What role cholesterol medication?

A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.

Supplement Mania!

Ever hear of "polypharmacy"? That's when someone takes too many medicines. People will have lists of 15-20 prescription medicines, for instance, with crazy interactions and oodles of side-effects.

Well, how about "poly-supplments"? That's when someone takes a large number of nutritional supplements.

Let me tell you about a 45 year old man I met.

In an effort to rid himself of risk for heart disease that he felt was likely shared with his family (brother and father diagnosed with heart attacks in their late 40s), Steve followed a program of nutritional supplementation. You name it, he took it: hawthorne, anti-oxidant mixtures, vitamins C, E, B-complex, saw palmetto, 7-keto DHEA, velvet deer antler, gingko biloba, policosanol, chronium picolinate, green tea, pine bark extract, St. John's Wort, CoEnzyme Q10, papain and other digestive enzymes...He became a distributor for a nutritional supplement company to allow him to afford his own extraordinary program.

To satisfy himself that he had indeed "cured" himself of heart disease, he got himself a CT heart scan. His score: 470, in th 99th percentile. Steve's heart attack risk based on this score was around 10% per year. High risk, no question.

For weeks after his scan, Steve admitted walking around in a daze, not knowing what to do. Years of telling himself that he had effectively dealt with his heart disease risk, now all down the drain.

When we met, I persuaded him that to think that this collection of supplements would reverse heart disease was magical thinking. We trimmed his list down to the essentials and got him on the right track.

Heart disease is controllable and reversible, but not this way. Don't fool yourself into thinking that some collection of supplements will be enough to stamp out your heart disease risk. Just like taking an antibiotic when you don't have an infection achieves nothing, so does taking the wrong supplements.

What does heart scanning mean to you?

CT heart scans can mean different things to different people.


What does a heart scan mean to you? There are several possibilities:

1) A way of reducing uncertainty in your future.

2) A tool to crystallize your commitment to health.

3) A device to help you track how successful your heart disease prevention program is.

4) A trick to get you in the hospital.

5) A moneymaking tool for unscrupulous physicians hoping to profit from "downstream" testing, particularly heart catheterizations.


Like anything, heart scans can be used for both good and evil. How can you be sure that your heart scan is put to proper use--for your benefit and not someone else's profit?

Simple: Get educated. Understand the issues, be armed with informed questions.

If, for instance, you're a 55-year old female with a heart scan score of 90, active without symptoms, and you're told to have a heart catheterization right off the bat---run the other way. This is bad advice. A heart procedure like catheterization at this score in an asymptomatic woman is very rarely necessary. That decision can only be made after a step-by-step series of decisions are made by a truly interested, unbiased party. (A stress test is almost always required in this situation before the decision can be made to proceed with a catheterization.)

Unfortunately, in 2006, getting unbiased advice from your doctor is still a struggle. That's why we started Track Your Plaque---unbiased information, uncolored by drug or device company support, with an interest in the truth.

Coronary disease is drying up!

I had an interesting conversation with a device representative this morning. He was a sales representative for a major medical manufacturer of stents, defibrillators, and other such devices for heart disease.

Since I'm still involved with hospital heart care and cardiac catheterization laboratories, this representative asked me if I was interested in getting involved with some of the new cardiac devices making it to market over the next year or two. "The coronary market is drying up, what with coated stents and such. We've got to find new profit sources."

Well, doesn't that sum it up? If you haven't already had this epiphany, here it is:

HEART DISEASE IS A PROFITABLE BUSINESS!

Why else can hospitals afford billboards, $10 million dollar annual ad campaigns, etc.? They do it for PROFIT. Likewise, device and drug manufacturers see the tremendous profit in heart disease.

The representative's comments about the market "drying up" simply means that the use of coated stents has cut back on the need for repeat procedures. It does NOT mean that coronary disease is on the way out. On the contrary, for the people and institutions who stand to profit from heart care, there's lots of opportunity.

Track Your Plaque is trying to battle this trend. Heart disease should NOT be profitable. For the vast majority of us, it is a preventable process, much like house fires and dental cavities.

Mammogram for your heart

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.

Is your doctor using "leeches"?

What if you went to your doctor for a problem and he/she promptly placed leeches on your body?

Yeccchhhh! Would you go back? I'd bet that you'd run the other way as fast as your bleeding legs could take you. Outdated health practices like "bleeding" are outdated for good reason.

Then why would you allow your doctor to approach your heart disease prevention program by checking cholesterol and then waiting for symptoms to appear? That miserable approach leads to tragedy and death all too often--ask Bill Clinton! He might as well have had leeches!

