horn about successes like this!)

The Ornish diet made me fat

13. juli 2007 William Davis (16)
I got that kind of question today that tempts me to roll my eyes and say, "Not again!"

"If I want to reverse my heart scan score, should I do the Ornish diet?" You know, the one by Dr. Dean Ornish: Dr. Dean Ornish's Program for Reversal of Heart Disease.

I personally followed the Ornish program way back in the early 1990s. I reduced fat intake of all sorts to <10% of calories; eliminated all fish and meats, vegetable oils, and nuts; ate vegetables and fruits; and upped my reliance on whole grains. I used many of his recipes. I exercised by running 5 miles per day. (Far more than I do now!) I avoided sweets like candies and fruit juices.

What happened?

I gained 31 lbs, going from 155 to 186 lbs (I'm 5 ft 8 inches tall), my abdomen developed that loose, fleshy look, hanging over my beltline. My HDL plummeted to 28 mg/dl, triglycerides skyrocketed to 336 mg/dl, and I developed a severe small LDL pattern. I experienced a mental fogginess every afternoon. I felt tired and crabby much of the time. I sometimes struggled to suppress an irrational anger and frustration over the silliest things. I required huge amounts of coffee just to function day to day.

Hundreds of my patients suffered similar phenomena.

Few of us wear bell-bottomed jeans, tie-dyed t-shirts, or say "groovy". Rowan and Martin's Laugh-in is an "oldie", it's no longer cool to hold your index and middle fingers up in the "V" sign of peace. Even Ladybird Johnson has passed.

So should go the misadventures of the ultra low-fat diet, as articulated by Dr. Ornish. His day came and went. We learned from our mistakes. Now let's do something better.

Keep your eyes open for the New Track Your Plaque Diet.

Do lower heart scan scores grow faster?

11. juli 2007 William Davis (0)
If Mary's heart scan score increases from 2 to 4 in one year, it represents a 100% increase in score.

If Jane's heart scan score increases from 1002 to 1004 over the same period, it represents <1% increase, even though the true growth is the same: 2 points.

This quirk of arithmetic needs to be factored in whenever you and your doctor try to puzzle out the meaning of an increasing CT heart scan score. Lower numbers, particularly those <100, can grow at seemingly much faster rates if viewed by percent per year increase. If no effort is taken to stop the growth in your coronary plaque, then scores of 10, 20, 30, or the like can easily grow 50-100% per year.

In contrast, scores of 1000, 1500, and 2000 tend to grow at "slower" rates of 20% or so per year without corrective efforts, even though the absolute growth may be substantial. (Obviously, this bit of confusion can be best eliminated by reducing your heart scan score, but it doesn't always work out that way.)

If we were all adept at advanced math, we should probably rely on logarithmic measures of plaque increase, rather than percent increase. Or, you can just keep in mind that the rate of plaque growth must always be viewed in the context of the absolute score.

Mr. Salazar: Check your Lp(a)

9. juli 2007 William Davis (8)
Marathon star Alberto Salazar was just released from the hospital following a heart attack and a heart catheterization that led to a stent. The MSNBC version of the report can be viewed at http://www.msnbc.msn.com/id/19653682/.

At 48 years old and holder of several American records for marathon times, Salazar's story is eerily reminiscent of Jim Fixx, who died at age 52 after writing a bestselling book, The Complete Book of Running. Thankfully, Salazar's story has a happier ending.

Fixx died at a time when prevention of heart disease was quite primitive. Lipoprotein analysis was not broadly available to the public, CT heart scans had not yet been invented. Even statin drugs were just a gleam in the pharmaceutical industry's eye.

But not so with Salazar. This Cuban-born marathoner experienced his heart attack at at a time when enormously useful steps can be taken to 1) document the extent of disease with a CT heart scan (the presence of a stent just means that one artery can't be "scored"), and 2) identify the causes of his disease.

