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.

Lipoprotein testing

19. October 2007 William Davis (5)
This is an update of a post I made about a year ago. However, I'm reposting it since the question comes up so often.


How can I get my lipoproteins tested?
This question came up on our recent online chat session and comes up frequently phone calls and e-mails.

If lipoprotein testing is the best way to uncover hidden causes of coronary heart disease, but your doctor is unable, unknowledgeable, or unwilling to help you, then what can you do?

There are several options:

1) Get the names of physicians who will obtain and interpret the test for you. That’s the best way. However, it is also the most difficult. Lipoprotein testing, despite over a decade of considerable scientific exploration and validation in thousands of research publications, still remains a sophisticated tool that only specialists in lipids will use. But this provides you with the best information on you’re your lipoproteins mean.
2) If you don’t have a doctor who can provide lipoprotein testing and interpretation, go to the websites for the three labs that actually perform the lipoprotein tests: www.liposcience.com (NMR); www.berkeleyheartlab.com (electropheresis or GGE); www.atherotech.com (ultracentrifugation). None of them will provide you with the names of actual physicians. They can provide you with the name of a local representative who will know (should know) which doctors in your area are well-acquainted with their technology. I prefer this route to just having a representative identify a laboratory in your area where the blood sample can be drawn, because you will still need a physician to interpret the results¾this is crucial. The test is of no use to you unless someone interprets it intelligently and understands the range of treatment possibilities available. Don’t be persuaded by your doctor if he/she agrees to have the blood drawn but has never seen the test before. This will be a waste of your time. That’s like hoping the kid next door can fix your car just because he says he fixed his Mom’s car once. Interpretation of lipoproteins takes time, education, and experience.

3) Seek out a lipidologist. Lipidologists are the new breed of physician who has sought out additional training and certification in lipid and lipoprotein disorders. Sometimes they’re listed in the yellow pages, or you can search online in your area. One drawback: Most lipidologists have been heavily brainwashed by the statin industry and tend to be heavy drug users.

4) Contact us. I frankly don’t like doing this because I feel that I can only provide limited information through this method and, frankly, it is very time consuming. I provide a written discussion of the implications and choices for treatment with the caveat to discuss them with your doctor, since I can’t provide medical advice without a formal medical relationship. We also charge $75 for the interpretation. But it’s better than nothing.

5) Make do with basic testing. Basic lipids along with a lipoprotein(a), C-reactive protein, fibrinogen, and homocysteine would provide a reasonable facsimile of lipoprotein testing. You’ll still lack small LDL and postprandial (after-eating) information, but you can still do reasonably well if you try to achieve the Track Your Plaque targets of 60-60-60. It’s sometimes a necessary compromise.

Our discussions on the Track Your Plaque Forum have impressed me with the difficulty many people encounter in getting lipoproteins drawn and interpreted. Some of our Members have been very resourceful identifying blood draw laboratories around the country, such as Lab Safe, that will at least provide the blood draw service.

I wish it was easier and we are working on some ideas to facilitate this nationwide. It will take time.

In 20 years, this will be a lot easier when doctors more commonly use lipoprotein testing. But for now, you can still obtain reasonably good results choosing one of the above alternatives.

Is it exercise or diet?

18. October 2007 William Davis (7)
Wayne, a 61-year old retired school superintendent, had been an exercise fanatic all his adult life. If not running long distances and occasional marathons, he'd bike up to 70 miles a day. He did this year-round. In cold weather, he set his bicycle up on an indoor device and also ran on a treadmill and added weight training.

That's why it was kind of surprising that he sported a large belly. At 5 ft 8 inch and 190 lbs, that put his Body Mass Index (BMI) also high at 28.8 (desirable <25). You'd think that vigorous, almost extreme, exercise like this would guarantee a slender build.

Wayne also had lipoproteins to match: triglycerides 205 mg/dl, LDL 176 mg/dl but LDL particle number much higher at 2403 nmol/l (an effective LDL of 240 mg/dl); 75% of LDL particles were small.

I asked Wayne about his diet. "I eat healthy. Cheerios for breakfast usually. Some days I'll skip breakfast. Lunch is almost always a sandwich: tuna, turkey, something like that on whole wheat bread or a whole wheat bagel. Chips, too, but I guess that's not too healthy. Dinners vary and we eat pretty healthy. Almost never pizza or junk like that."

"Pasta?" I asked.

"Oh. sure. Two or three tiems a week. Always whole wheat. With a salad."

Wayne was well aware of the conventional advice for whole grains and, indeed, had been trying to increase his intake, particularly since his basic cholesterol numbers had been high in past. To his surprise, the more he tried at diet, the more LDL seemed to go up, as did triglycerides.

