Pre-diabetes: An explanation for explosive coronary plaque growth

1. June 2006 William Davis (0)
Art's first CT heart scan in March, 2006 yielded a concerning score of 1336. He felt fine--no chest discomfort, no breathlessness, etc.

Art agreed to take the statin cholesterol drug his primary care doctor prescribed. He also agreed to take the fish oil, niacin, and some of the nutritional supplements that we advised. But Art just couldn't bring himself to make the commitment to lose weight.

At the start of his program, Art--at 5 ft. 8 inches--was 40 lbs overweight (212 lb). This was important since his blood sugar wavered in the pre-diabetic range, going as high as 130 mg. (The American Diabetes Assn. defines diabetes as a blood glucose of 126 mg or greater.)

One year later, Art's lipid and lipoprotein values were corrected to perfection. But he still weighed in at a hefty 209 lbs--essentially no change. His blood sugar likewise hovered in the 120's.

I felt Art need to be prodded, so I asked him to undergo another heart scan. His score: 1935--a 600 point increase, or 45%!

Only now has Art begun to comprehend to power of diabetes and pre-diabetes to fan the flames of plaque growth. Recent published data, in fact, show that the majority of recently diagnosed diabetics already have well-established coronary artery disease.

Don't let this happen to you. Do not dismiss diabetic patterns as they will catch up to you. If Art can lose the 30-40 lbs in the abdominal weight that is creating the diabetic pattern, he will likely succeed in stopping plaque growth. Otherwise, it's just a matter of time before his heart attack, stent, or bypass.

Who cares if you're pre-diabetic?

31. May 2006 William Davis (0)
Marta is a smart lady. She's worked in hospital laboratories for the last 23 years and knows many of the ins and outs of lab tests and their implications.

After years of being told that her cholesterol was acceptable, she needed to undergo urgent bypass surgery after experiencing severe breathlessness that proved to be a small warning heart attack at age 57. But this made Marta skeptical of relying on cholesterol to identify heart disease risk.

I met Marta two years after her bypass surgery when she was seeking better answers. And, indeed, she proved to have several concealed sources of heart disease: small LDL particles, Lipoprotein(a), intermediate-density lipoprotein (IDL--a very important abnormality that means she is unable to clear dietary fats from her blood), among others. But she was also mildly diabetic with a blood sugar of 131 mg (normal < or = 100 mg). This had not been previously recognized.

As I'm a cardiologist and our program focuses on reversal and control of coronary plaque, I asked Marta to return to her primary care doctor to continue the conversation about diabetes. She was a bit frightened but followed through.

"Well, you're not urinating excessively. And your long-term measure of blood sugar, hemoglobin A1C, is still normal. I wouldn't worry about it. We'll just watch it."

I guess I should know better. What the poor primary care doctor doesn't know is that pre-diabetes and mild diabetes are potent risks for heart disease. In fact, some of the most explosive rates of plaque growth occur when these patterns are present. It's well established that risk for heart attack in a diabetic is the same as that of someone who's already suffered a prior heart attack--very high risk, in other words.

Marta's primary care doctor's advice would be like inquiring about cancer and the doctor says "Let's just wait until it's metastatic--then we'll start to worry." Of course, this is insane.

Pre-diabetes and mild diabetes should not be ignored or just "watched". Even though the blood sugar itself may not be high enough to endanger you, the hidden patterns underlying your body's unresponsiveness to insulin creates a torrent of hidden coronary risk.

For better answers, Track Your Plaque members can read "Shutting Off Metabolic Syndrome" at http://www.cureality.com/library/fl_dp001metabolic.asp on the www.cureality.com website. ("Metabolic syndrome" is the name commonly given to the constellation of abnormalities associated with pre-diabetes and diabetes.)

Don't get smug!

31. May 2006 William Davis (2)
It may sound silly, but after someone succeeds in stopping their heart scan score from increasing or reduces their score, I warn them to not get smug. Let me explain.

I'll tell you about Jack. I met Jack a few years ago after he had a heart scan at age 39. His score: 1441! A score this high at his age obviously puts him in the 99th percentile. Also recall that a score >1000 carries a 25% annual risk for heart attack.

This captured Jack's attention. At the start, his lipoproteins were disastrous with numerous abnormal patterns. Jack committed to the program. After one year, his lipoproteins were around 80-90% corrected towards perfection. He'd lost 27 lbs, was exercising six days a week, and felt great.

Jack's repeat score one year later: 1107--over a 300 point drop! A huge success. He was ecstatic.

Unfortunately, work and life in general distracted him. Jack allowed himself to drift back to old habits, indulging in fast food 2 or 3 times a week, slacking on exercise such that it became sporadic, half-hearted efforts, and regained 15 lbs. He even failed to show up for appointments and we lost contact for two years.

One day, Jack simply decided to see where he stood, so he got himself another heart scan. The score: 2473--over a doubling from his reduced score.

The message: Long-term consistency is key, even after you've achieved control over your score. Stick with your program--and don't get smug!

Holidays are dangerous!

29. May 2006 William Davis (0)
If you're on holiday from work today, make sure you're not on holiday from your health, too.

Too often, people come back to the office telling me that the holidays simply got out of hand--cookouts, picnics, family gatherings, etc.--and they simply couldn't avoid overeating, overdrinking, sitting around--and gaining 3-5 lbs in a weekend. (Our record is 10 lbs in a weekend!)

I don't want to harp on this issue and ruin your holiday, but I can't stress how important it is that you don't allow this to happen to you. Weight gained in a brief space of time has exceptionally destructive effects. Ever see the movie "Super Size Me"? It's an entertaining and well-done yet graphic portrayal of the damaging effects of rapid weight gain.

Enjoy your time off. Relax, enjoy your family and friends--but continue to pay attention to choosing the right foods, don't overeat, take time out to do something (or several things) physical. It'll pay off hugely in the long run.

More on carotid plaque...

29. May 2006 William Davis (1)
Although not a perfect test, carotid ultrasound is an exceptionally easy and accessible test. Using high-frequency sound, clear images are available for most people.

I say it's not perfect because the way it's done in 2006 makes it a non-quantitative test. It is a qualitative test. In other words, you may find out that there's a 30% blockage ("stenosis"), at the far end of the common carotid artery on the right side. Unfortunately, this gives you an isolated measure of diameter of the plaque compared to the artery. What it does not tell you is what the volume of the entire plaque is. That's a far more accurate measure (and one that is incorporated into your heart scan score, by the way).

Nonetheless, carotid ultrasound is easy, very safe, and available in most hospitals and many clinics. One difficulty: most insurance companies will not allow you to go through a carotid ultrasound scan as a "screening" procedure, i.e., a test just to see if you have a carotid plaque. They will generally pay if you're having symptoms of a stroke or "mini-stroke" (transient ischemic attack, or "TIA"), have an abnormal sound in your carotid ultrasound detected by your doctor (a carotid "bruit"), or some other unusual indications. Sometimes, a resourceful physician will muster up a diagnosis based on something in your history (e.g., left arm numbness, a common and often benign complaint that can also signal stroke).

Another option are the mobile scanners or some hospital services that offer carotid screening, usually for a very modest price. Drawback: Sporadic availability, difficulty in obtaining serial scans, and imprecise reporting since it's viewed as a screening test. But it's better than nothing.

My hope is that, as screening services using safe imaging techniques like ultrasound propagate and increase in direct availability to the public, you'll be able to circumvent the obstacles imposed by your insurance company and even, sometimes, your doctor. But try your doctor first.

Carotid plaque can be shrunk

28. May 2006 William Davis (1)
Rose, a 64-year old woman, just had a 70% carotid blockage identified by a screening ultrasound. When the result was given to her doctor, he prescribed Lipitor and told Rose that an ultrasound would be required every year. She would need carotid surgery, an "endarterectomy", if the blockage worsened.

"Can't I reduce the amount of blockage I have?" asked Rose.

"No. Once you've got it, it doesn't get any better."


Is this true? Once you've got carotid plaque, you can only expect it to get worse and it can't be reduced?

This is absolutely not true. In fact, compared to coronary plaque, carotid plaque is easier to reduce!

Of course, the Track Your Plaque program is designed to help you control or reduce coronary plaque. But, in our experience, people who have both coronary and carotid plaque will show far greater and faster reduction of carotid plaque. Dramatic reductions are sometimes seen. I've personally seen 50-70% blockages reduced to <30% on many occasions.