I suspect that the fact that yet another marathoner in the limelight will once again prompt the (likely non-sensical) conversation about long-distance running and the increased risk of heart disease. Unfortunately, I fear that the real cause will be left unidentfied and untreated: Lipoprotein(a), or Lp(a).

It's almost certain that Fixx had Lp(a), given the fact that his dad had a heart attack at age 35. Running simply postponed the untreated inevitable.

I hope Mr. Salazar is surrounded by doctors who have his true interests in mind (not just procedural excitement) and ask the crucial question: Why?

The answer is almost certain to be Lp(a).

Heart Scan Curiosities #8: Fat heart

8. juli 2007 William Davis (2)
Here's a curious incidental finding on a heart scan: an unusual fat accumulation around the heart.



The arrows point to an unusually large accumulation of fat tissue on either side of the heart. This man was mildly but not excessively overweight at 5 ft 10 inches and 201 lbs.

I know of no specific implications of this curiosity. It makes me wonder if he was very obese at one time and has since lost the weight.

Chocolate and blood pressure

7. juli 2007 William Davis (1)
A recent very detailed and clean study on the effects of a small serving of dark chocolate on blood pressure was just published in the Journal of the American Medical Association.

I was going to do a little Blogging on this interesting study but I read the Fanatic Cook's wonderfully insightful comments. I'd direct you to her discussion, instead: A small daily dose of dark chocalate lowers blood pressure at http://fanaticcook.blogspot.com/. I couldn't have said it any better.

By the way, the authors of the study had no financial ties to the chocolate or cocoa industry. Refreshing.

Does prevention save money?

7. juli 2007 William Davis (2)
Prevention and reversal of heart disease are undoubtedly preferable to the current crash and repair model currently followed by doctors and hospital, the model that has created an enormous medical device industry to support it.

But does it save money? This debate often boils down to a metric of "lives saved per $100,000". Thus, the statin drugs (of course) have been subjected to such analyses and have been shown to be "cost-effective."

But how does a powerful heart disease prevention and reversal program like Track Your Plaque compare to the current crash and repair procedural approach to heart disease? This is a very difficult analysis, one that is subject to enormous variation, depending on the population studied and the prevalence of disease, the local practice habits (e.g., in the northwest Cleveland suburb of Lorain, virtually everybody going to the hospital for any heart problem gets one or several heart catheterizations), and other factors.

There's also the difficulty of what should constitute a prevention program. Is it like that used in the COURAGE Trial of "optimal medical therapy" that included nitroglycerin, aspirin, a beta blocker, and statin drug (which we regard as a laughably silly approach), or one like Track Your Plaque in which we try to correct the causes of heart disease, not just palliate (BandAid) them? Costs vary. The "optimal medical therapy" is very costly due to its reliance on medications to treat symptoms. Our program is somewhat costly because of the reliance on a CT heart scan and lipoprotein analysis (though, in the long perspective, our costs are modest).

We asked this question and came up with a lengthy analysis. Bottom line: Following the Track Your Plaque program saves enormous sums of money. Because of the complexity of the analysis, which is theoretical and not a real-world test, we confined our analysis to men in the 40-59 year old age group. If this group alone were to subscribe to a intensive but rational program of prevention like Track Your Plaque, over $20 billion dollars per year would be saved.

If the analysis were extended to women of all ages and men older than 59, the numbers would balloon to many more tens of billions of dollars. Such a savings wouldn't cure the healthcare system's growing financial crisis, but it sure would be a big help. Sort of like converting to a hydrid car--you don't eliminate the need for gas, but you'll save a lot in fuel costs.

The Track Your Plaque approach makes sense because it is, bar none, the most powerful approach to gaining hold of heart disease risk available. But it also makes sense from a financial standpoint. Now, if we can only convince the hospitals, the $30 million annual salary device manufacturer CEO, and my procedure-crazy colleagues that this way makes more sense.

Watch for our analysis on an upcoming Track Your Plaque Special Report.

Where should fiber come from?

7. juli 2007 William Davis (1)
Ray had the usual protuberant belly overhanging his beltline of someone who was over-reliant on processed starches, particularly wheat.