I see this situation every day: The obsession with processed carbohydrate foods, worsened by the message perpetuated by the American Heart Association, the USDA Food Pyramid, Kraft, Kelloggs, Post, etc. Eat more fiber, eat whole grains.

NY Times columnist, Jane Brody, chronicles her (embarassing) mis-adventure following the same mis-guided advice in Cutting Cholesterol, an Uphill Battle.

According to the USDA Food Pyramid, Wayne is not getting enough grains and whole grains, particularly since he is highly physically active. Consistent with the message given by the food industry: "Eat more!"

The food industry-supported Whole Grain Council advises:

Whole Grains at Every Meal
The US Dietary Guidelines recommend meeting the daily requirement by eating three "ounce-equivalents" of breads, rolls, cereals or other grain foods made with 100% whole grains. A slice of bread or a serving of breakfast cereal usually weighs about an ounce.

Want an easier way to think about it? Just look at your plate at each meal, and make sure you've included some source of whole grains. That's why our slogan is "Whole Grains at Every Meal."


By this scheme, if you are overweight, it's because you lack fiber and you're too inactive. "Get up and go!" It's not the diet, they say, it's you!

See through this for what it is: Nonsense. Wayne was overweight, packing 20 extra pounds in his abdomen from his over-dependence on processsed carbohydrates--"whole grains"--not from inactivity.

Instant heart disease reversal

17. October 2007 William Davis (16)

What if reversal of heart disease--regression of coronary atherosclerotic plaque--were achievable instantly? Just add water and--voila!!

To my knowledge, it is not--yet. But I sometimes play with this idea in my head. I could imagine that such a program would consist of a few essential elements:

--A fast or semi-fast, or at least a very spare diet, over a period like 10 days to promote net catabolism. It is also supremely anti-inflammatory to restrict calories.

--High-dose vitamin D, e.g., 20,000 units per day of D3 to fully replenish depleted stores and achieve all the metabolism-correcting effects of D3 restoration.

--EPA + DHA at a higher than usual dose with frequent throughout-the-day dosing to encourage replacement of cellular lipid constituents with the more stable omega-3 fraction of fatty acids.

Beyond this, I'm uncertain. What role l-arginine, statins, niacin . . . conjugated linoleic acid? ApoA1 Milano infusions?

This is simply whimsical at this point. I don't know if such an approach would work. But if it did, you might imagine that it would offer an opportunity--for the properly motivated--as an alternative treatment for angina, advanced coronary disease, a means to pull someone back from the brink.

With the insights gained from our slow-but-powerful Track Your Plaque approach, perhaps we will also gain insights into how to accelerate such a process of reversal so that it is achievable in days, rather than months or years.

The small LDL epidemic

16. October 2007 William Davis (24)
Ten years ago, small LDL was fairly common, affecting approximately 50% of the patients I'd see. For instance, an LDL particle number of 1800 nmol/l would be 40-50% small LDL in about half the people.

But in the last few years, I've witnessed an explosion in the proportion of people with small LDL, which now exceeds 80-90% of people. The people who show small LDL also show more severe patterns. 80-90% small LDL is not uncommon.

Why the surge in the small LDL pattern? Two reasons: 1) The extraordinary surge in excess weight and obesity, both of which favor formation of small LDL particles, and 2) over-reliance on processed carbohydrates, especially wheat-based convenience foods.

The constant media din that parrots such nonsense as the report on CNN Health website, Healthful Breakfast Tips to Keep You Fueled All Day, helps perpetuate this misguided advice. The dietitian they quote states:

"If you don't like what you're eating, you won't stick with it. If your choices aren't the most nutritious, small tweaks can make them more healthful. For example, if you have a sweet tooth in the morning, try a piece of nutty whole-grain bread spread with a tablespoon each of almond butter (it's slightly sweeter than peanut butter) and fruit preserves instead of eating foods that offer sweetness but little nutritional benefit, like doughnuts or muffins. If you enjoy egg dishes but don't have time to prepare your favorite before work, try microwaving an egg while toasting two slices whole wheat or rye (whole-grain) bread. Add a slice of low-fat cheese for a healthful breakfast sandwich that's ready in minutes. And don't overlook leftovers. If you feel like cold pizza (which contains antioxidant-filled tomato sauce, calcium-rich cheese, and lots of veggies), have it. It's a good breakfast that's better than no breakfast at all."

It sure sounds healthy, but it's same worn advice that has resulted in a nation drowning in obesity. The food choices advocated by this dietitian keep us fat. It also perpetuates this epidemic of small LDL particles.