Don't allow your doctor's ignorance or disinterest impede your prevention program. Get your coronary plaque measured, then attack it from all sides by knowing all causes, hidden and obvious. That's why Track Your Plaque is such an effective program.

I often wonder why more doctors aren't using this unbelievably powerful approach to deal with heart disease. But when I see colleagues implanting stents, defibrillators, and the like for many thousands of dollars per patient, the answers are obvious. Given a choice of a rational, effective program of prevention that pays the doctor a few hundred dollars for his time, versus $2000 to $10,000 for a procedure, you can see that the temptation is irresistible for many physicians.

All in the family--What to do if there's heart disease in your family

What should you do if a close relative of yours is diagnosed with coronary disease?
This question came up recently with a patient of mine. The patient--a strapping, 47 year old businessman who looked the absolute picture of health--was undergoing bypass surgery. Although I'd met him for the purposes of plaque reversal, he was already having symptoms and his stress test was flagrantly abnormal, all discovered after a heart scan score of 765. On the day after the patient's bypass, the patient's brother came to me. Understandably concerned about his own health, he asked what he should do. The answer: get a heart scan.
Measure the disease with the easiest test available. If his heart scan score is zero, great--he's at exceptionally low (near zero) risk for heart attack. A modest program of long-term prevention is all that's necessary. What if his score is like his brother, should he get in line for his bypass? No, absolutely not! But he will need two things: 1) a stress test to ascertain whether or not he's safe (60% likelihood a stress test would be normal), and 2) an effort to determine how the heck he got so much plaque. (We favor lipoprotein testing, of course, for greatest diagnostic certainty.)
Message: Learn from the lessons your own family provides. Don't let this valuable information go to waste.
Carbohydrate-LDL double whammy

Carbohydrate-LDL double whammy

Carbohydrates in the diet trigger formation of small LDL particles. Because carbohydrates, such as products made from wheat, increase triglycerides and triglyceride-containing lipoproteins (chylomicrons, chylomicron remnants, VLDL, and IDL), LDL particles (NOT LDL cholesterol) become triglyceride-enriched. Triglyceride-enriched LDL particles are "remodeled" by the enzyme, hepatic lipase, into triglyceride-depleted, small LDL particles.

The list of reasons why small LDL particles are more atherogenic, i.e., plaque-causing, is long:

--Small LDL particles, being smaller, more readily penetrate the endothelial barrier of the arterial wall.
--Small LDL particles are more adherent to glycosaminoglycans in the artery wall.
--Small LDL particles are poorly taken up by the liver LDL receptor, but enthusiastically taken up by macrophage receptors of the sort in your artery walls.
--Because of their poor liver clearance, small LDL persists in the bloodstream far longer than large LDL.
--Small LDL particles are more oxidation-prone. Oxidized LDL are more likely to trigger inflammatory phenomena and be taken up by macrophages in the artery wall.

Let me add another reason why small LDL particles are more likely to cause plaque: They are more likely to undergo glycation. (More on glycation here.)

Glycation occurs when glucose (sugar) molecules in the blood or tissue modify proteins, usually irreversibly. Small LDL particles are uniquely glycation-prone. (This is likely due to a conformational change of the apoprotein B in the small LDL particle, exposing lysine residues along apo B that become glycated.)

Here's a great demonstration of this phenomenon by Younis et al:


"LDL3" is the small type. Note that small LDL particles are 4-5 times more glycated than large LDL. That's a big difference.

Once glycated, small LDL is especially resistant to being taken up by the liver. Like annoying in-laws, they hang around and hang around and . . . The longer they hang around, they more opportunity they have to contribute to plaque formation.

So, carbohydrates trigger formation of small LDL particles. Once formed, small LDL particles are glycated when blood sugar increases. While LDL can be glycated even when blood sugars are in the normal range (90 mg/dl or less), glycation goes berserk when blood sugars go higher, such as a blood sugar of 155 mg/dl after a bowl of steel-cut oatmeal.

Comments (14) -

  • Tony

    7/9/2010 4:06:01 PM |

    I used diet and supplements instead of a statin to control my cholesterol, and my recent VAP test indicated I had "large buoyant" LDL. We know statins reduce LDL and inflammation, but do they affect particle size?

  • Red Sphynx

    7/9/2010 4:26:18 PM |

    Does increasing dietary fiber have a significant effect on the abundance of of LDL3, or its oxidation or glycation?

