Can I see your linea alba?

2. November 2010 William Davis (19)
As more and more people are eliminating wheat from their diet and losing their "wheat bellies," i.e., the muffin top around their waists along with the visceral fat beneath, I am frequently seeing something I haven't seen in years: the linea alba.

Linea alba, or "white line," refers to the band of connective tissue running vertically from sternum to pubic area. It underlies the depression that separates the horizontal abdominal rectus muscles of the "six pack" abdomen.

It's like digging in your closet and finding something you thought you'd lost years earlier. Surprise! It's been there all along. Buried deep beneath the abdominal fat from dozens of deep-crust pizzas, whole wheat pasta, and whole grain sandwiches is this pleasing anatomical feature long lost from most peoples' anteriors.


Can you see your linea alba?

Dwarf mutant wheat

31. October 2010 William Davis (13)
Here's my 12-year old standing next to dwarf wheat grown near my house. The wheat is full-grown, harvested about 2 weeks after I took this photo.

Wheat is no longer the 4-foot tall "amber waves of grain" of the 20th century. Over 99% of all wheat grown worldwide is now the 18- to 24-inch tall dwarf. New size, new biochemistry, new effects on humans. I call it dwarf "mutant" wheat despite its lack of extra limbs or eyes because of the dramatic transformation required to breed this unique synthetic plant. 

Short-stature means less stalk, faster growing. The stockier stalk also means that the heavy seed head won't cause the plant to "buckle," as 4-foot tall wheat used to. 





The thousand-plus proteins of wheat that have been transformed to generate this dwarf mutant also changed wheat's relationship to consuming humans.

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.

The Great Low-Carb Connector

28. October 2010 William Davis (15)
The effusive Jimmy Moore of Livin' La Vida Low-Carb asked me to help get the word out about his new podcast subscription service, The Livin' La Vida Low-Carb Show Fan Club.

Jimmy has been The Great Connector for the low-carb discussion, from his ubiquitous online and social media presence, to his annual low-carb cruise. He has also broadcast first class interviews of nutritional notables like Gary Taubes, Dr. Robert Lustig, and blogger Stephan Guyenet. His Fan Club expands listener involvement in the podcast process and, potentially, greater access to his guests:

My faithful listeners have long been asking me about how they can become even more engaged in the behind-the-scenes workings of the show to get the inside scoop about what’s coming next. I’ve heard people ask specifically for access to transcripts of the most popular podcasts, a listing of the interviews I’m currently working on with the ability to ask questions of those guests, to have sneak peek of audio from not-yet-released interviews and more. My amazing podcast producer, Kevin Kennedy-Spaein, and I have been discussing how to best do this for a while in an effort to meet the demands of our biggest fans and we think we’ve got just the answer for you. Introducing The Livin’ La Vida Low-Carb Show Fan Club!

This is for all intents and purposes the quintessential destination for people who can’t get enough of this podcast that goes much deeper than discussion about the low-carb lifestyle. Yes, I speak with a lot of people who are supporters of carbohydrate-restricted diets, but I also talk with fitness gurus, people who support alternative eating plans, those who have interesting theories and beliefs regarding health and much more. Wouldn’t you love to have a chance to know who’s coming up in my schedule to be able to ask them questions BEFORE I interview them? Keep in mind that my interviews are pre-recorded and air sometimes as much as 5-6 months afterwards. Members of the “fan club” would know all about who’s coming and likely will have their question asked on the air just for signing up to be a part of this exciting new addition to “The Livin’ La Vida Low-Carb Show.”

Jimmy is the guy who is bringing this disparate and widely-spread community together. He's the guy we all know, he knows "everybody." I'm looking forward to seeing how this new project makes a more involved, personal delivery of interaction possible.

New Track Your Plaque record!

27. October 2010 William Davis (19)
The record for the largest drop in heart scan score (by percentage of starting score) has been held for around three years, with 63% reduction in score.

Well, the longstanding record was broken this week: 75% reduction in score.