If you have small LDL and its good friend, low HDL, it's time for elimination of wheat products, not some politically-correct silliness about increasing fiber by eating whole grains. Whole grains create small LDL! Or, I should say, what passes as whole grains on the supermarket shelves.

For some helpful commentary on this issue, see Fanatic Cook's latest post, Playing with Grains.

Mini-dose CTA?

15. October 2007 William Davis (11)
I caught this little news report in the online edition of Canyon News , an LA paper, under the title Cedars-Sinai Develops Test to Prevent Heart Attacks .

They report that Dr. Daniel S. Berman M.D., chief of Cardiac Imaging and Nuclear Cardiology at Cedars-Sinai, reports that a new method of performing CT coronary angiography, "mini-dose CTA," has been developed that allows both coronary calcium scoring as well as CT coronary angiography (CTA) at a dose as low as 10% of standard dose. No technical details were provided.

Now, that may be worth knowing more about. If this is true, then CTA may indeed be useful as a "screening" procedure. However, we are going to need to know more: What devices are capable of doing this, what settings on the devices were used, etc. It does indeed come from a reputable source in Dr. Dan Berman, who is well known in nuclear cardiology circles.

We will try and dig for info. Stay tuned.

Wheat-free and weight loss

13. October 2007 William Davis (14)
With a heart scan score of 1222, Leslie could be in deep trouble in short order.

At 64 years old, Leslie had gained nearly 40 lbs since she'd given up a lot of her activities caring for a husband who'd developed psychological difficulties and stopped contributing to the household duties. A tall woman at 5 ft 9 inches, she held her 202 lbs well, but her lipoprotein patterns were a disaster:

--LDL particle number 2482 nmol/l--an equivalent LDL cholesterol of 248 mg/dl (drop the last digit)
--HDL 38 mg/dl
--Triglycerides 241 mg/dl
--90% of LDL particles were small
--Lipoprotein(a) 240 nmol/l

Blood sugar was in the pre-diabetic range at 112 mg/dl, C-reactive protein was high at 3.0 mg/l, blood pressure was somewhat high at 140/84.

Now, with the exception of lipoprotein(a), these patterns are exquisitely weight-sensitive. A reduction in weight would yield effects superior to any medication I could give her.

Processed wheat products were a big problem for Leslie: whole wheat bread, pretzels for snacks, whole wheat pasta. Yes, they sound healthy, even endorsed by the American Heart Association, often bearing "heart healthy" labels on the packages. Don't you believe it.

In particular, Leslie had the number one cause for heart disease in America: small LDL particles, a pattern that is magnified 30-70% by wheat products. Endorsed by the Heart Association? (As I often tell people, if you want heart disease, follow the diet advocated by the American Heart Association.)

Leslie was skeptical, worried that she would be hungry all the time and would have virtually nothing left to eat. Instead, when she returned to the office three months later, she reported that eating was easy, finding healthy foods not containing wheat was easier than she thought, she felt great, finding more energy than she'd had in years.

She'd also shed 30 lbs.

Leslie's lipoprotein patterns also reflected the weight loss. She achieved her 60:60:60 Track Your Plaque lipid targets, small LDL shrunk dramatically, blood sugar and blood pressure were back in normal ranges.

I see results like Leslie's several times every week. For those of us with patterns like Leslie's, or just obesity that accumulates in the abdomen, going wheat-free is among the most powerful single strategies I know of.

If you need convincing, try an experiment. Eliminate--not reduce, but eliminate wheat products from your diet, whether or not the fancy label on the package says it's healthy, high in fiber, a "healthy low-fat snack", etc. This means no bread, pasta, crackers, cookies, breads, chips, pancakes, waffles, breading on chicken, rolls, bagels, cakes, breakfast cereal. I find elimination of wheat easier than just cutting back. I believe this is because wheat is powerfully addictive. It's very similar to telling an alcoholic that a drink now and then is okay--it just doesn't work. They need to be alcohol-free. Most of us need to be wheat-free, not just cut back.

You won't be hungry if you replace the lost calories with plenty of raw almonds, walnuts, pecans, sunflower and pumpkin seeds; more liberal use of healthy olive oil, canola oil and flaxseed oil; adding ground flaxseed and oat bran to yogurt, cottage cheese, etc.; and more lean proteins like lean beef, chicken, turkey, fish, and eggs.

The majority of people who go wheat-free lose weight, sometimes dramatically. Most people also feel better: more energy, more alert, better sleep, less mood swings. Time and again, people who try this will tell me that the daytime grogginess they've suffered and lived with for years, and would treat with loads of caffeine, is suddenly gone. They cruise through their day with extra energy.