After all, he ran a sandwich bakery. He sheepishly admitted that he ate the products of his own production line every day while at work, even bringing a few sandwiches home.

At 5 ft 10 inches, 201 lbs, he wasn't terribly overweight, but all the excess was in his beltline. He had the lipoproteins to match: HDL 38 mg/dl, triglycerides 180 mg/dl, 83% of all LDL particles were small, excess VLDL and IDL. Blood pressure: 140/88. Blood sugar: 112 mg/dl.

With a CT heart scan score of 698, Ray had some work to do.

Among the strategies we discussed was a need to dramatically reduce, perhaps eliminate, wheat products and other high-glycemic index foods.

"You've got to be kidding me!" Besides the inconsistency with his business, he was puzzled on what foods were edible for his pattern. We discussed how he could easily replace his reliance on wheat and breads with more vegetables, more fruits, more lean proteins, and more healthy oils.

"But I won't get any fiber!" he declared. That was why he tried to choose whole wheat bread for his sandwiches.

This is a common concern when we discuss how grains, particuarly wheat, need to be sharply reduced. In the most recent edition of his Paleo Diet Newsletter, Dr. Loren Cordain has laid out a wonderful graph that beautifully illustrates the issue:




(From The Paleo Diet Newsletter at http://www.thepaleodiet.com/newsletter/back_issues.shtml)


In other words, reducing or eliminating "fiber-rich" grains and replacing their calories dramatically increases fiber content of your diet.

For Ray, whose livelihood depends on promoting and perpetuating the use of wheat breads, it will be tough to keep him on the right track. My prediction: the results he will see will be substantial and it will become difficult to return to eating his own products.

There's no doubt that this concept can be economically disruptive for many people, including Ray. It's a tough situation we've created: a huge industrial complex based on growing grains and wheat, processing it into breakfast cereals, bagels, pretzels, crackers, and sandwiches. But it has also contributed to the epidemic of obesity and the patterns that people like Ray have.

But the startling fact remains: If replaced with vegetables and fruits, reducing grains increases the fiber content of your diet, and not jsut a little bit, but enormously. If green peppers and spinach had brand names like "Fiber One" and "Smart Start" along with flashy boxes, then maybe it would be an easier concept to grasp.

To sign up for Dr. Cordain's wonderfully informative newsletter, go to http://www.thepaleodiet.com/newsletter/back_issues.shtml.

The Detection Gap

5. juli 2007 William Davis (3)
You've heard of the Generation Gap, the Income Gap, the Technology Gap, the Gender Gap, and the Achievement Gap.

How about the Detection Gap?

Haven't heard of it? That's the gap between coronary heart disease detected by conventional methods widely practiced in the community and the real prevalence of the disease.

The standard approach to coronary heart disease detection is a relatively simple formula. One of three things are sought:

1) Symptoms of heart disease like chest pain or breathlessness.
2) An abnormal EKG or abnormal stress test.
3) A catastrophe like heart attack or sudden cardiac death.

By this equation, the American Heart Association (AHA) estimates that 36% of American men and women have coronary disease.

However, we say the number is more like 48%. That's the number we arrive at when we ask: How many men and women have CT heart scan scores above zero?

The difference is the Detection Gap. Though only around 12%, it amounts to millions of people. The problem is that, by the conventional approach to detection of heart disease, you often don't know you have it until you're lying on a hospital gurney being wheeled off to a major procedure. Or your friends, family or neighbors find your body.

If heart disease is detected by a CT heart scan, it tends to be early, before catastrophe strikes. You can use tools like niacin, vitamin D, flaxseed, etc., all the components of the Track Your Plaque approach.

If heart disease is detected by waiting for the appearance of symptoms, then a stress test (usually nuclear) is followed by a heart catheterization, stents, bypass, etc. So there's more than a Detection Gap. There's also a difference in the sorts of therapies chosen. There's certainly a difference in cost.