At the start, Freddie has disastrous lipid values:

LDL cholesterol 263 mg/dl
HDL 26 mg/dl
Triglycerides 323 mg/dl
Total cholesterol 354 mg/dl

Lipoproteins (NMR) were worse:

LDL particle number 3360 nmol/L
Small LDL 2677 nmol/L

Heart scan score: 732

Interestingly, Freddie had virtually no vitamin D in his body, with a 25-hydroxy vitamin D level that was unmeasurable.

Freddie was miserably intolerant to statin drugs, with even the smallest dose resulting in intolerable muscle aches. That's when his doctor sent him to me.

Because I felt that the dominant abnormality in Freddie's lipids and lipoproteins was small LDL particles, representing 80% of total LDL particle number, we focused his program on correcting this parameter. Freddie's program was therefore focused elimination of wheat, cornstarch, oats, and sugars, along with an eventual vitamin D dose of 20,000 units to finally achieve a 25-hydroxy vitamin D level of 66 ng/ml. No statin drug in sight.

43 lbs of weight loss and 18 months later, a second heart scan score: 183--a 75% reduction.

While the rest of the world continues to insist that coronary calcium (heart scan) scores cannot be reduced, I am seeing records being broken. I add Freddie's experience to the rapidly growing list of people who have not just stopped coronary plaque from growing, but are seizing control and reducing it, sometimes to dramatic degrees.

The Anti-AGEing Diet

22. October 2010 William Davis (36)
Advanced Glycation End-products, AGEs, are a diverse collection of compounds that have been associated with endothelial dysfunction, cataracts, kidney disease, and atherosclerosis in both animal models and human studies. Not all involve glycation nor glucose, but the catch-all name has stuck.

There are a number of actively-held theories of aging, such as the idea that aging is the result of accumulated products of oxidative injury; a genetically pre-programmed script of declining hormones and other phenomena; genetic "mis-reading" that results in disordered gene expression, debris, and uncontrolled cell proliferation (e.g., cancer); among others.

One of the fascinating theories of aging is, cutely, the AGEing theory of aging, i.e., the accumulation of AGE debris in various tissues. Such AGEs have been recovered in lenses from the eyes, atherosclerotic plaque in arteries, kidney and liver tissue, even brain tissue of people with Alzheimer's dementia. AGEs perform no known useful physiologic function: They are relatively inert once formed (especially polymeric AGEs), they do not participate in communication, they make no contribution of significance. They simply gum up the works--debris. (AGEs are to health as the USDA food pyramid is to dietary advice: material for the junkyard.)

There are two general ways to develop AGEs:

1) Endogenous--High blood glucose (any blood sugar above 100 mg/dl) will permit glycation of the various proteins of the body. The higher the blood glucose, the more glycation will proceed. Glycation also occurs at low velocity at blood glucose levels below 100 mg/dl, though this would therefore represent the "normal," expected rate of glycation. Endogenous glycation explains why people with diabetes appear to age and develop all the phenomena of aging faster than non-diabetics (kidney disease, eye diseases, atherosclerosis, dementia, etc.). Hemoglobin A1c, HbA1c, is a readily-obtainable blood test that can show how enthusiastically you have been glycating proteins (hemoglobin, in this case) over the last 2 to 3 months.

A low-carbohydrate diet is the nutritional path that limits endogenous glycation leading to AGE formation. Restricting the most obnoxious carbohydrates, the ones that increase blood sugar the most, such as wheat, cornstarch, rice starch, potato starch, tapioca starch, and sucrose, will limit endogenous AGE formation.

2) Exogenous--AGEs (here especially is where the "AGE" label is misleading, since many other reactions besides glycation lead to such compounds) are formed with cooking at high temperatures, especially meats and animal products. Therefore, a rare steak will have far less than a well-done steak. A thoroughly baked piece of salmon will have greater AGE content than sashimi.

The forms of cooking that increase AGE content the most: roasting,deep-frying, and barbecuing. Temperatures of 350 degrees Fahrenheit and greater increase AGE formation.