Even without weight loss, going wheat-free usually raises HDL, reduces the dreaded small LDL dramtically. It also reduces triglycerides, blood sugar, C-reactive protein, blood pressure. Blood sugar control in diabetics is far easier, with less fluctuations and sharp rises in blood sugar.

Success at this also yields great advantage for your heart scan score control and reversal efforts.

Collective wisdom

12. October 2007 William Davis (5)

As public consciousness and knowledge about health issues grows, thanks to the internet and other media, I predict that:

1) Hospitals will recede into a role of acute and catastrophic care ONLY, dropping the charade of providing health, which they do NOT.

2) Doctors and other health professionals will begin to see themselves as providers of acute and catastrophic care, also. They will stop providing day to day care, such as treating high blood pressure, cholesterol, breast exams, and other preventive maintenance.

3) Instead, preventive care will be self-provided. The public will have acquired sufficient savvy and know-how to manage issues like blood pressure themselves. They will need the assistance of helpful information resources, web-based for the most part. Much preventive care can, in fact, be algorithm-driven, just like following a simple recipe.

All the worries about runaway health care costs will be much reduced, since excessive testing driven by liability worries will disappear, repeated office visits for day-to-day issues will go away. Yes, you will need a doctor and hospital for a broken leg, car accident, unexpected cancer, or non-compliance or neglect of prevention.

But osteoporosis, high blood pressure, nutrition, weight loss, hormone management, cholesterol issues, minor complaints will all be managed by people themselves with the assistance of web-based knowledge systems.

I already sense this sort of phenomeonon developing, though in its infancy, in venues like the Track Your Plaque Forum and other health portals, places where the information being discussed exceeds the quality of information you can obtain from your doctor. Over and over again, for instance, the sophistication and knowledge demonstrated by our Track Your Plaque Forum discussions shows that the public is capable of far more understanding of health issues than many previously believed. Most of our members could carry on a credible conversation with trained lipid experts. The knowledge base of our members exceeds that of 98% of most of my colleagues when it comes to heart scans, lipoproteins, and nutrition.

I am in awe of Wikipedia, the popular online encyclopedia. Five 20- and 30-somethings have created a knowledge base that has now eclipsed Encyclopedia Britannica in size and scope, with equivalent accuracy, and relatively little cost. I'd like to see the same phenomenon occur in health care information, helping to usurp the current paternalistic "I'll tell you what to do" model.

Success--Slow but sure

12. October 2007 William Davis (5)
John is a gentleman.

At age 76, he continues to teach at a local college. He's a delight to talk to, having written several scholarly books on religious topics. He's a fountain of knowledge on religious history and the roots of faith.

John is one of those incurably optimistic people, always greeting me with a smile and a warm handshake. I can't help but linger for a hour or so to talk with John, unfortunately disrupting my office schedule miserably.

John is another Track Your Plaque success story. Though he didn't set any records in reduction of his heart scan score, he did it simply by adhering to the program over a period of two years, succeeding slowly but surely.

John's first heart scan score: 1190, a score that carries as much as a 25% annual risk for heart attack. Among the list of causes was an LDL cholesterol in the 170 mg/dl range, along with an LDL particle number that verified the accuracy of LDL.

Among John's suggested treatments was a statin drug, since I was not confident he could reduce LDL with diet and nutritional modifications sufficiently to safely reduce both LDL and his risk for heart attack. But he proved terribly intolerant to any dose of any statin, with incapacitating and strange side-effects, like head-to-toe itching, abdominal cramps and diarrhea. It was clear: John needed to do the program without benefit of a statin drug.

I therefore asked John to maximize all efforts that reduce LDL, 70% of which were small LDL paricles despite his very slender build. He used oat bran and ground flaxseed daily, raw nuts, a soy protein smoothie every morning, and eliminated wheat and other high-glycemic index foods (including the Oreos he loved to snack on). Because the mis-adventures with statin drugs wasted nearly a year, I asked John to undergo another heart scan. Score 2: 1383, a 16% increase.

I asked John to keep on going. Thankfully, he did manage to tolerate fish oil, niacin (though it required over a year just to get to a 1000 mg per day dose), and vitamin D. With all these efforts, he did reduce LDL to the 80-90 mg/dl range. Of course, John's unflagging optimism was crucial. He did express his occasional anxiety over his heart scan score, but dealt with it in a logical, philosophical way. He understood that there was no role for prophylactic stents or bypass, and he accepted that much of his program rested on his ability to adhere to the strategies we advised.