The requirements to achieve reduction of carotid plaque are very similar to the approach we use to reduce coronary plaque. One difference is that hypertension may play a more important role with carotid plaque and needs to be reduced confidently to the normal range before carotid plaque is controlled.

I find it shocking that the attitude like the one provided by this physician continue to prevail. Unlike coronary plaque, which has a relatively small body of scientific literature documenting how it can be reduced, carotid plaque actually enjoys a substantial clinical literature. Part of the reason is that the carotids are more easily imaged using ultrasound. (Heart structures can be seen with ultrasound, but not the coronary arteries.)

Numerous agents have been shown to contribute to reduction of carotid plaque: statin drugs, niacin, fish oil, the anti-diabetic "TZD" drugs (Actos, Avandia), several anti-hypertensive drugs, vitamin E, pomegranate juice, and several others.

It outrages me to hear stories like this. Rose is not the only one.

Don't accept the flip dismissals or the over-enthusiastic referral for carotid procedures. Insist on a conversation about plaque regression.


Note: Although I am a vigorous advocate of atherosclerotic plaque regression, this does not mean that if you have a severe (70% blockage or greater), or if there are symptoms from your carotid disease, that you should engage in a program of reversal. You must always take the advice of your doctor if your safety is in question.

Vitamin D--A coronary risk factor

27. May 2006 William Davis (1)
Look up "coronary risk factors" in any text and you'll find high cholesterol, smoking, diabetes, and high blood pressure listed. You won't find deficiency of vitamin D listed.

Ask 99% of physicians if a deficiency of vitamin D is a coronary risk factor and you'll get rolling eyes and a sigh.

Yet, in the Track Your Plaque experience, vitamin D is emerging as a very important factor in coronary plaque development. We have observed that there are a substantial number of people whose lipids and lipoproteins are not abnormal enough to fully explain their heart scan score. In other words, there seems to be something else necessary to satisfactorily explain the magnitude of coronary plaque.

I believe that severe vitamin D deficiency is at least one of the most important factors. We've seen many people with blood levels of vitamin in the range of severe deficiency (<20 ng/ml of 25-OH-Vitamin D3) yet bland lipids and lipoproteins.

Correcting vitamin D blood levels to 50 ng/ml also seems to be among the required factors in stopping coronary plaque growth, or stopping your heart scan score from increasing.

Keep your eye on this extremely important and exciting issue. Sadly, it won't be propelled into the media like the conversation about cholesterol or high-tech procedures, since no company stands to profit from it. But you and I don't have to play that game.

Cholesterol is dead!

26. May 2006 William Davis (0)
I saw a patient in the office yesterday. He came to me for an opinion regarding his high heart scan score of 525, putting him in the 90th percentile (5% annual risk of heart attack).

His doctor had been puzzled because his LDL cholesterols had ranged from 110 to 131 mg--actually below average. (The average LDL for the U.S. is 132 mg.) Likewise, HDL was a favorable 63 mg.

Lipoprotein analysis told the story loud and clear. His LDL particle number, a far more precise measure of LDL, was 2448 nmol/l. This means that his true LDL was more like 240-250 mg! (You can get a sense for what the true LDL is from LDL particle number by dropping the last digit: 2448 becomes 244.) Conventional LDL was therefore inaccurate by over 100 mg.

He also had a severe small LDL particle pattern. The cause of his coronary plaque was a large excess of small LDL particles. LDL cholesterol (and total cholesterol, likewise) didn't even hint at this pattern. Nor did his favorable HDL.

Think of LDL particle number as an actual count of LDL particles per volume, e.g., number of particles per cc of blood. This makes it easier to conceptualize. LDL particle number is the measure you get when you have an NMR lipoprotein profile, our preferred method of lipoprotein testing. If this is unavailable to you, apoprotein B is a reasonable second choice, though not as accurate in my view. More info on NMR is available at their website, www.lipoprofile.com.

How to make a $1 million in cardiology

26. May 2006 William Davis (0)
Want to make a $1,000,000 as a cardiologist in the next year? It's easy. All you have to do is:

1) Perform heart catheterizations or other procedures on anybody you can, even if it's not necessary. Perform them even if the patient has no symptoms and the stress test is normal.

2) Perform heart catheterizations if the patient is too timid or ill-informed to object.

3) Insert coronary stents in blockages, even when they're minor and it's not necessary.

4) Turn every heart procedure into a revenue-producing stream by looking for other profit opportunties, such as minor kidney artery blockages.

5) Heart disease is frightening. Scare the heck out of patients by exagerrating the dangers so they'll go through testing and procedures gratefully.


Sound absurd? Well, it would be if these weren't all true.

These are real examples, as awful as it sounds. I've witnessed all these behaviors. Not just occasionally, but with regularity.

Just today, I encountered a colleague who performs heart catheterizations routinely (up to several per day) when any symptom is present and the stress test is entirely normal. This is grossly inappropriate.

Your protection is being better-informed and avoid being sucked into the vast and frightening cardiovascular machine of revenue-yielding procedures. Part of your protection is to get a CT heart scan, then engage in a program of heart disease prevention.

Doctor, do I have lipoprotein (a)?

25. May 2006 William Davis (0)
I met Joyce today for a 2nd opinion. She told me about this conversation she'd had with her cardiologist:

"Doctor, do you think I could have lipoprotein (a)? I read about how it can cause heart attacks even when cholesterol is controlled."

"What does it matter? Even if you have it, there's nothing we can do about it. There's no treatment for it."

Joyce was understandably groping for some means to prevent her coronary disease from causing more danger. At 56, she'd already survived a heart attack that resulted in two stents to her left anterior descending. Around 9 months later, she received a 3rd stent to another artery.

Her doctor had put her on Pravachol and said that was enough. "We know that cholesterol causes heart disease and the Pravachol reduces it. Why do we need to know anything more?"

So Joyce came to me for another view. I explained to her that there are, in fact, several ways to deal with lipoprotein(a). It is, without a doubt, among the more difficult patterns to manage--but not impossible. In fact, we have a growing list of participants in the Track Your Plaque program who have stopped or reduced their heart scan scores.

I continue to be horrified at the level of ignorance that prevails among my colleagues, the cardiologists, and the primary care community. If your doctor gives you advice like this, get a new doctor.

Why do the Japanese have less heart disease?

24. April 2011 William Davis (49)
We should look to the Japanese to teach us a few lessons about preventing heart disease. A Japanese male has only 65% of the risk of an American male (despite 40% of Japanese men being smokers), while a Japanese woman has 80% less risk than an American woman. While the U.S. is near the top of the list of nations with highest cardiovascular risk, Japan is the lowest.

What are they doing right?

There is no one explanation, but several. Genetics probably does not play a substantial role, by the way, as demonstrated by observations of Japanese people who emigrate to Western cultures. People of Japanese heritage living in Hawaii, for instance, develop the same cardiovascular risk as non-Japanese living in Hawaii. They also develop obesity and diabetes.

Among the factors that likely contribute to reduced risk in Japanese people:

--A style of eating that does not include a lot of sweet foods. No breakfast cereal or donuts for breakfast, for instance, but miso soup with tofu, fish, green onions, and daikon (as takuan, or pickled radish).
--Seaweed--It's probably a combination of the green phytonutrients and iodine. Typical daily iodine intake is in the neighborhood of 5000 mcg per day from nori, kombu, wakame, and other seaweed forms. (The average American obtains 125 mcg per day of iodine from diet.)
--Seafood--Fish in many forms not seen in the U.S. are popular.
--Green tea--Consumption of green tea has been confidently linked to reduced cardiovascular risk, probably via visceral fat-reducing, anti-oxidative, and anti-inflammatory effects. Although tea in Japan is often the less flavonoid-rich oolong tea, softer benefits from this form are likely.
--Soy--Tofu, miso, and soy sauce are staples. It's not clear to me whether soy is intrinsically beneficial or whether it is beneficial because it serves to replace unhealthy alternatives. (Genetic modification may change this effect.)
--Reduced exposure to cooked animal products (except seafood). This is not a saturated fat issue, but probably an advanced glycation end-product/lipoxidation issue that result from cooking.
--The lack of a "eat more healthy whole grain" mentality, the advice that has plunged the entire U.S. into the depths of a diabetes and obesity crisis (along with high-fructose corn syrup and sugar). Noodles like udon and ramen do have a place in their diet, as do some dessert foods. But the overall wheat exposure is less--no bagels, sandwiches, and breakfast cereals.
--Less overweight and obesity--The above eating style leads to less weight gain.