Therefore, cooking foods at lower temperature (e.g., baking, sauteeing, or boiling), eating meats rare whenever possible (not chicken or pork, of course), eating raw foods whenever possible (e.g., nuts) are all strategies that limit exogenous AGE exposure. And minimize or avoid butter use, if we are to believe the data that suggest that it contains the highest exogenous AGE content of any known food.

If we connect the dots and limit exposure to both endogenous and exogenous AGEs, we will therefore not trigger this collection of debris that is likely associated with disease and aging. So following a low-AGE diet may also be an anti-aging strategy.

The New Track Your Plaque Diet, soon to be released on the Track Your Plaque website, has incorporated strategies to limit both endogenous as well as exogenous AGEs.

Butter: Just because it's low-carb doesn't mean it's good

21. October 2010 William Davis (59)
The diet I advocate in the Track Your Plaque program to gain control over the factors that lead us to coronary plaque and heart attack is a low-carbohydrate diet. We begin with elimination of wheat, cornstarch, oats, and sugars in the context of an overall carbohydrate-reduced diet. We refine the program by monitoring postprandial (after-meal) glucoses.

But not everything low-carb is good for you. Fried sausages, for instance, are exceptionally unhealthy, despite having little to no carbohydrates.

An emerging but potentially very powerful issue is that of Advanced Glycation End-products, or AGEs. There are two general varieties of AGEs: endogenous (formed within the body) and exogenous (formed in food that is consumed).

Endogenous AGEs form in the body as a result of high blood glucose, i.e., glycation. When exposed to any blood glucose level of 100 mg/dl or greater, some measure of glycation will develop due to a reaction between glucose and various proteins, e.g., proteins in the lens of the eye, forming cataracts over time.

Exogenous AGEs form in food, generally as a result of heating to high-temperature. (AGEs is really a catch-all term; there are actually a number of reactions that occur in foods, not all of them involving sugars. However, the "AGE" label is used to signify all the various related compounds. The values quoted here are from Dr. Helen Vlassara's Mt. Sinai Hospital laboratory; reference below.)

Beef cooked to high-temperature yields plentiful AGEs. One gram of roast beef, for instance, contains 306,238 units. This means that an 8-oz serving yields 13.8 million units AGEs. Compare this to a boiled egg with 573 units per gram, raw tomato with 234 units per gram.

Butter contains an impressive 264,873 units AGEs per gram, the highest content per gram in the entire list of 250 foods tested in the Mt. Sinai study. A couple pats of butter (10 g) therefore contains 2.64 million units. A stick of butter that you might add to cake batter to make a cake therefore yields 30 million units of AGEs.

So there's nothing wrong with the fat of butter. It's AGEs that appear to be responsible for the endothelial dysfunction/artery-constricting, insulin-blocking, oxidation and inflammation reactions that are triggered. Among all of our food choices, butter is among the worst from this viewpoint.

Throw in the peculiar "insulinotrophic" effect of butter, and you have potent distortion of metabolic pathways, courtesy of the butter on your lobster.

(AGE data from Goldberg 2004. In this analysis, carboxymethyllysine was the marker used for AGE content.)

Incidentally, the new Track Your Plaque diet will soon be released as chapter 9 of the new Track Your Plaque book on the website.

Einkorn now in Whole Foods

16. October 2010 William Davis (19)
I just saw this at Whole Foods: einkorn pasta.

In my einkorn bread experience (In search of wheat: We bake einkorn bread), I was spared the high blood glucose and neurologic and gastrointestinal effects of conventional whole wheat grain (dwarf Triticum aestivum). I shared the einkorn bread  with four other people with histories of acute wheat sensitivities, only one of whom experienced a mild diffuse joint reaction, the other three not experiencing any symptoms.

Anyone wishing to try einkorn can now obtain commercial pasta from Jovial, an Italy-based manufacturer. It comes in spaghetti, linguine, rigatoni, fusilli, and penne rigate shapes.

