Who knows what 4. September 2008 William Davis (4) You know that cynical old saying:It’s not what you know, it’s who you know. In other words, knowing the right person provides you strategic advantage in business, social advancement, etc. In health, it was often true. Knowing who the better doctors were, for instance, in your city might provide you with access to better care. Enter the Information Age. You now have access to medical information equal to that of your doctor. You now have access to patient discussions about doctors, their practices, their performance records. There is now a depth and breadth of information on health that was never available before. I’d therefore turn the old saying into the new Health 2.0 version:It’s not who you know, it’s what you know.In health, information now reigns supreme, not knowing somebody else who has the right connections. Positive: Everybody now theoretically has access to an equal amount of information, since you can access information on any topic just as easily as I can. Negative: It puts more of the burden on you. If you screw up in health, perhaps you didn’t try to get the best information hard enough. I love this new development, this emergence of empowerment in health. I call it self-directed health, the individual capacity to exert enormous influence over the quality of your healthcare. This is obviously a work in progress. All the answers and tools for self-directed care, self-empowerment are not yet available, some haven’t even yet been imagined. But they are coming.
“Too many false positives” 4. September 2008 William Davis (6) “Do you really think I need a heart scan?” asked Terry. “My doctor said that heart scans show too many false positives. He says that many people end up getting unnecessary heart catheterizations because of them.” At age 56, Terry was becoming increasingly frightened. His father had suffered his first heart attack at age 53, Terry’s paternal uncle had a heart attack at age 56, his paternal grandfather a heart attack at age 50. Is this true? Do heart scans yield too many false positives, meaning abnormal results when there really is no abnormality?No, it is not. What Terry’s doctor is referring to is the fact that, in the decades-long process that leads to heart attack, heart scans have the ability to detect early phases of developing coronary atherosclerotic plaque. Let’s take Terry’s case, for example. Given his family history, it is quite likely that he does indeed have coronary atherosclerotic plaque. Will it be detectable by performing a stress test? Probably not. In fact, Terry jogs and feels well while doing so. While a stress test abnormality that fails to reach conscious perception is possible, it’s fairly unlikely given his exercise routine. Will Terry’s coronary atherosclerotic plaque be detectable by heart catheterization? Very likely. But why perform an invasive hospital procedure just as a screening test? Should a woman wishing to undergo a screening test for breast cancer undergo breast removal? Of course not. Is waiting for symptoms a rational way to approach diagnosis of heart disease? Well, when symptoms appear, it means that coronary blood flow is reduced. Stents and bypass surgery may be indicated. The risk of heart attack and death skyrocket. Sudden death becomes a real possibility. In the 30 or so years required to establish sufficient coronary plaque to permit the appearance of symptoms or the development of an abnormality detectable by stress testing, there were many years when the disease was early--too early to generate symptoms, too early to be detectable by stress testing. That’s when heart scans uncover evidence for silent coronary atherosclerotic plaque.Should we call this a “false positive” just because it doesn’t also correlate with “need” for a catheterization, stent, bypass operation or result in heart attack within the next few weeks? The detection of early plaque is just that: early disease detection. Imagine, for instance, that the breast cancer that will grow into a palpable nodule or mass detectable by mammogram is detectable by a special breast scan 15 years before it becomes a full-blown tumor, metastasizing to other organs. What if effective means to halt that earliest evidence of cancer could put a stop to this devastating disease decades ahead of danger? Is this a “false positive” too?In my view, this is the knuckleheaded thinking of the conventional practitioner: “Don’t bother me until you’re really sick.” Prevention is a practice that has become fashionable only because of the push of the drug industry. Nutrition is an afterthought, a message conceived through consensus of “experts” with suspect motivations and allegiances. So, no, heart scans do not uncover “false positives.” They uncover early disease--true positives--years before it is detectable by standard tests or by the appearance of catastrophe. But that is the whole point: Early detection means getting a head start on prevention.Do heart scans lead to unnecessary heart catheterizations? Yes, sadly they do. But not because heart scans are false positive. It happens because of unscrupulous or ignorant cardiologists who use the information wrongly. In my view, heart scans should NEVER lead directly to heart catheterization in an asymptomatic patient. Heart scans, as helpful as they are, do not modify the standard reasons for performing heart procedures. If a car mechanic is dishonest and fixes a carburetor that didn't need fixing, should we condemn all car mechanics? No, of course not. We only need to develop the means to weed out the bad apples. The same applies to heart scans.