Japanese foods have a unique taste, consistency, and mouth-feel that go well with saltiness, thus the downside of their diet: salt consumption. On a broad scale, high salt consumption has been associated with hypertension and gastric cancer. But the tradeoff has, on the whole, been a favorable one.


One study trying to find some answers:

Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study.

Shimazu T, Kuriyama S, Hozawa A et al.
Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Japan.


We prospectively assessed the association between dietary patterns among the Japanese and CVD mortality. Dietary information was collected from 40 547 Japanese men and women aged 40-79 years without a history of diabetes, stroke, myocardial infarction or cancer at the baseline in 1994.
During 7 years of follow-up, 801 participants died of CVD.

Factor analysis (principal component) based on a validated food frequency questionnaire identified three dietary patterns: (i) a Japanese dietary pattern highly correlated with soybean products, fish, seaweeds, vegetables, fruits and green tea, (ii) an 'animal food' dietary pattern and (iii) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. The Japanese dietary pattern was related to high sodium intake and high prevalence of hypertension. After adjustment for potential confounders, the Japanese dietary pattern score was associated with a lower risk of CVD mortality (hazard ratio of the highest quartile vs the lowest, 0.73; 95% confidence interval: 0.59-0.90; P for trend = 0.003). The 'animal food' dietary pattern was associated with an increased risk of CVD, but the DFA dietary pattern was not.

The Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.

Niacin: What forms are safe?

20. April 2011 William Davis (52)
Niacin, or vitamin B3, remains a confusing issue for many people. It shouldn't be.

It doesn't help that most physicians and many pharmacists also do not understand the basic issues surrounding niacin. The only reason why there is any level of prevailing knowledge about niacin is that Kos Pharmaceuticals managed to "pharmaceuticalize" a niacin preparation, prescription Niaspan, that provided the revenue to fund professional "education."

Niacin can be helpful to increase HDL, reduce small LDL particles and shift them towards the more benign large particles, reduce triglycerides, and reduce lipoprotein(a).

So here's a brief description of the various forms that you will find niacin:

Immediate-release niacin--Also called crystalline niacin or just niacin. This is the original niacin that releases within minutes of ingestion. Because it releases rapidly, it triggers the most intense "hot flush." While this form of niacin works wonderfully well, is the safest, and is dirt cheap, the majority of people are simply unable to tolerate the intense flush. It also works best taken twice a day, generating two intolerable flushes per day.

Slow-release niacin--These preparations were popular in the 1980s, since the slow 12 to 24 hour pattern of release minimized the annoying hot flush. But, with prolonged use, it also became apparent that an unnaceptable frequency of liver toxicity developed. Unfortunately, this means that any niacin preparation that trickles niacin out over an extended period, including many of the slow-release preparations now sold in health food stores and pharmacies, have potential for liver toxicity. These preparations should be avoided.

6-hour release niacin--Releasing niacin more slowly than immediate-release niacin but more rapidly than slow-release niacin, 6-hour release (or what the Niaspan people call "extended-release" niacin) is nearly as effective as immediate-release niacin with approximately the same low potential for liver toxicity. It is far less liver toxic than slow-release niacin. 6-hour release niacin therefore offers the best balance between effectiveness and safety. Preparations that show this pattern of release include Niaspan ($180 per month), the poorly-named Sloniacin (about $8 per month), and Enduracin (about $7 per month) for 1000 mg per day. (Some Track Your Plaque Members have also determined that several other over-the-counter preparations have been demonstrated to share a similar pattern of release.)

Then there are the scam products that have no useful effect at all:

Flush-free or no-flush niacin--Inositol hexaniacinate, or 6 niacin molecules bound to the sugar, inositol, has no effect in humans, at least not with the dozen or so preparations that I've seen used. Nor are there any data to document the effectiveness of flush-free niacin. It's also more expensive.

Nicotinamide--This niacin derivative likewise has no effect on the usual targets for niacin treatment.

While I used to prescribe Niaspan, the ridiculous pricing and aggressive marketing really turned me off. I now advise my patients and our online followers to use only Sloniacin or Enduracin, unless you can tolerate immediate-release niacin.

Introduction to the New Track Your Plaque book, version 2.0

18. April 2011 William Davis (0)

Out with the old,
in with the new  



“I believe that you are suffering from what is called a fatty degeneration of the heart.”

Dr. Tertius Lydgate to Mr. Casaubon on making a diagnosis with the new medical device, the stethoscope.

George Elliot
Middlemarch, 1871





Old notions in medicine have a peculiar way of lingering.

In 1882, Dr. Robert Koch discovered the tubercle bacillus in tissues of people with “consumption.” By connecting a bacterium with the disease, he usurped the long held notion that tuberculosis was a degenerative disease caused by lack of fresh air. But, for decades after Dr. Koch’s revelation, the “bad air” belief persisted. Surgical collapse of the lung, a painful and barbaric treatment for tuberculosis, persisted well into the 1960s, years after effective antibiotics were discovered in 1947.

The medical community of the 19th century viewed mental illness as the hereditary end-product of ancestral nervousness, alcoholism, prostitution and criminal behavior, a bias that remained widespread well into the mid-20th century. Nazi physicians invoked the theory of heritable “mental degeneration” to justify wholesale extermination of schizophrenics. Electro-convulsive therapy (ECT, or “electroshock therapy”) was widely applied to treat schizophrenia, depression, homosexuality, and criminal behavior for over 30 years, gradually abandoned (at least in its original form) after years of abusive application to subdue patients, demonized in the 1975 movie, “One Flew Over the Cuckoo’s Nest,” depicting the author’s real-life experience with ECT.

Long after a theory or practice has been discredited, it can persist, refusing to die. The new and improved may not be adopted into mainstream practice for years, even decades.

Back to the 21st century: What if you realized that, by quirks of human nature and the uneven adoption of health information, your doctor practiced medicine appropriate for 1985? 1975?

While digital information nowadays is transmitted at the speed of light, disseminating as fast as it takes the next juicy tidbit to be “virally” reproduced via social networking websites, it’s the human factor that still operates with the inertia of human behavior. Habits and attitudes slow the adoption of new information in time measured not in seconds, but in years or decades.

A century ago, 20 years were required for the new technology of blood pressure measurement to be adopted after its introduction in the U.S. in 1910, since physicians were long comfortable with the practice of “pulse palpation” (feeling the pulse). (The arcane language of pulse palpation persists to this day, terms like “pulsus parvus et tardus,” the slow rising pulse of a stiff aortic valve; and the "water-hammer" pulse of a leaking aortic valve.)

The discovery of new, health-changing information today in the 21st century disseminates through the ranks of modern healthcare providers at much the same pace as measuring blood pressure did in the early 20th century.

It’s also tempting to paint American medicine as a fiefdom intent on maintaining exclusive rein over health information. Look back over the hierarchical relationship of medicine over nursing in the past century: When blood pressure measurement was adopted on a broad scale in the 1930s, it was practiced only by physicians, since nurses were deemed incapable. (Modern-day nurses should surely have a hearty laugh over this.) Stethoscopes, around even longer than blood pressure cuffs, weren’t permitted to fall into the hands of nurses until the 1960s, since the medical community feared that nurses might command too much control over patient care. Even after nurses were permitted to have their own stethoscopes, great pains were taken to be certain the nurses’ version was readily distinguishable from the “real” tool wielded by physicians; nurses’ stethoscopes were therefore labeled “nurse-o-scopes,” or “assistoscopes,” and were required to be smaller and flimsier.

Old and ineffective doesn’t always give way to new and better at once; it is slowed by habit as well as an unwillingness to relinquish control.

Somehow technology marches on. But it does so unevenly, sweeping some along in its first wave, others in its wake, some never at all.

Just as effective antibiotics to cure tuberculosis were available for 20 years while surgeons continued to remove patients’ lungs, so better solutions to heart disease are already available but not yet employed by your neighborhood physician. The primary care physician may have heard about some of the newest means to prevent heart disease, but is too overwhelmed with the day-to-day of sore throats, diarrhea, and rashes. Cardiologists, intent on inserting the next best stent or defibrillator, have little but passing interest in strategies that might halt or reverse the heart disease that can be “managed,” no matter how imperfectly, with procedural solutions like angioplasty and bypass surgery. We should bear these flawed human tendencies in mind as we explore the world of heart disease prevention.