In my view, there is no rational reason not to close the Detection Gap. While CT heart scan scores aren't perfect, they're damn close. The Detection Gap could be closed to around 2%. We'd also save billions of dollars.

Apoprotein B on VAP

3. juli 2007 William Davis (3)
We've just received an announcement that, if your Vertical Auto Profile lipoprotein test (Atherotech) is provided through the national Quest laboratories (a large national laboratory company), they will include an apoprotein B.

This represents an improvement over the previous "direct LDL," a measured LDL cholesterol. Recall that standard lipid panels obtained in hospitals and doctors' offices is a calculated LDL, based on the 40-some year old Friedewald calculation. In my view, the Friedewald calculated LDL is a dinosaur that is virtually useless and needs to be retired.

Direct, or measured, LDL is a slight improvement. It removes some of the inaccuracy introduced by the assumptions built into the calculated value.

Apoprotein B (also called apoprotein B100) is yet another improvement. Apo B's have been available for years, but was not provided on the VAP. The Atherotech people have done a good job of making VAP more broadly available through "drawing stations" and proponents like Life Extension. Adding an ApoB is a favorable development, since it incorporates the risk of other ApoB-containing particles, like VLDL, IDL, and Lp(a). Several studies like the Quebec Cardiovascular Study have shown that ApoB is a superior predictor of heart disease compared to calculated LDL.

I still believe that the gold standard for assessing risk from an LDL standpoint is the LDL particle number along with the other measures provided by the NMR assay (Liposcience). However, the addition of the ApoB to VAP adds greater confidence to the measures provided by this technique. Those of you who rely on the VAP assay provided by Quest for your Track Your Plaque program for control of CT heart scan scores therefore have access to this improved panel.
Look like Jimmy Stewart

Look like Jimmy Stewart

15. January 2010 William Davis (23)

"This diet works great," Don declared. "But I think I've lost too much weight."

At 67 years old and 5 ft. 11 inches, Don began the program weighing 228 lbs (BMI 31.9). Because of high triglycerides, high blood sugar, high c-reactive protein, and excessive small LDL, I instructed Don to eliminate all wheat products from his diet, along with cornstarch and sweets. His intake of lean meats, eggs, vegetables, oils, raw nuts, etc. was unlimited.

Don now weighed 194 lbs, down 34 lbs over 6 months (BMI 27.1). Triglycerides, blood sugar, blood pressure, and well-being had improved dramatically; small LDL, however, had dropped only 30%--still room for improvement.

"My friends say I'm too skinny. They ask if I have cancer!"

I've heard this many times: Someone loses weight in a relatively short period of time and friends and family tell you you're too skinny. "It must be cancer. Nobody loses weight like that."

Unfortunately, many Americans have forgotten what normal looks like. Normal is certainly not a 190-lb, 5 ft 4 in woman, nor is it a 228 lb, 5 ft 11 inch man. But Americans have put on so much weight that the prevailing view of what constitutes "normal" weight has been revised upward. Normal is closer to what we see in old movies from the 1940s and '50s with people like Jimmy Stewart and Donna Reed. That's what we are supposed to look like.

So Don actually remains mildly overweight but is judged as "too skinny," or even cancer-ridden, by friends and family.

Ignore such comments. As you lose pounds and approach a truly desirable weight, realize that you are returning to the normal state, not the vision of "normal" now held by most Americans.
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Comments (23) -

  • AllenS

    1/15/2010 8:40:24 PM |

    This is funny because as a 5'11" male I'm 165lbs and considered by some to be "emaciated" even though I have 10% body fat and quite a bit of muscle. I remember 45 years ago as a kid when my 6' tall father weighed 170lbs. Nobody ever called him skinny because he pretty much looked like all of his friends. He was considered normal at that time. I remember his weight at that time because he often boasted about it seeing as how he only weighed 125 lbs when he was drafted into the Navy.

    We have indeed forgotten what normal looks like.

  • Sarah

    1/15/2010 9:07:45 PM |

    I think you're onto something with this 'standards' business. I'm down to 171 pounds (nearly 70 pounds!) since going on my diet. It hasn't been a FAST loss, but people who haven't seen me in a while are surprised and remark that I look like a 'stick'.