Triglycerides divided by five 3. September 2008 William Davis (8) Here's a bit of lipid tedium that might nonetheless help you one day decipher the meaning of shifts in your cholesterol panel. Recall from prior discussions that conventional LDL cholesterol is a calculated value. Contrary to popular opinion, LDL is usually not measured, but calculated from the Friedewald equation:LDL cholesterol = Total cholesterol - HDL cholesterol - triglycerides/5For the sake of simplicity, let's call total cholesterol TC; HDL cholesterol HDL, and triglycerides TG. We've also talked in past how a low HDL makes calculated LDL inaccurate, sometimes wildly so. (See Low HDL makes Dr. Friedewald a liar.)Here's yet another source of inaccuracy of the Friedewald-calculated LDL: any increase in triglycerides.Let's say, for instance, that starting lipid panel shows:TC 170 mg/dlLDL 100 mg/dl HDL 50 mg/dlTG 100 mg/dlYou're advised to follow a standard low-fat, whole grain-rich diet advocated by "official" agencies (the diet I bash as knuckleheaded). Another panel a few months later shows:TC 230 mg/dlLDL 140 mg/dlHDL 50 mg/dlTG 200 mg/dl(Obviously, I've oversimplified the response for the sake of argument. HDL would likely go down, LDL would change more depending on body weight, small LDL tendencies, and other factors. You'd also likely get fat.) Now your doctor declares that your LDL has gone up and you "need" a statin agent. Nonsense, absolute nonsense. What has really happened is that the increased dietary intake of wheat and other "healthy whole-grain foods" has caused triglycerides to skyrocket. LDL increases, in turn, by a factor of TG/5, or 40 mg/dl. Thus, LDL has been inflated by the triglyceride-raising effect of whole grains. This is yet another reason why the standard lipid panel, full of hazards and landmines, needs to be abandoned. But calculated LDL in particular is an exercise in frustration. Though the example used is hypothetical, I've witnessed this effect thousands of times. I've also seen many people placed on statin drugs unnecessarily, due to the appearance of a high LDL cholesterol that really represented increased TG/5, usually induced by an excessive carbohydrate intake, including those commonly misrepresented as healthy such as whole grains.
Who reads The Heart Scan Blog? 2. September 2008 William Davis (0) In the Heart Scan Blog, I am often guilty of speaking out loud of my varied thoughts on this crazy thing that we've created called the cardiovascular healthcare machine. But I discuss it in the context of asking "How could this be done better--better outcomes, more patient-friendly, more accessible . . . more do-it-yourself? The last part is the part that throws most people. Do-it-yourself? My colleagues would claim I'm nuts, suggesting that coronary heart disease is something manageable by yourself. In the conventional pathway, after all, coronary disease is that unpredictable, poorly detected by standard tests, condition that then leads to heart catheterization, stents, bypass , and the like. Several factors distinguish the readers of The Heart Scan Blog that surprised me:--Nearly 60% are women--There are a disproportionate number of Asian people. (Can someone explain this to me?) --A great number have graduate degreesI believe this tells me that The Heart Scan Blog appeals to a somewhat more sophisticated audience. This, to some degree, warms my heart, since it means that I've captured the attention of some people who may be more discriminating and thoughtful in their Internet surfing. However, I also lament the fact that these conversations are not achieving the mainstream. After all,
Kitchen sink approach for Lp(a) 29. August 2008 William Davis (12) Lipoprotein(a), Lp(a), can be a tough nut to crack. Having struggled and wrestled with this genetic pattern for the last 12 years or so in hundreds of patients, I have gained great respect for this difficult to control pattern. I regard lipoprotein(a) as the number one most aggressive cause for heart disease and coronary plaque known. It can account for heart attacks in men in their 40s, women in their 50s. It can cause heart disease and heart attacks in even the ultra-fit like marathon runners. It accounts for both excessive coronary risk and misleading cholesterol values in slender, healthy-appearing people. Niacin is the number one treatment choice for Lp(a), followed by testosterone for men, estrogens (preferably human, not horse or other non-human mammal) for women. I then often resort to DHEA, along with adjunctive nutritional agents like raw almonds, ground flaxseed, and others. Our most recent addition to the Lp(a) treatment list is high-dose fish oil, which appears to exert a significant effect in about 