We need look no farther than the front page of the newspaper to find evidence of the failure of present-day heart disease detection and management. Over the past several years, headlines have carried the likes of Tim Russert, Bill Clinton, Larry King, Dick Cheney, David Letterman, Tommy Lasorda, Ed Bradley, Mike Ditka, Walter Cronkite, Alberto Salazar, all heart disease sufferers. Some, like talk show host David Letterman, survived their brush with heart catastrophe and underwent successful bypass surgery. Others, like marathoners Fixx and Salazar, raised none of the conventional red flags for heart disease. All received standard, “modern” medical care . . . all the way up to their heart attack, bypass surgery, or untimely death.

Like the sphygnomanometer (blood pressure) cuffs of 1910, Track Your Plaque represents an example of the new. But, unlike the simple practice of taking blood pressure in the early 20th century, Track Your Plaque represents an entirely new way to look at coronary heart disease: a new way to measure it, a new way to identify its causes, and a new way to seize control over it, often to the point of achieving reversal of the process. It also puts control over much of this process into your hands and away from hospitals, cardiologists, and heart procedures. 

I could speak of revealing “secrets,” but that’s not true. In Track Your Plaque, I simply convey information about heart disease that you were likely unaware existed, strategies that doctors fail to discuss. I assemble them into a “package” that, together, create an enormously empowering unique approach to prevent heart disease and heart attack.

Track Your Plaque also challenges the high-tech status quo, practices that occupy exalted places in the enormous cardiovascular healthcare machine that has dominated American healthcare for the past 40 years. I propose that high-tech hospital procedures should join the practice of ECT for homosexuality and insanity¾and become yet another relic of the past.

What are "normal" triglycerides?

12. April 2011 William Davis (67)
Among the most neglected yet enormously helpful values on any standard cholesterol panel is the triglyceride value.

Triglycerides traverse the bloodstream by hitching a ride on water (serum)-soluble lipoproteins, or lipid-carrying proteins. We measure triglycerides as an indirect index of triglyceride-containing lipoproteins.

Triglycerides are a basic currency of energy. While the average American ingests around 300 mg of cholesterol per day, he or she also ingests 60,000-120,000 mg (60-120 grams) of triglycerides, i.e., 200 to 400 times greater amounts, from fat intake. Zero triglycerides in the diet or in the bloodstream is not an option.

But what represents too much triglycerides in the bloodstream? There are several observations to help us make this determination:

1) When fasting triglycerides are 133 mg/dl or greater, 80% of people will show show at least some degree of small LDL particles.

2) When fasting triglycerides are 60 mg/dl or less, most (though not all, since genetic factors enter into the picture) people will show little to no small LDL particles.

3) When fasting triglycerides are 200 mg/dl or greater, small LDL particles will dominate and large LDL particles will be in the minority or be gone entirely.

4) When triglycerides are 88 mg/dl or greater after eating, then risk for heart attack is doubled. Non-fasting triglycerides in the 400+ mg/dl range are associated with 17-fold greater risk for heart attack.



From Austin et al 1990. "Phenotype A" means that large LDL particles dominate; "phenotype B" means that small LDL particles dominate.

Note that conventional "wisdom" (i.e., NCEP ATP-3 guidelines) is that triglycerides of up to 150 mg/dl are okay, a level that virtually guarantees expression of small LDL particles and increased cardiovascular risk.

Based on observations like these, in the Track Your Plaque program we aim for fasting triglycerides of no higher than 60 mg/dl and postprandial (after-meal) triglycerides of no more than 90 mg/dl.

Curiously, while fat intake (i.e., triglyceride intake) plays a role in determining postprandial triglyceride blood levels, it's carbohydrate intake that plays a much larger role. That will be an issue for another day.

1985: The Year of Whole Grains

9. April 2011 William Davis (30)
In 1985, the National Cholesterol Education Panel delivered its Adult Treatment Panel guidelines to Americans, advice to cut cholesterol intake, reduce saturated fat, and increase "healthy whole grains" to reduce the incidence of heart attack and other cardiovascular events.

Per capita wheat consumption increased accordingly. Wheat consumption today is 26 lbs per year greater than in 1970 and now totals 133 lbs per person per year. (Because infants and children are lumped together with adults, average adult consumption is likely greater than 200 lbs per year, or the equivalent of approximately 300 loaves of bread per year.) Another twist: The mid- and late-1980s also marks the widespread adoption of the genetically-altered dwarf variants of wheat to replace standard-height wheat.

In 1985, the Centers for Disease Control also began to track multiple health conditions, including diabetes. Here is the curve for diabetes:


Note that, from 1958 until 1985, the curve was climbing slowly. After 1985, the curve shifted sharply upward. (Not shown is the data point for 2010, an even steeper upward ascent.) Now diabetes is skyrocketing, projected to afflict 1 in 3 adults in the coming decades.

You think there's a relationship?

Have some more

7. April 2011 William Davis (37)
Wheat, via exorphin effects, is an appetite stimulant. Eat a whole wheat bagel or bran muffin, you want another. You also want more of other foods. You also want something to eat every two hours due to widely-swinging insulin-glucose responses: blood sugar high followed by a sharp downturn that triggers a powerful impulse to eat (thus the cravings for a snack at 9 and 11 a.m. after a 7 a.m. breakfast).

If wheat is a stimulant of appetite, then removing it should yield reduced appetite and reduced calorie intake. That is precisely what happens.

When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing--calorie intake drops 350 to 400 calories per day. This calorie figure remains curiously consistent across multiple studies in which wheat was eliminated.

400 calories per day results in 21 lbs lost over 6 months, based just on calories. (3500 calories per pound lost.) That is what happens in wheat elimination diets: 21-26 lbs lost over 6 months.

Wheat is the processed food industry's nicotine, a means of ensuring repeat food purchases. It's also low-cost (subsidized by the U.S. government), high-yield, an ingredient that even has its very own withdrawal syndrome should you miss a "hit."

When MIGHT statins be helpful?

7. April 2011 William Davis (17)
I spend a lot of my day bashing statin drugs and helping people get rid of them.

But are there instances in which statin drugs do indeed provide real advantage? If someone follows the diet I've articulated in these posts and in the Track Your Plaque program, supplements omega-3 fatty acids and vitamin D, normalizes thyroid measures, and identifies and corrects hidden genetic sources of cardiovascular risk (e.g., Lp(a)), then are there any people who obtain incremental benefit from use of a statin drug?

I believe there are some groups of people who do indeed do better with statin drugs. These include:

Apoprotein E4 homozygotes

Apoprotein E2 homozygotes

Familial combined hyperlipidemia (apoprotein B overproduction and/or defective degradation)

Cholesteryl ester transfer protein homozygotes (though occasionally manageable strictly with diet)

Familial heterozygous hypercholesterolemia, familial homozygous hypercholesterolemia

Other rare variants, e.g., apo B and C variants

The vast majority of people now taking statin drugs do NOT have the above genetic diagnoses. The majority either have increased LDL from the absurd "cut your fat, eat more healthy whole grains" diet that introduces grotesque distortions into metabolism (like skyrocketing apo B/VLDL and small LDL particles) or have misleading calculated LDL cholesterol values (since conventional LDL is calculated, not measured).

As time passes, we are witnessing more and more people slow, stop, or reverse coronary plaque using no statin drugs.

Like antibiotics and other drugs, there may be an appropriate time and situation in which they are helpful, but not for every sneeze, runny nose, or chill. Same with statin drugs: There may be an occasional person who, for genetically-determined reasons, is unable to, for example, clear postprandial (after-eating) lipoproteins from the bloodstream and thereby develops coronary atherosclerotic plaque and heart attack at age 40. But these people are the exception.

Advanced topics in nutrition

5. April 2011 William Davis (0)
Nutrition in the modern world has become an increasingly problematic topic. From genetic modification to commercialized methods of mass production, we are having to navigate all manner of complex issues in food choices, particularly if ideal health, including maximal control over coronary plaque, is among our goals.

We will therefore be releasing a series of discussions on the Track Your Plaque website in the coming months, a series I call "Track Your Plaque Advanced Topics in Nutrition." These will be, as the series title suggests, discussions for anyone interested in more than the "eat a balanced diet" nonsense that issues from "official" sources. Among the topics to be covered:

1)Advanced Glycation End-products--both endogenous and exogenous, including peripheral issues like lipoxidation and acrylamides.

2)Dietary influences on LDL oxidation--including the concept of "glycoxidation." Protection from oxidative phenomena is not just about taking antioxidants.

3) Foods you MUST eat--We've talked a lot about foods that you shouldn't eat. How about foods you should eat?

The New Track Your Plaque Guide now available

4. April 2011 William Davis (5)
The New Track Your Plaque Guide is now available!

The Track Your Plaque program has evolved over its 8 year history. While the original Track Your Plaque book reflected the program details that got the program started back in 2003-2004, plenty has changed.

This new version of the book, what I call the program Guide, represents version 2.0 of Track Your Plaque and includes:

--Updated lipoprotein treatment strategies--including new and expanded treatment choices for small LDL and lipoprotein(a).

--An entire chapter on vitamin D and its crucial role in cardiovascular health and plaque control.

--A new and expanded diet--All the reasons why the New Track Your Plaque Diet can achieve spectacular improvement in lipids/lipoproteins, reversal of insulin resistance/pre-diabetes/diabetes, weight loss, reduction in blood pressure, etc. are discussed in considerable detail. The diet is crafted to achieve maximum control over both metabolic responses and coronary plaque.

--An entire chapter on the role of omega-3 fatty acids is included.

--A detailed discussion on the role of iodine and thyroid health--One of the newest additions to the Track Your Plaque menu of strategies is to achieve and maintain ideal thyroid health. This tips the scales in your favor for improved control over lipids/lipoproteins, weight, blood sugar, and coronary plaque.


The new guide, as well as our new Member kits that include the new Track Your Plaque Recipe Book, At-Home Lab Test kits, and nutritional supplements, are all available in the Track Your Plaque Marketplace.

Don't wet yourself

3. April 2011 William Davis (13)
While there is more to wheat's adverse effects on human health than celiac disease, studying celiac disease provides important insights into why and how wheat--the gluten component of wheat, in this case--is so destructive to human health.

Modern wheat, in particular, is capable of causing "celiac disease" without intestinal symptoms---no cramping or diarrhea--but instead shows itself as brain injury (ataxia, dementia), peripheral nervous system damage (peripheral neuropathy), joint and muscle inflammation (rheumatoid arthritis, polymyalgia rheumatica and others), and gastrointestinal cancers.

One neurological manifestation of wheat's effect on the human brain is a condition called cerebellar ataxia. This is a condition that can affect adults (average age 48 years) and children and consists of incoordination, falls, and incontinence.

Because brain tissue has limited capacity for healing and regeneration, symptoms of cerebellar ataxia usually improve slowly and modestly with meticulous elimination of wheat and other gluten sources.

Such observations are relevant even to people without celiac disease. Celiac disease sufferers are more susceptible to such extra-intestinal phenomena, but it can also happen in people without positive celiac antibodies.



Some references:

Neurological symptoms in patients with biopsy proven celiac disease

A total of 72 patients with biopsy proven celiac disease (CD) (mean age 51 +/- 15 years, mean disease duration 8 +/- 11 years) were recruited through advertisements. All participants adhered to a gluten-free diet. Patients were interviewed following a standard questionnaire and examined clinically for neurological symptoms. Medical history revealed neurological disorders such as migraine (28%), carpal tunnel syndrome (20%), vestibular dysfunction (8%), seizures (6%), and myelitis (3%). Interestingly, 35% of patients with CD reported of a history of psychiatric disease including depression, personality changes, or even psychosis. Physical examination yielded stance and gait problems in about one third of patients that could be attributed to afferent ataxia in 26%, vestibular dysfunction in 6%, and cerebellar ataxia in 6%. Other motor features such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus were infrequent. 35% of patients with CD showed deep sensory loss and reduced ankle reflexes in 14%. Gait disturbances in CD do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment.



Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics

Two hundred and twenty-four patients with various causes of ataxia from North Trent (59 familial and/or positive testing for spinocerebellar ataxias 1, 2, 3, 6 and 7, and Friedreich's ataxia, 132 sporadic idiopathic and 33 clinically probable cerebellar variant of multiple system atrophy MSA-C) and 44 patients with sporadic idiopathic ataxia from The Institute of Neurology, London, were screened for the presence of antigliadin antibodies. A total of 1200 volunteers were screened as normal controls. The prevalence of antigliadin antibodies in the familial group was eight out of 59 (14%), 54 out of 132 (41%) in the sporadic idiopathic group, five out of 33 (15%) in the MSA-C group and 149 out of 1200 (12%) in the normal controls. The prevalence in the sporadic idiopathic group from London was 14 out of 44 (32%). The difference in prevalence between the idiopathic sporadic groups and the other groups was highly significant (P < 0.0001 and P < 0.003, respectively). The clinical characteristics of 68 patients with gluten ataxia were as follows: the mean age at onset of the ataxia was 48 years (range 14-81 years) with a mean duration of the ataxia of 9.7 years (range 1-40 years). Ocular signs were observed in 84% and dysarthria in 66%. Upper limb ataxia was evident in 75%, lower limb ataxia in 90% and gait ataxia in 100% of patients. Gastrointestinal symptoms were present in only 13%. MRI revealed atrophy of the cerebellum in 79% and white matter hyperintensities in 19%. Forty-five percent of patients had neurophysiological evidence of a sensorimotor axonal neuropathy. Gluten-sensitive enteropathy was found in 24%. HLA DQ2 was present in 72% of patients. Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia.
Medical education in the days of Big Pharma

Medical education in the days of Big Pharma

30. October 2010 William Davis (43)
I received this detailed email from an unexpected source: a 3rd-year medical student.

In her email, Theresa describes her frustrations in what she is witnessing for the first time, proceeding through her training and getting exposed to the realities of medical life.

Medical training, particularly clinical training from the 3rd and 4th years of medical school, onwards through internship, residency, and fellowship training, consists largely of bullying, "pimping" (meaning rapid-fire grilling of questions at trainees), and sleep deprivation. It is an extended hazing period meant to demoralize and inculcate the trainee into following the lead of superiors. Buck the system and you're . . . out. Imagine you've just sunk $190,000 and 8 years of college into getting to your internship. You are not going to chance being thrown out on principle. So you just swallow your pride, go along with the game, and echo all the answers they want you to repeat.

While Theresa laments the sad state of modern American pharmaceutical- and procedure-obsessed medicine, she provides me with hope that some young people training to practice medicine today will carve out their own paths, not the one laid for them by the pharmaceutical industry, nor fall for the temptation of higher-paying procedural specialties like orthopedics and cardiology. I am impressed with her ability to see this so early in her career.


Dr. Davis,

I am a 3rd year medical student at ________ University. I came across
your blog today, and I'm very glad I did. I appreciate the value of your time,
so I want to be as succinct as possible while still getting across what I'm
really thinking and feeling:

From what I gathered exploring your blog for a while this afternoon, the
wellness strategies you incorporate into your practice are some of the exact
things I want to do with my future patients. Personally, I strongly believe in
staying healthy by eating right, staying active, etc. For instance, I don't eat
grains or much in the way of starches and sugars. So I love the fact that you
are helping your patients make these powerful and foundational changes in their
lives.

As I'm sure was your experience, a full appreciation of nutrition and lifestyle
as a first-line health strategy is not something that was taught to me in
medical school. I came to school with this deep conviction already in my heart
and mind, and now, on my 3rd year rotations, I am still conflicted and at a loss
as to how I'm going to be able to practice medicine the way I want to, which is
to incorporate these all-important principles into the care of my patients.

What I've come to understand about the medical field today is that the
information that exists is primarily subsidized by the pharmaceutical industry,
and dictated to medical professionals as "evidence-based" treatment guidelines
and recommendations by organizations with sincere and official sounding names
like American Heart Association and American Cancer Society. Add to that the
pressure of potential malpractice litigation and the complexities of the
insurance reimbursement game, and it seems to me like what you get is a bunch of
diagnostic and medication management algorithms that any half-trained monkey
could follow. In his sleep. Which I guess would be alright if at least they
weren't algorithms based on misguided, self-serving, profit-seeking Big Pharma,
Food Inc, insurance conglomerates, and agri-politics (I think I just made that
word up.)