    Since when did 171 fall into the 'stick' range for a 5'4" woman? Maybe >30 BMI is thin for Kentucky.

    Note: I love Jimmy Stewart!

  • Jeanie Campbell

    1/15/2010 10:32:44 PM |

    Excellent post!  My question, then, is, where do we find a reliable place to find out what our desirable weight IS?  I'm not sure I trust the ones I have found on-line.  Can you recommend one?  Especially for folks over 50.  Thanks!

  • whatsonthemenu

    1/15/2010 11:44:56 PM |

    "Unfortunately, many Americans have forgotten what normal looks like. Normal is certainly not a 190-lb, 5 ft 4 in woman, nor is it a 228 lb, 5 ft 11 inch man."

    So true.  Walking through the airport terminal on a visit from Asia immediately oriented me back to the US with the long chain of fast food franchises and big, waddling passengers.  A trip to Walmart to see morbidly obese people in motorized carts is a tourist attraction for Asians.  They can't believe it until they see it.

  • jnkdaniel@hotmail.com

    1/16/2010 1:16:58 AM |

    Yes, this blog is definitely detrimental to my fat.

    For five months, I've swam, taken fish oil, cut out juice and bread from my fridge.  As a result I've lost 16 pounds, 12 beats per minute, and 3 off my blood pressure.

    I'm currently 29m 6'2 and at 184 lb, 48 bpm resting, and at 125 for blood pressure.

    It is truly scary to see how easy it is to lose weight once you know how bad certain foods are.  It is borderline addicting!

    I'm curious to see if I will hit an equilibrium or I will have to do something to stop the weight loss once I reach 175-180.

  • Anonymous

    1/16/2010 2:01:02 AM |

    This is so true, many of my friends think I'm extremely skinny, yet I'm at my optimal weight. My mom refuses to lose more weight,she says "people will say that I look old and sick"

  • Anonymous

    1/16/2010 6:26:42 AM |

    You hit the nail on the head. I too, as a 50-something year old male, was about 220 at 5'10" last year this time, and as I approached 185 mid-year, several folks asked, "Are you all right?" and "Did you intend to lose the weight?" Yet I still am not at an ideal weight for my height, and although I look slim in comparison, I still have abdominal fat that needs to go. I've also had people tell me, "You look too thin," and "Don't lose any more weight." We must recapture a sense of normal. However, during a recent visit to a Glen Ivy Spa in So. Cal. my wife and I marveled at how many grossly obese people there were sauntering around in swimsuits. We've definitely got a problem here. For me, I'd rather look like Jimmie Stewart or Jack Lalane or Art Devany, and I don't care what anyone else thinks about it!

  • pmpctek

    1/16/2010 7:20:44 AM |

    I had a friend say to me once, "you lost a lot of weight, are you sick 'r something?"

    I'm a 5' 9" 49 y.o. North American male and went from 192 lbs. to 168 lbs. in nine months.  This was a couple years ago. I lost most of it off my mid-section and face.  I have the incredible shrinking waist (now 30 inches.)

    I did this by simply eliminating grains, starches, and sugars.  I actually had to slightly increase my daily calorie intake (than when I weighed 192) because I too was concerned I might have been losing too much weight.

    When I share with family and friends why I look so lean, that it's from permanent grain, starch and sugar abstention, they always respond with "oh no, I can't do that"  or "how can you do that?"

  • Kurt

    1/16/2010 1:36:58 PM |

    This is reassuring. I've been worrying because, since I started a heart healthy diet, I've gone from 183 lbs to 167 lbs, which is less than I weighed when I was 18 years old (170).

  • Dr. William Davis

    1/16/2010 3:00:21 PM |

    Hi, Jeannie--

    There are a number of ways to determine ideal weight. BMI, though an imperfect concept, is a good starting place. Here's a BMI calculator: http://www.nhlbisupport.com/bmi/

    This gives me an idea for a future post: "What is ideal weight?"