Another year later, a 3rd heart scan: 1210, a 12% reduction.

I'm very proud of John and his success. When you think about it, he succeeded in conquering heart disease with some very simple tools, minus statin drugs. It can be done, but requires consistency and patience--and an optimistic outlook.

Vitamin D and octagenarians

10. October 2007 William Davis (28)
Roger practically bounced in his chair vibrating with energy.

"It must be the vitamin D! I haven't felt like this in years. I can work around the yard all day and still have energy left over."

At age 84, Roger started out with pretty good health, despite a prosthetic valve and bypass surgery 5 years earlier. He looked 74, perhaps younger.

I've seen this effect now in about 20 octagenarians. A Track Your Plaque Member mentioned this same effect in his father-in-law in a discussion in our Forum. Most are taking around 6000-8000 units per day (gelcap, of course). The average dose of vitamin D tends to be higher in this age group, since by age 80, you've essentially lost the capacity to convert 7-hydrocholesterol to active vitamin D3 in the skin. Most octagenarians start with 25-OH-vitamin D3 levels of 10 ng/ml or less--profound deficiency.

I believe the effect is real, having now witnessed it multiple times. Unfortunately, my observations are too informal to qualify as a study. (I wouldn't even know how to quantify this. I suppose some sort of muscle and coordination testing might yield quantifiable measures.) However, there are some data emerging that show less fractures, falls, improved coordination, and perhaps improved memory and mentation with vitamin D supplementation, though doses often used in studies tend to be lower than what we are using in practice.

I haven't been so excited about the effects of a nutritional supplement in a long time. Vitamin D continues to yield surprises every day in its array of positive and powerful effects.

Could we say that vitamin D restores youthfulness?
How to have a heart attack in 10 easy steps

How to have a heart attack in 10 easy steps

29. June 2010 William Davis (48)
If you would like to plan a heart attack in your future, here are some easy-to-follow steps to get you there in just a few short months or years:


1) Follow a low-fat diet.

2) Replace fat calories with "healthy whole grains" like whole wheat bread.

3) Eat "heart healthy" foods like heart healthy yogurt and breakfast cereals from the grocery store.

4) Use cholesterol-reducing plant sterols.

5) Take a multivitamin to obtain all the "necessary" nutrients.

6) Take the advice of your doctor who declares your heart "in great shape" based on your cholesterol values.

7) Take the advice of your cardiologist who declares your heart "like that of a 30-year old" based on a stress test.

8) Take a statin drug to reduce LDL and c-reactive protein while maintaining your low-fat diet.

9) Neglect sun exposure and vitamin D restoration.

10) Limit your salt intake while not supplementing iodine.



There you have it: An easy, 10-step process to do your part to help your local hospital add on its next $40 million heart care center.

If you would instead like to prevent a heart attack in your future, then you should consider not doing any of the above.
Tags :

Comments (48) -

  • Danny Roddy

    6/29/2010 1:52:30 AM |

    Hmmm the Kitavans break your first rule and they don't have any signs of heart disease.

  • Anonymous

    6/29/2010 2:10:36 AM |

    Danny,

    Multifactorial, much?  And of the 20% or so of TEI from fat, the Kitavans consumed most of that as SFA.  Quite a bit different from the Ornish recommended screw you fat down as low as you can go approach.

  • Josh

    6/29/2010 2:13:53 AM |

    Hmmm... maybe they're good on the other 9 steps perhaps???

  • Anonymous

    6/29/2010 2:22:35 AM |

    I'm just curious about the inclusion of a multivitamin. How does a multi increase your chances of a heart attack? Maybe the ones with iron? Thanks

    Elliot

  • Anonymous

    6/29/2010 2:24:04 AM |

    I would love to know the reasons behind these - would you be interested in posting brief explanations?

  • Jamie Scott

    6/29/2010 3:10:29 AM |

    I'm assuming the multi-vitamin is included for those types who can eat shite but as long as they are swallowing 20 vitamins & minerals everyday, they'll be fine and dandy... no need to change your diet when you can get everything you need from a pill you know.

  • hans keer

    6/29/2010 6:04:26 AM |

    Very good advice for thrill seakers. Perhaps, to make it even more exciting, you can advice them to consume lots of omega 6 containing vegetable oils. VBR Hans

  • HeartHealth

    6/29/2010 7:06:11 AM |

    This post is something one has to ead carefully as far as heart health is concerned. A source of information like this will help you understand so much about your health and how to deal with unexpected illness like heart attack.