A lot of well-intentioned physicians are just parroting the party
line, as their patients dutifully and gratefully chomp down their statins and
diabetes drugs and blood pressure pills. And I'm sorry, but "diabetes
education" programs with curriculum put together by drug companies? How is that
even legal? Massive corporations raking in massive profits that are dependent
on uncontrolled blood sugars telling people how to best control their blood
sugars?!

Anyway, forgive my rant. What I'm getting at is this: How can I practice
medicine, with the freedom to educate/coach/treat my patients with diet and
lifestyle changes to mitigate/reverse their chronic health conditions? Without
feeling like I automatically have to first and foremost prescribe the litany of
drugs dictated by "evidence-based" guidelines? Without excessive fear of
litigation or loss of credibility among my peers? Without having to lie through
my teeth to my patients, and tell them that eating low-fat and heart-healthy
whole grains is the best way (implication also being the only scientifically
proven way) to control their diabetes, lower their cholesterol, etc, etc, etc?

I want my patients to have the full benefit of honest nutrition and lifestyle
information, and medications and surgery as necessary. I'm afraid that there
isn't room for this kind of holistic emphasis in the medical profession today.
Are there residencies that include this kind of training or at least respect
these "unconventional" philosophies? Are there clinics or practice groups that
would allow me to practice with this emphasis, or is there a bias against docs
who do not necessarily conform to the party position? Will I have no other
option but to go it alone under the auspices of my own shingle? How do you
handle these kinds of issues in your professional life?

Sincerely,
Theresa M.


A ray of hope! Perhaps Theresa is just the first among many more medical students who refuse to submit to the brainwashing practices of the pharmaceutical industry, the same mind manipulation that has hopelessly turned most of my colleagues into their unwitting puppets.

I'll be interested in watching how Theresa's experience unfolds. I've asked her to keep us informed every so often.
Tags :

Comments (43) -

  • Sassy

    10/29/2010 8:16:32 PM |

    I would love to see your answers to her questions.

  • Tara BRIDGES

    10/29/2010 8:24:51 PM |

    Welcome to my world... only as a dietitian it is WAY worse.  Trust me.

    Not only do we have to deal with bogus "evidence-based guidelines," the loss of respect of colleagues, and risk of losing our license... We have to do it all with less than a quarter of the salary that the average physician makes and much, much less respect.

    I'm so frustrated in this field, but I'm at a loss as to what to do...

  • Tommy

    10/29/2010 8:28:25 PM |

    Timely. I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and  again suggest niacin. Again, he says he knows better. She is right...it is a sad state of affairs.

  • Jonathan

    10/29/2010 8:49:12 PM |

    @Tommy
    Maybe your doc needs to watch Tom's latest post.
    http://www.fathead-movie.com/index.php/2010/10/28/video-of-the-big-fat-fiasco-speech/

    And maybe your doc doesn't need to be your doc anymore.

  • Lucy

    10/29/2010 9:54:30 PM |

    Wow-Thank you Theresa. We need more like you!

  • Lori Miller

    10/30/2010 1:28:42 AM |

    Theresa, I'm not a health care provider, just someone who leads an independent life and writes a humble blog on solving one's own health problems, so take this FWIW.

    How do you think for yourself and do things your way? Study the Socratic method. Go by results. Look at how conclusions were arrived at, and weak links in the chain. Don't hang around with people who are dishonest or have stopped thinking for themselves. Always admit your mistakes instead of justifying them.

    If colleagues disapprove of you, check yourself and see if the criticism is valid. Going by what you've said, you'll probably have to choose between professional camaraderie and the best interests of your patients.

    A couple of books that are good tools for thinking for yourself: The Consolations of Philosophy by Alain de Botton and Mistakes were Made (but not by me).

  • kellgy

    10/30/2010 1:35:05 AM |

    I know exactly how Theresa feels. After losing 95 pounds, reversing hypertension, and arrhythmias, I have returned to school for an advanced degree as a FNP. My hope is also to provide an approach of health and wellness through nutrition, education, and exercise.
    I have the feeling that there are going to be more of us than the pharmaceutical companies know what to do with. Maybe I am a hopeful optimist, but the influence of a sustainable evidenced based approach as propagated here is already having it's effects.

  • Valerie LeComte

    10/30/2010 1:43:47 AM |

    I agree with Sassy, I would love to see your answers.  I am a second year medical student and am struggling with similar issues.  
    You aren't the only one Theresa! Good luck!

  • Anonymous

    10/30/2010 1:59:07 AM |

    Theresa,

    The practice model you are seeking already exists.  Check out the Institute for Functional Medicine at www.functionalmedicine.org .  After reading your letter to Dr. Davis, I think you'll find IFM exciting.  Good Luck.

  • Anonymous

    10/30/2010 2:40:22 AM |

    Medicine isn't the only field like that. Clinical & school psychology is just as rigid with its hierarchy of gurus and 'prescriptions for care' that are questionable. I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed unceremoniously. Those smiling faces have knives behind their backs. Where do you turn for straight answers? As always, you have to find them yourself. (My identity is anonymous because my username/password is being rejected. Wonder if 'they' have gotten to blogger dotcom too. JK.)

  • Anonymous

    10/30/2010 3:07:00 AM |

    A typo in my last post; should have read:

    I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

  • Kim

    10/30/2010 4:41:05 AM |

    Theresa, please tell me you will practice in Arizona. I need a doctor just like you. Im sick of being offered bandaids to cover up symptoms instead of figuring out a cause for the symptoms. I wish you the best and hope there are more out there like you and Dr. Davis.

  • moblogs

    10/30/2010 9:09:25 AM |

    Just hearing one account of a student upset with the status quo definitely makes me more hopeful for the future. Eventually these voices accumulate and change happens.

  • Buy Flonase Online

    10/30/2010 11:16:57 AM |

    I was in the field for 10 yrs,Medicine isn't the only field like that, before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

  • Anonymous

    10/30/2010 11:25:22 AM |

    I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  

    So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.

    Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  

    Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Anonymous

    10/30/2010 11:26:53 AM |

    I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  
      So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.
      Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
      Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Anonymous

    10/30/2010 11:32:15 AM |

    Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about your writings.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
      Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures - as if I have a choice in the matter - they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Dr. William Davis

    10/30/2010 12:32:36 PM |

    Hi, Sassy--

    This was my simple response. I operate in the real world, too, and do not have perfect solutions. I also invited her to my office to see what it is I do and how I do it.


    Sadly, your criticisms and concerns are right on the money.

    The problem: It will take 30 years and legions of our colleagues before there is a "sea change" of practice patterns and what we do becomes the norm. In the meantime, you have a satisfying and honest career to carve out.

    Training will try to push your round shape into a square hole, forcing you to mimic the thinking of conventional medicine. It may be a compromise you have to draw. I know of few good opportunities to break out of this mold. I believe that University of Arizona offers some sort of holistic medicine training. More of these programs are popping up. While they may not be precisely what you are looking for, perhaps they offer more leeway and less dogmatic training.

    I do sense that more and more of the primary care community are slowly rejecting conventional approaches, but I estimate it's less than 5%. But it used to be practically nobody. So it's a start.

    One good thing to know: I do what I do with little friction from colleagues. Most have no idea what it is you're talking about, but most stop arguing when they see what you can accomplish. Then they kind of turn a blind eye to how you did it, rarely asking why you did worked and their approach didn't.

  • Dr. William Davis

    10/30/2010 12:39:14 PM |

    Anonymous from Meijers--

    I hear you. I agree wholeheartedly that there is a huge and growing role for self-empowerment in health. It certainly will not come from conventional health channels, but from unconventional sources, such as online health information, direct-to-consumer testing, and other growing services.

  • Dr. William Davis

    10/30/2010 12:40:52 PM |

    Hi, Tara--

    I empathize.

    I know several very excellent dietitians, all of whom are affiliated with hospital systems (the only ones who hire), who are deeply frustrated as you are.

    I can only hope that we achieve a "critical mass" sometime soon, numbers of dissenters sufficient to be heard and not shunned, criticized, or fired.

  • Anonymous

    10/30/2010 12:47:31 PM |

    My dad is a family physician (MD) for 30+ years and over the past few years has been implementing many more natural approaches to preventing illness. It is a DIFFICULT path to take and one that is fought every day in the exam rooms with the patients and in the hallways with other doctors.