Eli Rogosa, founder of The Heritage Wheat Conservancy, tells me that, in her experience, celiac suffers seem to not experience immunologic phenomena triggered by conventional wheat.

However, we've got to be careful here. The so-called ("diploid") "A" genome of einkorn shares many of the same genes as the ("hexaploid") "ABD" genomes of modern wheat, including overlap in the sequences coding for the 50-or so different glutens and glutenins. Most of the genes that code for the glutens that cause celiac and related illnesses reside in the "D" genome that are absent in the einkorn "A" genome. However, the "A" genome still codes for glutens. So there is potential for activating celiac disease in some people. Insufficient research has been devoted to this question. It is a question of extreme importance to people with celiac and other immune-mediated conditions, since re-exposure to the wrong form of gluten can increase risk of intestinal lymphoma 77-fold, as well as risk of other gastrointestinal cancers.

So einkorn should not be viewed as a cure-all for all things wheat, but as something to consider for a carbohydrate indulgence. Yes, indeed: It is a carbohydrate, with 61 grams ("net") carbs per 4 oz (uncooked) serving.
Should anyone give it a try, please be sure to report back your experience, especially if you have a history of wheat intolerance. If you have a glucose meter, pre- and 1-hour post values are the ones to measure to gauge the blood sugar effects of consumption. Because pasta tends to cause long sustained blood sugar rises, another value at 2-4 hours might be interesting.

Noodles without the headaches

14. October 2010 William Davis (26)
If you are looking for a wheat-free noodle or pasta, shirataki noodles are worth a try.

Shirataki noodles are low-carbohydrate (less than 3 g per 8 oz package) and, of course, do not trigger all the unhealthy effects of wheat--no blood sugar/insulin provocation, no addictive brain effects (exorphins), no gluten-mediated inflammatory effects.

(I advise avoiding gluten-free pasta alternatives made with rice flour and other common gluten alternatives, since they trigger blood sugar, small LDL, and growth of visceral fat just like wheat.)

I made a stir-fry using the shirataki-tofu noodles, shown below. (Tofu is added to make the noodles more noodly in consistency, as opposed to the chewier non-tofu variety.) The noodles were a lot like the ramen I used to eat as a kid. They were filling and tasted great in the sesame oil, soy sauce, tofu, and vegetables I used.


The noodles are easy to use. Just drain liquid out of package. (The noodles come in water.) Rinse in collander 30 seconds, then boil for 3 minutes. Add to your stir-fry or other dish. Some manufacturers, such as House Foods, also have angel hair and fettucine style noodles.

You're fried

13. October 2010 William Davis (26)
If I could invent a food that illustrates nearly all of the shortcomings of the American diet, it would be French fries, the familiar fixture of fast food.

What we have come to view as French fries contain just about every one of the unhealthy ingredients that lead us down the path of obesity, diabetes, heart disease, high blood pressure, etc.

Let's take them one by one:

Potato starch--Potato starch exerts an effect on blood sugar similar to that of table sugar, only worse. (Glycemic index french fries 75; glycemic index sucrose 65.)

Advanced Glycation End-products (AGEs)--AGEs form when proteins and fats are subjected to high temperature cooking; the longer the high temperature, the more the food reaction creating AGEs proceeds. AGEs are the likely culprit in roasted and fried foods that made it appear that saturated fats were bad, when it was really AGEs all along. AGEs have been shown to block insulin's effects, increase blood sugar, cause endothelial dysfunction and high blood pressure.

Acrylamides--Acrylamides, like AGEs, are created through high-temperature heating. French fries are unusually rich in AGEs. Brewed coffee also contains a small quantity, while French fries contain 82-fold greater quantities, among the highest of all known sources of acrylamides.

Oxidized oils--The amount of oxidized oils will depend on what sort of oil was used for frying. As more restaurants are trying to get away from hydrogenated oils, many are turning back to polyunsaturates. Others are turning to commercial-grade oils that contain both hydrogenated and polyunsaturates. If oils are permitted to oxidize, then they will trigger oxidative phenomena in your body upon consumptions, e.g., LDL oxidation (Staprans 1994).