  • Aaron Blaisdell

    1/16/2010 4:20:20 PM |

    I won't even tell you what my Chinese in-laws think. Two English words my Chinese-speaking mother-in-law knows are "eat more." I always fend her of with with the retort "Che bao la."

  • Eclecbit

    1/16/2010 6:07:27 PM |

    There's also the problem of finding clothes that fit. I'm a 5'11" male and weigh 152lbs. I've got a 32" waist, but when I try on 32" waist pants they fall off of me because they're really 34" (I believe this is called vanity sizing), so I look for the 30" waist pants and guess what? There are none!

    Maybe it's because I live in the South, but 30" waist pants are pretty much non-existent, and the ones that I do find are always too short.

    My wife used to think I was too skinny, but then she remembered all her Oriental friends back in California who are as skinny as I am. For them it's considered normal.

  • Steve L.

    1/16/2010 6:26:22 PM |

    I say revel in it!  I knew from past temporary weight loss that people would start to notice after I lost 30 pounds or so.  Since I needed to lose 70 to get to ideal weight, I also knew that those comments were nothing but signs of sucess.  We truly have adapted to a new normal in our perceptions.  The shock value does diminish over time though.  Now three years out from adopting a healthy diet (currently 6'3", 190 lbs.), I got all the comments along the way, but now people have adjusted to my new look (as have I).  Once in a while though, I see someone, usually business-related, that I haven't seen for a few years, and they're shocked.  I just enjoy it, and try to recruit them over from the dark side.

    The thing that I find interesting now is that, while I was losing people were interesting in why I was losing, and several adopted the low-carb/paleo approach with great success.  But now that I have reached an ideal weight, the memory of the previous me fades, and few see me as a potential source of healthy diet information.  I think some actually think I must be a bit of a freak for having done so well, and so there's nothing useful to be learned from me by non-freaks.

  • Anne

    1/16/2010 9:36:40 PM |

    I am another who lost weight when I dropped all grains and sugars and greatly limited high carb veges and fruits. The weight just melted away. I did not need to lose much and when I hit 20 lbs, the weight loss stopped. I have been at 120-125 for many months now. I am 5' 4". I never feel hungry eating the higher fat diet. Honestly, sometimes I do miss the junky food but not enough to eat it and jeopardize my health.

  • Nick

    1/17/2010 3:38:15 AM |

    I wonder if anyone has information on cornstarch and why it places right next to wheat as a 'food' to avoid?  I have seen a great deal of convincing argument with regard to wheat, but almost none with regard to cornstarch (other than for those who may need to closely watch blood glucose levels).  

    If anyone can lead me to more information on how it affects our organism, I would great appreciate it.

  • steve

    1/17/2010 4:21:28 PM |

    Dr. Davis.  If you do a post on ideal weight, it might be helpful to include a discussion of muscle mass.  Many athletes are heavier than those of comparable ages in the general population, but have body fat levels that are extremely low.  There is a trade-off with weight loss and muscle loss, and I suppose a happy equilibrium at some leve.  Perhaps body fat level is a better gauge than absolute weight level, but hard to accuratley measure.  Thanks,

  • Claire

    1/18/2010 6:40:22 AM |

    I read an newspaper article about how parents in the UK didn't realise their children were obese. Yes, that's obese - not just overweight.

    We have lost sight of what it is to be of normal weight. I catch myself looking at people's sizes in old movies to remind myself of what "normal" should be.

  • AllenS

    1/18/2010 5:43:56 PM |

    I really don't like the BMI indicator. First, there is no differentiation between males and females or body type. Fit males who have any kind of muscle tone or who may be big-boned will invariably have a BMI greater than 25. I'm very close even though I'm only 10% body fat.

    Instead, I think that a better measure is to ignore weight altogether and get your % body fat computed. Ideally it should be 14-17% for males and 21-24% for females.

    I too have difficulty finding pants that fit. I wear a 30" waist. Its tough to find anything smaller than a 38"-40" waist which is pretty sad.