    What amazes me is other doctors willingness to RX medications that JUST CAME OUT ON THE MARKET without having done their due research, yet they very quickly judge and frown upon my dad's approach to medicine which he arrived at after many, many months of reading and researching these alternative therapies.

    While they claim to not doubt his intentions, its clear they disapprove of his methods, even in the face of proven results (less flu, fewer office visits for his patients, improved lab results).

    The reality is, he studies more in one evening (after seeing patients all day) than others study in a year. When he employs a therapy, its because he's researched the hell out of it and he's convinced it's the right approach to take. He understands the science behind HOW it works.

    Taking a preventative approach is difficult enough, but enduring the constant judgment from others who practice big-pharma medicine is what makes my dad the top-notch physician that he is. He doesn't back down from a good opportunity to educate both patients and other physicians alike about why he's decided to prevent disease instead of simply treating it.

    How refreshing to see others (especially younger physicians) who are also enduring this difficult path. It is the right thing to do.

    (P.S. Dr Davis- Vitamin D, Magnesium, Iodine, and now Lipoprotein A....you and my dad are following similar paths. I tried getting him to check lipoprotein As on his patients about a year ago (after studying them on your blog), but he was coming up to speed on Iodine at that time. Now he's embraced lipoprotein A and I know it's going to save lives. THANK YOU!)

  • Anonymous

    10/30/2010 1:30:38 PM |

    If a physician steps outside guideline-based medicine (statins for MI), he/she would open themselves up for the lawyers if the patient had an event.  

    The system is defective, but in some situations, the fear of getting sued is stronger than any influence from pharma.  

    Also, many training programs do not allow interaction with pharma reps at this time (from what I have heard).  This has been a new development in the last 1-2 years.

  • Carolyn Thomas

    10/30/2010 4:45:44 PM |

    Interesting comments from this med student.  Welcome to the wonderful world of marketing-based medicine!

    But we live in hope! Many medical schools are in fact taking action to address the pervasive influence of Big Pharma on medical education.

    For example, here in Canada pharmaceutical companies have long supplied free lunches – and even fridges to store them in – in the student lounges of all Canadian medical schools.

    But if the association that represents Canada’s medical schools has anything to say about it, there really will be no such thing as a free lunch anymore – at least for medical students.

    This also means no more talks given by physician experts paid by pharmaceutical companies. No more unsupervised meetings with drug reps.

    The Association of Faculties of Medicine of Canada say that their aim is to limit the influence that the pharmaceutical industry has on medical students and residents, as well as to address the public’s concerns about the perceived coziness between medical schools and Big Pharma.

    Dr. Irving Gold of the AFMC described the potential impact of drug company relationships on these students:

    “There’s no question that the environment within which you’re trained will have an impact on the way you perceive these issues. The public has to trust that the doctors they see do not have any debts to pay to individual pharmaceutical companies or to the sector as a whole.”

    More on this at "Pens, Pizza, Parties: How Big Pharma Freebies Impact Your Doctor" on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED - http://ethicalnag.org/2009/12/08/pens-pizza-parties/

  • Larry

    10/30/2010 7:33:19 PM |

    Hang in there Theresa M.
    You have to do what your heart tells you to.

    Anyway.... about Dieticians and Hospital food.
    Does the average dietician really, truly, believe that the food they serve is really nutrititional ?
    Does Monsanto dictate the cirriculum ?
    We've all seen Cancer patients being fed juice, milk, bread, cereal, canned (dead) food, potatoes, cookies, cold cuts, etc.
    How can a dietician with a conscience, be part of this ?
    Not trying to be offensive, I'm just asking, as they have to know the whole paradigm is wrong.

  • Gutted

    10/30/2010 9:32:22 PM |

    Thank you, Theresa, for speaking out! Hopefully, we'll see more and more medical students like you who really care about patients' health versus playing the Big Pharma, imaging and "slice 'em up"  marketing games. Unfortunately, with all the greed I see in this world, I don't have high hopes. But please don't let that stop you!

    It doesn't help that I was victimized by the medical profession in a big way. My ob/gyn of 20 years rushed me into surgery for possible ovarian cancer. Despite a benign frozen section, he proceeded to remove all my female organs. I suspect part of the reason was to train two gyn residents. This experience has shown me how corrupt the medical profession can be. Many things in the oncologist's records gave the appearance of collusion with my ob/gyn. I now realize that the oncologist was protecting his referral base to the permanent detriment of my health. A complaint to my state's medical board resulted in no disciplinary action. The outcome of a complaint I filed with my insurance company was confidential but the doctor is still in their network.  

    After many problems from the assault on my endocrine system amd anatomy (aging 15 years overnight along with profound depression and anxiety which I'd never experienced), I started frequenting hysterectomy forums. That's when I discovered that my story is quite common. If women were getting informed consent from their gynecologists, 1 in 3 women would not be hysterectomized by age 60 (1 in 2 by age 65). 73% of women are castrated at the time of hysterectomy. These women have a much greater risk of all-cause mortality. Yet, the carnage continues to the tune of a hysterectomy every minute in the U.S.  

    The book "The Treatment Trap" is a real eye-opener into the dark side of medicine. I highly recommend it.

    Here's an article - Lies, Damned Lies, and Medical Science - about the flaws of medical studies:

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269

    Per the article, a leading expert in medical research credibility estimates that up to 90% of published medical information is flawed.

  • Tara

    10/30/2010 11:43:40 PM |

    @ Larry

    I work in outpatient, but I can go ahead and tell you that the inpatient dietitians don't actually "serve" the food, nor do the prepare it or even choose it.  The food service company (typically Aramark or Morrison) is responsible for the selection, preparation, and serving of food to patients.  An inpatient dietitian's job is to oversee patient care related to nutrition in various disease states, calculate needs, educate, and in some cases order/manage TPN or tube feedings.

    Many of us HATE the awful food that is served in hospitals, but we have no say in the matter.  Hospitals are run like businesses, so the quality of food is not as important as the cost.  When my dad had his bypass surgery, I cooked and brought him food from home.

  • Dr. William Davis

    10/31/2010 2:34:52 PM |

    Hi, Tara--

    You know, the plight of enlightened dietitians today reminds me of the way the German people must have felt when the National Socialism movement coerced them to follow their dictates on pain of imprisonment.

    The whisperings of neighbors was all it took to have the Gestapo knocking on your door at night.

    Your experience, by the way, would be a great conversation for this blog. Please tell us more.

  • blogblog

    11/1/2010 6:42:05 AM |

    I was friends with two Indonesian medical graduates. In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies. Before graduation they must deliver a minimum of 100 babies!

  • blogblog

    11/1/2010 7:14:29 AM |

    Hi Tara,
    with respect being a dietitian or other health practitioner is simply not comparable with practising medicine. I should know because I studied exercise physiology as a postgraduate. My academic workload was probably less than 1/4 that of a medical student.

    The fact is that allied health degrees like nursing, dietitics and exercise physiology are actually quite easy.

    The amount of underlying theoretical knowledge, the workload and responsibility is vastly greater in medicine than in any other health related profession.

    The reality is you get 1/4 the pay of a doctor because your job is 1/4 as hard. You don't have to work nights, weekends and public holidays. You also don't have to be on call, work 36 hour shifts, make instantaneous life and death decisions or deal with grieving relatives like doctors do.

  • Anonymous

    11/2/2010 1:03:07 AM |

    "In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies."

    But only on adults who ask to be circumcised, right?

    I certainly hope the mutilation of nonconsenting infants is not the standard of care in Indonesia.

  • blogblog

    11/2/2010 5:55:28 AM |

    Hi Anonymous. Indonesia is a Muslim, country so circumcision is routine for babies.

  • buy differrin online

    11/2/2010 3:52:18 PM |

    I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and again suggest niacin.

  • Tara

    11/3/2010 2:12:06 AM |

    @blogblog

    I think you missed my point... My post wasn't to complain about the difference in our salaries.  My point was that because we are in a lower position, we have an even tougher fight ahead.  It's hard to make a change when your grassroots efforts are poorly funded and your profession is not respected.

  • blogblog

    11/3/2010 7:28:16 AM |

    Tara,

    I'm sure that you are well intentioned and wish to help people but you aren't in a position to do that within the conventional dietetics framework.