    To me, if one learns something about health, it shows how care for yourself and how good you take care of your precious body.

    I say well done ! doc.

  • praguestepchild

    6/29/2010 7:46:05 AM |

    The Eades have a chapter about iron overload. Basically, our bodies have no mechanism for ridding excess iron, this historically happened naturally through blood loss: trauma and parasites. Then there's the famous study showing that beta carotene and vit A supplementation (18,000 people!) http://content.nejm.org/cgi/content/abstract/334/18/1150 Better to get things in their natural state, like from a vegetable, rather than popping a Centrum. I use a few supplements, mostly to try and make up for what I perceive as lacking from modern lifestyle, vit D for inadequate sunlight, coQ10 for lack of organ meat consumption, etc. I chucked the Centrum.

    Danny, the Kitavans also smoke a lot, so hey, that must be really good for your heart, also!

  • praguestepchild

    6/29/2010 7:54:08 AM |

    oops ... showed that vit A and beta carotene actually increased death rates by 28% for people at risk for lung cancer. The CARET study.

  • maxwell

    6/29/2010 10:14:07 AM |

    @Danny

    It depends if you consider coconut and fatty acids from fish as low-fat foods...i know i don't.

  • Chuck

    6/29/2010 11:43:45 AM |

    Kurt Harris will tell you about the Kitavans, Danny

    http://www.paleonu.com/panu-weblog/2009/11/2/im-so-bored-with-the-kitavans.html

  • Tony

    6/29/2010 12:33:36 PM |

    I have to say: On my old "American" diet, my LDL was 155, on a 20% fat diet, it was 113, and on a 10% fat diet, it was 95.

  • Jan

    6/29/2010 1:00:02 PM |

    Oh, my.  Well, I don't do any of these things any longer, so that's good.  However, I recently switched to natural sea salt after reading Sally Fallon's Nourishing Traditions, which is not fortified with added iodine.  Should I go back to the processed, bleached stuff?  I really don't want to, so how should I make sure I get enough iodine?

  • Matt Stone

    6/29/2010 1:28:08 PM |

    I would've kept my high-fat diet going for heart health, but I got tired of having chest pains.

  • Beth

    6/29/2010 5:03:42 PM |

    @Jan: No way, never go back to regular table salt. Stick with the good stuff. We have used Redmond's for years now and I was happily surprised when I first visited our new family doc and saw an empty Redmond's bag on his desk. I asked him why he had it there and he said it's the only salt he recommends to all his patients. My nurse (part of the same practice) actually told me to mix a tsp. of Redmond's in a glass of water each day for my thyroid. I also take supplemental iodine... and Vit.D because we live so far north we don't get much natural D absorption here, something about the angle of the rays.

  • Peter

    6/29/2010 7:56:04 PM |

    Pretty much I follow your advice but it seems like there are lots of indigenous cultures that eat unrefined carbs and seem to be much healthier than us.

  • Anonymous

    6/29/2010 9:53:05 PM |

    So what about Okinawa, Sardinia, Costa Rica and other places where little meat is consumed?  How do they live to be 100?

  • Linda

    6/29/2010 10:03:31 PM |

    In Okinawa they eat a lot of pork and cook everything in lard.

  • Anonymous

    6/29/2010 10:44:32 PM |

    I eat breakfast cereal because it's the simplest thing to prepare. All I need to do is mix milk and cereal and I'm done. In my half awake state, I funnel it into my tummy and I'm done.

    What is a good substitute for cereal that follows this beautiful simplicity? Help me check #3 off the list.

    -- Boris

  • Anonymous

    6/29/2010 11:27:40 PM |

    Dr. Davis,

    With respect to iodine, do you have any feelings regarding the use of granulated kelp?  For a while I had toyed with the idea of mixing it in a shaker with the seal salt I use, however the issue of arsenic levels made me hesitant to go that route.

    -Robert Daly

  • Anonymous

    6/30/2010 12:59:41 AM |

    @praguestepchild.  Well I can see by your picture that you are male.  For  50% of the population, menstruation might be a possible regular blood loss event. Just sayin'

  • Lori Miller

    6/30/2010 2:26:57 AM |

    My mother has #11: have your grown children live with you.

    I didn't tell her that #12, in susceptible individuals, is to live with your parents.

  • Lori Miller

    6/30/2010 2:57:56 AM |

    Re: iodine, I eat dulse, a wild Atlantic sea vegetable (read: seaweed). Properly prepared, it tastes good to me. To rehydrate it, I put it in a sealed container with salad overnight.

    The package says a 1/3 cup serving has 780% of the RDA of iodine and only 3g of carb, 2g of which are fiber.