    My reasoning is that the gut reabsorbs cholesterol and returns it to the gall bladder.  The gall bladder taps the liver for the make-up cholesterol.  The liver draws LDL out of the blood when it needs cholesterol.  Sooo... fiber decreases re-absorption of cholesterol  This  ought to, eventually, decrease the time that LDL3 particles circulate before the liver grabs them.

    But I don't know if it works out that way, or if the effect is negligible.  Can you say?

  • Hans Keer

    7/9/2010 5:09:58 PM |

    As far as I'm concerned, you cannot say enough bad things about carbohydrates, but unfortunately they are not responsible for the formation of chylomicrons and chylomicron remnants. Chylomicrons consist mainly of dietary fat.

  • Anonymous

    7/9/2010 10:49:58 PM |

    Assuming you can't measure your LDL particle sizes, would a low (<2) Triglicerides  ratio to HDL be a good indicator whether you have predominately Pattern A (awesome) or B (bad)?

  • MADBOB

    7/10/2010 12:18:03 AM |

    Hi Can someone please tell me if
    ALL BRAN cereal being all bran and insoluble fiber is the same as eating wheat products?  

    Thanks

  • Randy

    7/10/2010 8:51:13 AM |

    Hi Doctor Davis,

    I have two questions.

    1. How would you compare rice (unpolished but non brown) to other carbohydrates (non gluten based)?

    2. How far does the fermenting/sourdough making process make wheat or other gluten containing carbs a healthier choice?

    Thanks.

  • Anonymous

    7/10/2010 1:58:31 PM |

    A question for Dr Davis: Do you screen for pregnenolone deficiency?  If so, do you recommend pregnenolone supplements, in addition or in lieu of dhea?

    As a male, age 60+, I read TYP and  got the calcium scoring exam, which fortunately was zero percent.  Also had the carotid artery ultrasound which said no plaque (visual inspection).

    Got me to wondering why I (apparently) have no plaque.

    Well, twenty years ago when I was suffering arthritis joint pain I read Dr. Regelson's book the Super-Hormone Promise. (Still available on Amazon.) He discussed using pregnenlone as an arthritis treatment. So, I got the blood test and I discovered that I had a 100% deficiency of pregnenolone!

    I've been taking 500 mg a day of LEF's pregnenolone ever since. Blood levels back to normal immediately and no joint pain. (Re hormones, I also take 25 mg dhea and about 10 mg of melatonin at night.)

    My speculation is that perhaps supplementing my hormones at an earlier age, when serious deficiencies were starting to develop, helped keep my arteries healthy. On the other hand, it could be something else of course. Just my two cents!

  • Anonymous

    7/10/2010 4:27:18 PM |

    I got a good chuckle from the in-laws reference.  Thanks!

    Char

  • Anna

    7/10/2010 6:52:39 PM |

    Madrob:

    Yes.

    If you are consuming All Bran cereal, you are consuming wheat, though the bran doesn't have the starchiness that refined wheat and whole wheat flour have.  But the bran presents other problematic properties.  

    If you must supplement with a refined fiber product (for regularity, belief that high fiber diets are healthful, etc.), consider instead soluble fiber such as inulin and/or pectin (and whole foods which contain soluble fiber, such as onions, leeks, apples, sunchokes, etc.).  

    See Dr. Art Ayer's (Ph.D. researcher, not an MD) blog Cooling Inflammation  for fascinating discussions on feeding and promoting healthy gut bacteria populations ("inner gardens") with soluble fiber.

  • Anonymous

    7/11/2010 5:36:05 PM |

    happy to see denise mingers study featured here. Smile

    wheat asides, milk pasteurised or uht causes a pretty massive immune system flare up for me.

  • Anonymous

    7/13/2010 4:06:07 PM |

    Dr. Davis, I emailed you on this but figured I'd post this study in response to this.

    Can you comment on the following study ?

    4) Schaefer EJ.  Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet. JAMA. 1995 Nov 8;274(18):1450-5.

  • Adult Diaper

    7/15/2010 3:48:53 PM |

    Eversures incontinence underwear that fits your lifestyle. The best selling, patented, washable and reusable bladder control garments.  More products can be view at Adult Diaper

  • Anonymous

    7/22/2010 11:36:58 AM |

    can you decipher this new research for us? older women with low HDL are nore likely to be depressed, as well as more likely to have heart problems. Older men (over 65)with low LDL are more likely to be depressed, especially if their serotonin transport gene doesn't work efficiently.
    http://www.alphagalileo.org/ViewItem.aspx?ItemId=81683&CultureCode=en
    Research from ESPRIT study in Biological Psychiatry Journal (sobp.org/journal)

Loading