    The only really influential and widely respected professionals in health care are senior medical specialists working in teaching hospitals. The opinions and knowledge of others is often deemed irrelevant.

    I am speaking from the Australian perspective so my comments may not be relevant to you.

    The dietetics profession has an extremely unethical relationship with the food processing industry. Many food manufacturers employ dietitians primarily as effective PR personnel to give their extremely unhealthy products some credibility.

    The Dietitians Association of Australia actively endorses the type of unhealthy products manufactured by their commercial partners. In the recent past the DAA has even actively promoted confectionery as part of a 'balanced' diet for children.

  • Rogue Dietitian

    11/6/2010 5:26:05 PM |

    @Tara -- you're not alone! I too am a "rogue" dietitian and am so frustrated with my colleagues. I am lucky in that I work at a naturopathic practice where my nutritional point of view is in sync with the doctors I work for. So, I am not expected or criticized for straying from the ADA/USDA grain-dairy model. I hear your frustrations with the field. Luckily, there is so much you can do with it though. I had to find my own way.

    During my internship, I had reservations about having to give diet advice I didn't believe to be prudent -- eat a low fat diet, drink lots of milk, etc. Instead, I changed the script and focused on other pieces of advice. For example, for heart patients I focused on getting them to eat more vegetables, and ditching the margarine, and "forgot" to mention the parts I don't agree with. Or for diabetics, eating fewer carbs and focusing on gluten-free sources like potatoes, brown rice, etc. My preceptors were thrilled I was getting people to eat more vegetables, and I didn't feel like I sold out. Good luck to you.

    Dr. Davis, I have only recently discovered your blog but am enjoying it. I have some non-traditional ideas on heart health I would love to dialog with you about sometime.

  • Dr. William Davis

    11/7/2010 3:59:52 PM |

    Hi, Rogue--

    That's great! A clever, "stealth," way to say what you believe.

    You are welcome to post recipes here or to go to www.trackyourplaque.com and use the "contact" link. I look forward to seeing what you've come up with.

  • rangojigi

    11/11/2010 9:21:37 AM |

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    buy viagra online

  • Anonymous

    11/13/2010 3:27:27 AM |

    I learned a long time ago that 99.9% of doctors are worse than useless. I don't plan to ever see a doctor again. Sadly, I'll soon be forced into the medical system, like most Americans.

  • 2medicure

    12/10/2010 4:57:30 AM |

    Well after reading your blog and the comment from all the expert i will love to visit this blog to get update about good healthy habits

  • Dana Seilhan

    12/11/2010 9:35:44 AM |

    Anonymous, no one's being forced into the medical system. They're being made to pay for insurance.  No one says you have to go to the doctor.

    I was startled to learn there are actually sound economic reasons for making everyone buy into health insurance in a given country.  Too long to explain here but the book I learned this from, well predated the "health care reform" debate.  In a nutshell, if you didn't want to have to buy a health insurance plan, you should have supported the idea of single-payer coverage.  But you didn't want that, because it was "socialist," if you are like most Americans.  So this is the alternative everybody gets to live with, since they decided it was more important to have health insurance companies than to fund health care like we do police and fire departments.  Dem's de breaks.

  • dr cate

    9/19/2011 12:48:11 PM |

    HI Tara
    I work with a dietician who, like you, has a real passion for her job. She told me that she feels like she has participate in "tragedies unfolding every day" when the doctors send patients to her expecting the usual advice. She is fighting back, though. She has a health radio show you can listen to: http://www.wkxl1450.com/site/index.php?option=com_content&task=view&id=4182

    I encourage you to seek out doctors who think outside the box in your area. I have been so grateful to have Chris available for my patients, and I know other doctors would be grateful for someone like you, too!
    (PS I am relocating soon to Napa, CA, you don't happen to be there...?)

  • Barb

    10/5/2011 12:20:23 AM |

    Not meaning to be a s*&t disturber, but then why do an alarming number of doctors seem to only know 1/4 of what other allied health practitioners do?? Are they being taught too much 'feather' and not enough chicken??

  • jpatti

    5/31/2012 3:29:00 PM |

    I have a sister who doesn't understand much about biochemistry.  She asks me for advice all the time with various issues/problems.  Vast majority of my advice is dietary/supplements.  Sometimes, my advice is for prescription meds, which I can usually locate without a doctor (not talking narcotics or anything).

    But my advice to her in a ACUTE situation is... don't wait to ask me, do what the doctor says.  IMO, if you have a broken bone, or are actively having a heart attack, or have a big infected boil, mainstream medicine is OK, pretty much the best we've got.  

    When you have a CHRONIC disorder, or are trying to preempt having one, that is when taking your health into your own hands is good.  That is when you look up all the prescribing info for the drug they want to put you on before taking it.  That is when you become more of an expert on your disease than they are.  

    I had a CABG several years back, I've been a T2 diabetic for years, I had a bad rT3 problem, and adrenal insufficiency (reversed both the rT3 and adrenal issues and am weaned off meds), I have low sex hormones (E, P and T), I have systemic yeast.  I know more about my COMBINATION of diseases than any doctor cause I'm more INTERESTED and have GOBS of time to research each issue and the endocrinology (which includes nutrition. since cholesterol and vitamins A, D3 and K2 all profoundly effect hormones) and of how they all interact.  I can spend hours looking at a diagram of steroidogenesis and trying to figure out myself.

    So... if a doctor wants me to use more insulin for tighter control, I know I need more K-Dur to counteract the K loss from insulin else my BP will go skyhigh.  They don't.  They just see my BP go high and want to put me back on Lisinopril (which never lowered it, after 2 years of increasing doses).  I know niacin fixes my lipid panel better than statins - and that I can climb stairs on niacin.  I know that high omega 3 intake, and high vitamins A, D3 and K2, and lots of CoQ10 are absolutely required for my health.

    I DO know more than they do about my chronic stuff, and my sister's chronic stuff, and my daughter's and husband's issues.  If it's anything chronic, I WILL know more in a few weeks time than any doctor treating me.  Cause... no one can be an expert on EVERYTHING and I CARE more when it effects me or mine than they do.  I'm one of 30 patients they are seeing today; I'm the only me I've got.  I just flat out CARE more.

    But in an acute situation, I trust them.  My sister needs an MRI on her back, I agreed she needs it, and just said, "Do whatever they tell you if it's based on the MRI."  Cause... I can't become an expert in 10 minutes, and the acute stuff, they are mostly pretty good at.  Someone has to decide in those situations, and you don't have time to become an expert.

    There's other stuff mainstream medicine has gotten right.  Antibiotics as an example... though the overuse of them is what they got wrong.  Similarly, while I think we overdo vaccinations, the fact is that when polio came through a town and killed or crippled most of the children, that was some bad stuff.  Mainstream medicine gets some things right.

    The problem with medicine is that it is not evidence-based, though they say it is.  At BEST, it takes 10-15 years for good research info to change the practice of medicine.  At worst, if there is no profit motive, good research info may NEVER change the face of medicine.  

    IMO, with mainstream medicine, you take what is good and leave the rest.  But throwing out the baby with the bathwater makes no sense.  Doctors do have their uses.  No matter how we rant against their stupidity, there is some worthwhile stuff there.

    One of MY reasons for hanging out here is that Dr. Davis changes.  When I started hanging on this blog and his website and bought his first book, he wasn't discussing thyroid, or K2, and his dietary ideas were quite a bit different than today (though the anti-wheat stuff was there even then).  

    Not that I agree with him 100% about everything, but... he DOES change the way medicine does not; he actually DOES do evidence-based medicine, based on actual evidence, not just evidence provided by pharmaceutical studies.  And since evidence changes over time, and he keeps learning, his recommendations change.  That gives me confidence in his latest ideas, to go research them for myself.  

    And for those who can't really research for themselves, without a solid science background and an understanding of how to read studies, if they have cardio issues, I just tell them to go do what he says.  I've told people to read his books, sent them to the blog and website, I've even sent a few people to see him, cause they were local to him and able to get there.  Cause even if I don't agree 100% about everything, he's the only cardiologist I know who is actually reversing CHD.  

    Granted, Dr. D is a maverick and himself rants against mainstream medicine.  But... he rants agaisnt specific stupidity.  I'm sure if you were having an actual MI right now, he'd recommend a procedure to save you.  Just... he'd rather you not have the MI in the first place, which is why he rants.

    But... baby and bath water...

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