  • Anonymous

    6/30/2010 8:26:59 AM |

    Please submit a clarification or list of what one SHOULD DO (instead ) DO rather than the list of things here - I'm completely confused now! - I'd like some sort of explanation  - I want to ensure that I have an excellent lipid profile, low cholesterol and low risk or neglible heart disease and atherosclerosis, what SHOULD one do ???

  • mongander

    6/30/2010 10:05:52 AM |

    While I don't use Dr Esselstyn's diet I'm impressed that 100s of his heart disease patients have totally avoided repeat heart attacks by avoiding animal fat.  This record goes back decades.  I've taken Dr Davis' advice and generally avoid wheat (except for a little wheat germ) but I see nothing wrong with unprocessed grains for most people.
    http://www.youtube.com/watch?v=AYTf0z_zVs0&feature=channel

  • Anonymous

    6/30/2010 1:49:46 PM |

    Anon,

    If you read this blog on a regular basis, you'd know what to DO.
    DO your homework!

    Jeanne

  • Anonymous

    6/30/2010 4:42:32 PM |

    Love to get your take on this Dr. Davis: http://www.msnbc.msn.com/id/38007231/ns/health-diabetes/

  • Kent

    6/30/2010 7:27:05 PM |

    Dr Davis,

    Speaking of heart attacks, a friend of mine's wife is in the hospital as we speak with heart attack symptoms. (Chest pains, numbness in arm, sweating, etc).  She is only 42 years old. They have been running a series of tests including the tropinin test from the sounds of what he describes, which has been flutuating up and down to high of 13. They have done a Catheter Angiography amd say everything "looks fine", with no blockages, and say they are puzzled at this point. They don't want to release her due the the chest pains and tropinin test and are considering tranferring her to another hospital.  Any ideas? also, does the cardio angiography rule out plaque blockages?

    Thanks!
    Kent

  • Anonymous

    6/30/2010 10:57:53 PM |

    What's wrong with yogurt?

  • Anonymous

    7/1/2010 12:06:34 AM |

    Hey folks,
    I see that the moderator side of things for this blog appears to have gone away in that posts appear straight away.  No doubt some culling will occur.

    For those who are new, check out this blog for key items such as Vitamin D, Vitamin K2, LDL particle size (making the distribution mode larger),  HDL (increasing it), effect of Niacin on LDL and tryglycerides (dropping), impact of low fat/high carbs diets on type II diabetes, Iodine impact on thyroid function and finally Omega 3/fish oil intake.

    All this info is on this blog or you can download an interview of Dr Davis with Jimmy Moore of http://livinlavidalowcarb.com

    As someone mentioned, you should do your own homework, and make your decision on what is best

    other sources, Baylor College's www.lipidsonline.org  and the Med journal Circulation, eg http://www.circ.ahajournals.org/cgi/content/full/99/4/591 tells you about antioxidants.

    This blog, IMHO, is a good motivator and launch point for literature research.  If you need more hand holding then spring for the TYP subscription, what is your health worth to you?.  Personally, I am fine with the web and that has given me the confidence I need to chose diet and ask questions of my FP.

    I take a 20mg statin with 2.5g Niacin (most effective combination to lower trigs and reduce CAD event...See lipidsonline.org ), I eat mostly vegetarian but some fish. I have steered away from high amounts of wheat, based on information presented in this blog, and lowered my exposure to PUFAs based on Chris Masterjohn's blog (http://www.cholesterol-and-health.com/Vegetarianism.html .  Vitamin D3 normalization (8000IU),  3g DHA/EPA and 120mu vitamin K2 round out the preventative measures for me personally,  Some other folks will swear by their approach. One size does not fit all.  Make an informed decision based on a dialog with your doctor.  

    be healthy, not paranoid
    Trevor

  • Dr. William Davis

    7/1/2010 1:19:29 AM |

    Lori--

    I love your numbers 11 and 12!


    Jamie--

    My comment about multivitamins was not meant to bash multivitamins per se. People often say to me, "I don't need to take vitamin D, fish oil, magnesium, iodine, etc. because I already take a multivitamin."

    It is folly to believe that you can obtain all you need from a multivitamin. It would have to be the size of a golf ball.

  • Anonymous

    7/1/2010 2:05:10 AM |

    Trevor again..... one other good source for nubbies

    http://dhaomega3.org

    Dr Bruce Holub University of Guelph

    shows biggest risk factors for all-cause morbidity (1st smoking, 2nd high blood pressure). 70% higher risk of CAD event from the combination of High Trigs and low HDL.... DHA/EPA Omega3 is key to lowering risk factors

  • Anonymous

    7/1/2010 2:22:09 AM |

    @ Trevor

    Wonderful summation Trevor. Most of the answers are here in Dr. Davis' blog.  With your dose of Statin, why aren't you taking CoQ10?