40% of people with Lp(a). Even with this multi-agent approach, not everybody gains control over Lp(a).That makes me wonder if someone has Lp(a) at a substantial level of, say, 200 nmol/L or 70 mg/dl (values can differ tremendously, depending on the method of measurement), should we throw everything but the kitchen sink at Lp(a) from the start? Right now, by adding an agent one at a time, it often takes two years to gain control over Lp(a) (if we are going to get it at all).While many people might find this unpalatable and overwhelming from the starting gate of their program, I do believe it may be a strategy we should consider adopting for full and more immediate plaque control in the Track Your Plaque program. Something to chew on. Clearly, we need better answers for Lp(a). A "kitchen sink," full-frontal assault might be a way to gain faster control, though not necessarily a superior approach with regards to efficacy and potency. There are a number of unique, potentially effective therapies for Lp(a) that are worth examining. Given the difficulty of performing clinical trials with non-drug agents (largely a lack of financial support, since nobody gets a financial return with non-patent-protectable agents), I am anxious to put these potential treatments to a test in the Track Your Plaque program Virtual Clinical Trail (VCT). The VCT gives us a quick and relatively easy method to test various potential treatments, with feedback generated in months, rather than years. Any suggestions on promising agents to test? Of course, they must be widely available nutritional agents, not drugs.
Making Dr. Friedewald an honest man 28. August 2008 William Davis (3) Colleen started with the usual discrepancy between conventional calculated LDL cholesterol of 121 mg/dl and the far more accurate LDL particle number (NMR) of 1927 nmol/L. Those of you following this conversation or our many conversations on the Track Your Plaque Forum know that a useful and highly reliable rule-of-thumb for converting NMR LDL particle number to LDL is Psssst . . . There's sugar in there Toggle navigation Home Blog Home Archive Join Now Log in Psssst . . . There's sugar in there 1. March 2010 William Davis (13) You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl. Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:Balsamic vinaigretteMany commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.) HamburgersI learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy. Tomato soupIf it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar. GranolaSure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar. Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy. And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose). Related posts Low-carb eating for diabetes Jenny provided permission to reprint her very excellent introduction to low-carbohydrate eating for ... Psssst . . . There's sugar in there You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of... Rerun: To let low-carb right, you must check POSTPRANDIAL blood sugars Checking postprandial (after-eating) blood sugars yields extraordinary advantage in creati... Comments (13) - Benpercent 3/1/2010 10:04:29 PM | Regarding the hamburgers: Was the blood sugar increase due to some sort of recipe used or did you purchase the ground beef not knowing bread was added to it? A strange place to find it I'd say! I'll probably switch to grinding my own now. Steve Cooksey 3/1/2010 10:32:17 PM | Doctor Davis... YOU ROCK!!I'm a T1.5... who lost 78lbs, I have normal blood sugar ...for non-diabetics.NO meds, NO insulin... Keep Spreading the word... to ALL.Love your blog ... Steve Anna 3/2/2010 12:10:43 AM | I can pretty much count on higher BG readings when I eat at group meal gatherings away from home, unless I bring and eat only my own food. I don't normally eat much processed convenience food, so I forget that boxed heat & serve breakfast sausage links can be full of sugar. I also now know to steer clear of table grapes and fruit trays (I used to make sure to have fruit with the bacon or sausage and eggs for breakfast to deflect the comments from others, but now I don't bother with the fruit because it's always too high-sugar. At restaurants I ask for dressing on the side if I use dressing at all. I dip my fork in the dressing before spearing a bite - that provides enough flavor without all the dressing. Most of the time I avoid the dressings because they are made with soybean or canola oil anyway. I ask for Olive Oil and Vinegar - not vinaigrette, which is often sweetened. At home I always make salad dressing or simply toss with EVOO and a good vinegar, freshly ground SS & BP. It's been years since I bought salad dressing. Homemade is a breeze to make (even Ranch style) and economical, too.Frozen yogurt is far worse than full fat high quality ice cream. Frozen yogurt almost always has more sugar and no fat or eggs to slow the absorption of the sugar. Homemade ice cream is the best because you can control the sweetness level and use more cream and egg yolks (commercial is too sweet-tasting for me anymore, BG notwithstanding). OJ - like a glass of pure sugar - absorbs into the blood stream nearly instantly. I have a valencia orange tree in my garden but I don't dare drink the juice straight. I put a tiny splash of freshly squeezed OJ or drop a squeezed orange wedge in a tall glass of Gerolsteiner sparkling mineral water (good source of magnesium).BBQ sauce & catsup - loaded with sugars - watch out for honey mustard sauce, too. Anonymous 3/2/2010 12:48:34 AM | Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.http://www.reuters.com/article/idUSTRE6205AQ20100301Michael zach 3/2/2010 1:23:16 AM | I looked at the back of my vinegar and it has 5 grams of carbs per tablespoon, 2 of which are sugars. But the only ingredients listed are red wine vinegar and grape musts. David 3/2/2010 4:24:59 AM | Michael,That article isn't talking about a new study per se, but rather a review of several select studies. In other words, it's not really providing any new information. It's a (biased) interpretation of a sampling of the existing data.I found this quote from the article to be pretty funny:"Now, if there are specific instances of vitamin D or calcium deficiency, then that's a separate issue that should be discussed with a personal physician."Uh, except it's hardly a separate issue since nearly everyone is deficient in vitamin D. David Anonymous 3/2/2010 9:03:07 AM | grape musts? That should have given you a clue. Grapes are very high in sugar. It always comes down to the same thing: Always read the labels. Carefully. Never trust anything that is processed. Not even if you buy it in Health Food shops. Peter 3/2/2010 1:17:18 PM | You don't need to test your blood sugar. You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most. Mostly this is because you ingest those in greater quantities since you like them, but partly because you choose those because the blood sugar rushes feel good. David 3/2/2010 4:50:50 PM | "You don't need to test your blood sugar. You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most."No. This is not a reliable way to go about things, as it isn't always true. It's never good to simply trust your feelings. Being objective with a glucometer isn't difficult or expensive. There's nothing to lose. caphuff 3/2/2010 5:46:18 PM | re hamburgers, also watch out for worcestershire sauce! Just discovered (much to my dismay) that the brand I had been using contains molasses and high fructose corn syrup. Yech! Nigel Kinbrum 3/3/2010 10:23:18 AM | Michael said..."Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.Calcium, vitamin D pills don't help heart: study" The RDA for Vitamin D is set for bone health. Therefore, an RDA dose of Vitamin D makes no difference to anything except bone health. It takes a dose about ten times the RDA to be effective elsewhere.If you give people one tenth the correct dose of a medication, would you be surprised that the medication is ineffective?Nige. Kathy 3/3/2010 11:13:22 AM | so easy to make homemade tomato soup, still a little high in carb's but nowhere near store boguht, handy if you absolutely must have a bowl of tomato soup. Use tomato paste, water and some heavy cream and salt to taste. you don't need the cream, but it tastes better. One of the fastest "homemade' soups. Keep in mind that tomatoes do have carbs, about 4 per 2 tbsp of paste. You can add splenda to sweeten a little renegadediabetic 3/4/2010 2:26:14 PM | It's infuriating that sugar and starch show up in places you would least expect them. You have to read labels very carefully. I've been burned by failing to read labels. Even better, eat real food prepared from scratch. Add comment Comment Preview Name * E-mail * Comment * Preview Notify me when new comments are added The captcha text was not valid. Please try again.
Psssst . . . There's sugar in there 1. March 2010 William Davis (13) You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl. Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:Balsamic vinaigretteMany commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.) HamburgersI learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy. Tomato soupIf it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar. GranolaSure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar. Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy. And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose).