Hello Dr Davis,

Interesting post about hard and soft plaque.  I recently had a discussion with my GP regarding my serious increase in scan score (Jan 2006 = 235, Nov 2007 = 419).  

After the first scan we started aggressively going after my LDL, HDL and Trig.. 196,59,221

And have them down to 103, 65, 92 - we still have a way to go to 60/60/60 -

So the increase is a suprise, but my doctor said that the increase could in part be cause some of the soft plaque had been converted to hard plaque and the scan would show that conversion.

Does hard plaque register more than soft?

Thanks for what you  are doing.

Hi, Dave--

I'm glad your doctor is working with you on gaining better control over your plaque growth.

However, there is no such thing as soft plaque converting to hard plaque to increase calcium scores.

Think of it this way: Calcium is a surrogate measure of TOTAL plaque, both soft and hard. In the majority of settings, there is little advantage to characterizing soft vs. hard.

To seize better control, don't neglect: 1) hidden lipoprotein patterns, 2) vitamin D. Also see  our report "10 steps to take if your heart scan score increases more than 10% per year" at http://trackyourplaque.com/library/fl_02-006tensteps-2.asp.

Good luck!

Dr Davis,

Thanks for the response.

  I wonder if you are seeing any trends that indicate a "flywheel" or momentum in the creation of plaque.  I notice you have some patients that take two years or more to stop the growth.  

Starting point Jan 06 - score=236
Quit smoking - Jan 06
Vitamin D - taking 1200
Lost 20 #'s (5'11)=195
Exercise 40min 4x
Fish Oil = 1600 DHA+EHA
Crestor = 10mg
baby aspirin
Basic good diet - no processed foods
Oatmeal and blueberries/raisins everyday.

This month = score=419

After last scan
just added Zetia
Just quit all wheat products
Considering quiting redwine - I tend to have 3-4 glasses versus the recommended 2
Doctor is still saying no to L-arginine (not enough studies)
Considering Niaspan

Any comments?

Thanks again - Dave K

P.S. One more question... maybe this should be a separate post.  Do we know the exact connection between smoking and plaque?  Does it lower LDL size, lower HDL - iritate the lining of the vessels? Is it just elevated blood pressure?  What did my thirty years of smoking do to my heart (versus lungs)?

Hi, Dave--

I'm afraid there's too much to cover in this Blog. You will need lipoprotein testing and almost certainly require more than a baby-dose of vitamin D to gain better control over plaque growth. This rate of growth, however, is very concerning.  

I would invite you to look at the hundreds of pages of discussion on the www.trackyourplaque.com website devote to just this question.

Thanks Again Dr Davis,

I have poured over your website and I'm still reading.  I plan to make your list of turn around "stars".

BTW - here is the comment from my GP - sounds exactly like the cardiologist you mentioned in the original post.

"Remember that although your coronary calcium score has gone up, this does not mean that you are at greater risk than you were a year ago.  Remember that the most dangerous plaque is the not-yet calcified soft plaque, which will not show up on an EBT.  It is only the safe, calcified plaque that can be measured with the EBT.   For your score to go up like it did, while your lipids came down so much, what had to happen was that lots of dangerous unstable plaque was converted to stable, calcified plaque.    There are no accepted guidelines for interpreting changes in calcium scores over time, because the scores tend to go up as treatment converts dangerous plaque to safer plaque.    We do know that aggressively lowering LDL reduces both unstable and stable plaque, and we know that risk can be further lowered by adjuvant therapy such as I listed above. "

Sigh . . .

It's amazing what a simple reading of the literature by your doctor would reveal to him/her.

In near future, I will be posting some blogs that summarize crucial studies in the heart scan literature in an effort to provide better weapons in your fight.

Dr Davis,

Thanks again for all you are doing and I look forward to whatever you can post.  I plan to challenge some of my GPs positions.  Your data certainly is of enormous value.

Dave K

P.S. I going to 2000 vit "D" tomorrow.

Also - have you thought about a "track-your-plaque" certification.  Something to indicate that our Drs are at least up to speed on the latest in *preventative* proceedures...?  I would switch.....

Hi, Dave--

Yes, excellent thought.

It is something we'd like to aim for, but over the long term, since right now there are too few to make a difference. One by one, they are declaring themselves and separating from the "pack."

Stay tuned for more on this issue. In the meantime, I continue to try and inform my colleagues about what is right, what is wrong, what is preferable for patient safety and yields truly empowering information, and try to impress on them that the practice of cardiology is not just about enriching their retirement accounts.

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.

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!

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!

"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.

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.

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"

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!

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?"

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).

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?"

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."

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.

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.

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.

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.

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,

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.

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.

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

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.

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.

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.

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.