  • Ed Terry

    7/1/2010 1:19:20 PM |

    I recently saw a cardiologist to get an order for a second EBCT and I explained to him how I increased my HDL from 32 to 71.  I could see that he didn't have a frame of reference for processing that information.  He also commented on how all he knew about nutrition was what he learned in medical school.  I simply remarked "I understand".  I don't think he meets many well-informed patients.

    He also didn't think it was possible to reduce the calcium score.  Assuming he follows the ten rules listed by Dr. Davis, I think it's safe to say he never will.

  • Anonymous

    7/1/2010 4:02:39 PM |

    @ Ted,
    I hear you. That was a pretty dumb move by AstraZeneca.  Healthy people with no risk profile should not take any drugs "just in case".  

    Combination therapy of niacin and statin lowers the risk on CAD events by almost 90%

    @ Anon,
    I have used CoQ10 at the suggestion of my family physician.  But not so convinced of the need/expenditure.
    Trevor

  • Anonymous

    7/1/2010 5:16:36 PM |

    [citations needed]

  • Anonymous

    7/2/2010 5:49:09 PM |

    6 months ago after following a vegan diet my HDL had dropped to 21 and triglycerides were at 256. Now, with low-carb, niacin, vitamin d and fish oil HDL is at 61 with triglycerides at 98.

  • yvonne manecke

    7/3/2010 2:48:12 AM |

    What about people with the APOe 3/4 genetics? I was told by Berkley Labs that fish oils actually do the reverse for people like me. I  have had a 3 way bipass, am 52 yrs. old and can't get my HDL up past 32, even with 1500 mg niaspan. On an extremly low fat diet LDL went down to 76 but HDL didnt go up. What should a person do if they have hyperlipidemia and are APOe 3/4?

  • Yvonne Manecke

    7/3/2010 2:56:02 AM |

    Dr. Davis
    I sure wish I could find the truth for Apoe 3/4 people. I get conflicting reports about fats. I have spent the last 3 mo. researching and can see that your info is good for most people. What about us? I know that efa's are important to help ward off alzheimers, but I have been told that I can't process them and should count them in my daily fat allowance. Also Berkleys research showed that omega 3 helped all heart patients except APOe 3/4. What am I going to do? Yvonne

  • Dr. William Davis

    7/4/2010 1:10:42 AM |

    Hi, Yvonne--

    We will be having some conversations about the influence of Apo E genetics on dietary considerations in a future Track Your Plaque discussion.

  • Urgent Care California

    7/6/2010 8:35:40 AM |

    Your tips are really great. Thanks for sharing such a great post.

  • Olive Kaiser

    7/8/2010 4:20:40 AM |

    For the question about cereal for breakfast, use cooked brown rice or other whole grain cereal, gluten free if necessary.  Put it in the crock pot overnight with grass fed pastured milk, butter, honey and nutmeg or cinnamon.  Or crock pot it with delicious bone broth and some animal fat.  Add some lovely pastured cream and butter in the morning and a few bananas or berries, depending on the flavors you have going.  In the morning, just spoon it up and enjoy.  

    Next day if you have time, after it congeals in the frig, slice and saute it in bacon fat or butter until the edges are crispy.  Serve with a couple of over easy pastured soy free eggs.   MMMM!

  • gart

    8/4/2010 1:26:46 PM |

    Dear Dr. Davis,

    I'm new to your blog, which I find very interesting and full of what appears to be insightful comments and recommendations. I also find your "unorthodox" stance in many issues very refreshing. I would like to know:
    1.have you published research backing the advice you give on your blog?
    2. have your work been peer reviewed?
    3. could you, please, let me know where I can find them?

    Thanks in advance for your help.

  • Gart

    8/15/2010 8:45:17 AM |

    Dr. Davis,

    I really appreciate it if you could provide an answer to my previous comment regarding research backing your advice.

    Thanks!

  • gart

    8/20/2010 11:03:39 AM |

    Dear Dr. Davis,

    I'm extremely disappointed you haven't answered my question regarding your research, either in this forum or via e-mail. I want to give you the benefit of the doubt, otherwise I would have to conclude that your advice is baseless and does not carry any scientific weight.

  • thorfalk

    3/16/2011 1:00:57 PM |

    most of the stuff makes sense, but what is the issue with multi vitamins?

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