  • Anonymous

    1/18/2010 11:57:30 PM |

    Based on the posts here on HeartScan and my brothers insistence Atkin's was his preferred effective weight control solution, I started eating meat again after 10 years of being a pescatarian. I put on 12 lbs in 3 months.  OK, I am not too keen on eating slabs of meat and may have gone overboard with sausage meat / chicken wings but I hope my next blood test will show an increase in HDL as a result of the added fat and lower wheat/grains

    BTW. I stopped my 20mgs crestor and got a base line several months back (too scary !). I have taken 20mgs and 40mgs crestor with the latter leading to some muscle pain but perfect LDL (60). HDL only went up with Niacin (31 to 45 )

    What I want is no more than 20mgs crestor (which gives me LDL circa 75 and I can tolerate well) and to elevate my HDL to 60 without having to eat raw cow.

    This site is a great resource. I would like to see Dr D square off against the celeb TV Dr Oz who pushes high grain diets and low saturated fat.
    Trev

  • Apolloswabbie

    1/30/2010 10:03:43 PM |

    I think some of the response to too skinny is because folks are faced with how 'not skinny' they are looking at those who are not.

  • Anonymous

    2/8/2010 10:14:07 PM |

    I'm a caucasian male, 6'2" and I've been healthily below 160.  I have a thin body.  I don't know if it's because my bones are smaller, or what, but this is normal for me.

    And, I feel for the thin folks in the south.  When we lived in TN for a few years, I had a heck of a time finding 32" waist pants.  Now that I'm back in CA, it's much easier.

  • lockeender

    5/6/2010 4:09:25 AM |

    Jimmy Stewart was thought too skinny by Hollywood and the Army at the time.  When he was first signed to MGM they recognized that Stewart had an uncanny screen charisma and great star potential, but they considered him just so goofy looking that they didn't buy him having any male star sex appeal.  MGM wanted someone to compete with Tyrone Power, Clark Gable, Spencer Tracy and up and comers like Cary Grant (Grant would be a better example for you than Stewart).  Before MGM ever put Stewart in a movie they put him with one of the studio weight trainers, hoping to add some muscle to his physique.  The trainer had Stewart lifting weights and drinking a gallon of milk everyday.  After a month of this regimen Stewart had gained about three pounds, mostly of bloat.  MGM put him in a variety of bit parts but they figured he was basically useless to them so they loaned him out to Columbia for a pair of pictures, You Can't Take it with You and Mr. Smith Goes to Washington.  Stewart's star was made and he returned to MGM to make a slew of great films, Destry rides again, Philadelphia Story, & The shop Around the corner.  Stewart came from a very patriotic, midwestern family.  in 1940 Stewart basically quit his studio contract (after filming A Mortal Storm) and recognizing the world situation, he went to enlist in the Army with the idea of entering the Air Corps to train as a pilot.  He was rejected flat out because he did not weigh enough for the minimum standard to enlist.  And Stewart was 6' 3&3/4" he weighed next to nothing!  Since he was only a few lbs under, Stewart went back the next week, this time after waterloading himself.  he barely made it through the physical before bursting, but he was able to eek over that minimum weight standard by a single pound.  By the time Pearl Harbor hit, Stewart was a certified pilot and he spent most of the war continually flying bombing missions over Europe.

    Cary Grant on the other hand, would be a superb example. Grant began life as a circus tumbler, and he maintained his athleticism throughout his life.  His remarkable lack of aging until his final decade was due to his  eschewing alcohol and smoking in his private life, which was both very rare at the time and ironic considering the suave characters he played always drank and smoked.  He may also have been one of the oddball anti-sugar hollywood types (Gloria Swanson was one) that refused to eat anything with sugar in it.  But I'm not certain on that.

  • buy jeans

    11/3/2010 3:43:15 PM |

    Ignore such comments. As you lose pounds and approach a truly desirable weight, realize that you are returning to the normal state, not the vision of "normal" now held by most Americans.

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