In other words, the innocent appearing French fry unavoidably triggers oxidation, all the phenomena triggered by high blood glucose (high insulin, glycation, visceral fat accumulation), along with the cascade of effects arising from AGEs and acrylamides.

Top your French fries with some ketchup made with high-fructose corn syrup that exagerrates AGE formation, visceral fat, and distorts postprandial (after-eating) effects.

Is it any wonder that we've lost control over diet?
Normal cholesterol panel . . . no heart disease?

Normal cholesterol panel . . . no heart disease?

15. June 2011 William Davis (19)
I often hear this comment: "I have a normal cholesterol panel. So I have low risk for heart disease, right?"

While there's a germ of truth in the statement, there are many exceptions. Having "normal" cholesterol values is far from a guarantee that you won't drop over at your daughter's wedding or find yourself lying on a gurney at your nearest profit-center-for-health, aka hospital, heading for the cath lab.

Statistically, large populations do indeed show fewer heart attacks at the lower end of the curve for low total and  LDL cholesterol and the higher end of HDL. But that's on a population basis. When applied to a specific individual, population observations can fall apart. Heart attack can occur at the low risk end of the curve; no heart attack can occur at the high risk end of the curve.

First of all, to me a "normal" lipid panel is not adhering to the lax notion of "normal" specified in the lab's "reference range" drawn from population observations. Most labs, for instance, specify that an HDL cholesterol of 40 mg/dl or more and triglycerides of 150 mg/dl or less are in the normal ranges. However, heart disease can readily occur with normal values of, say, an HDL of 48 mg/dl and triglycerides of 125 mg/dl, both of which allow substantial small oxidation-prone LDL particles to develop. So "normal" may not be ideal or desirable. Look at any study comparing people with heart disease vs. those without, for instance: Typical HDLs in people with heart attacks are around 46 mg/dl, while HDLs in people without heart attacks typically average 48 mg/dl--there is nearly perfect overlap in the distribution curves.

There are also causes for heart disease that are not revealed by the lipid values. Lipoprotein(a), or Lp(a), is among the most important exceptions: You can have a heart attack, stroke, three stents or bypass surgery at age 40 even with spectacular lipid values if you have this genetically-determined condition. And it's not rare, since 11% of the population express it. How about people with the apo E2 genetic variation? These people tend to have normal fasting cholesterol values (if they have only one copy of E2, not two) but have extravagant abnormalities after they eat that contribute to risk. You won't know this from a standard cholesterol panel.

Vitamin D deficiency can be suggested by low HDL and omega-3 fatty acid deficiency suggested by higher triglycerides, but deficiencies of both can exist in severe degrees even with reasonably favorable ranges for both lipid values. Despite the recent inane comments by the Institute of Medicine committee, from what I've witnessed from replacing vitamin D to achieve serum 25-hydroxy vitamin D levels of 60-70 ng/ml, vitamin D deficiency is among the most powerful and correctable causes of heart disease I've ever seen. And, while greater quantities of omega-3 fatty acids from fish oil are associated with lower triglycerides, they are even better at reducing postprandial phenomena, i.e., the after-eating flood of lipoproteins like VLDL and chylomicron remnants, that underlie formation of much atherosclerotic plaque--but not revealed by fasting lipids.

I view standard cholesterol panels as the 1963 version of heart disease prediction. We've come a long way since then and we now have far better tools for prediction of heart attack. Yet the majority of physicians and the public still follow the outdated notion that a cholesterol panel is sufficient to predict your heart's future. Nostalgic, quaint perhaps, but as outdated as transistor radios and prime time acts on the Ed Sullivan show.

 
Tags :

Comments (19) -

  • Might-o'chondri-AL

    6/15/2011 4:14:41 PM |

    I  was surprised that in order to get my  vitamin D25 level to 58.3 ng/mL  this winter in southern California I had to take 6,000 IU daily  of vitamin D3;  as was outside in short sleeves a fair spell every day.   This was first time where could test,  and my first time supplementing as well;  now am using at least 7,000 IU daily of vitamin D3 and it's summer months.

    Set my blind trial dose,   as a precaution, on low side based on info read here (from T. Hutchinson) suggesting 1,000 IU D3 for every 25 pounds body weight;  I had no clue what my baseline D3 was . Used  glycerin drops from Vitality Works out of New Mexico,  where 5 drops = 2,000 IU D3 ;  I've no financial interest in this.

    All males on my paternal side died from heart related problems before their late 50's so went ahead and tested my Lp(a) a while back;  I got clued in to Lp(a) by reading Doc's posts here . Was pleased and relieved to see a Lp(a) reading of just 2 , since lab gives less than 20 Lp(a) as normal.

  • Jimmy

    6/16/2011 12:07:56 AM |

    Then how is Lp(a) best treated?
    I am 36 and have had high Lp(a) for 16 years now. It sits near 100. That with low HDL and high LDL I feel like a walking time bomb. My father passed at 44 and mom at 46 and all uncles on mom's side dead prior to 50 of heart disease. Father was adopted, so do not know his side. What is worse, is that I have just relocated to Toronto, Canada (from the US) and I cannot find a doctor who even acknowledges what Lp(a) is. Nor can I find one (and I have been searching for 2 years) who thinks my cholesterol is high enough to "worry about".  It's even worse here than in my small town back in the US as far as getting decent lipid testing and advice Frown     Sorry to rant.

  • Lora

    6/16/2011 1:33:58 AM |

    I'm glad that you are warning people with normal cholesterol panels not to be complacent about their arterial status. My  cholesterol totals from age 40 to 52  ranged between 114 and 132.  My HDLs in my late 40s/early 50s were 64, 58, 53; LDLs 55, 56, 48; triglycerides 66, 49, 70.  The cholesterol totals on the latter two panels were below the normal range, which I've read can be problematic, though that's a topic that it is very difficult to find info about. What a surprise to get an severely infected blister on my foot, complicated by poor circulation, and to subsequently be found to have "mild arteriosclerotic changes" in my lower extremities.  I wonder about the mildness b/c now I perceive the dramatically decreased amount of hair on my legs as an indicator of poor circulation.

  • Dr. William Davis

    6/16/2011 11:54:41 AM |

    Jimmy-

    Please do not accept the advice offered by many of my colleagues that there is no treatment for Lp(a), or that the only treatment is to reduce LDL to less than 80 mg/dl with statins. All nonsense.

    Undoubtedly, the science behind Lp(a) is still unfolding and is proving to be more complex than initially thought. For instance, newer observations are suggesting that the atherogenic (plaque-causing) potential of Lp(a) may be largely due to its oxidized phospholipid and phospholipase A2 content.

    Nonetheless, I urge you  to participate in our discussions on the Track Your Plaque website, where you will find extensive reports and discussions on what to do with Lp(a). Our current first treatment of choice is high-dose fish oil, i.e., 6000 mg per day EPA + DHA.

  • Dr. William Davis

    6/16/2011 11:56:51 AM |

    Hi, Lora--

    Clearly, your answers won't be found in cholesterol values. This is far more common than often thought.

    Look for Lp(a), small LDL, vitamin D deficiency, and consider omega-3 fatty acid supplementation. Consider unappreciated hypertension and endogenous glycation, i. e, high HbA1c.

  • James

    6/16/2011 8:22:33 PM |

    When I got my in-office lipid panel results, my doctor was pleased by the results (I was too):

    Trigs: 50
    Total Chol: 198
    HDL-C: 70
    LDL-C: 118 (slightly elevated)

    That gives me a TC/H of 2.8, which I assume is excellent.

    BUT, I also got a NMR LipoProfile test, and here were those results:
    LDL-P: 1410 (High)
    Small LDL-P: 613 (High)
    Vit D: 31.4 (Low)

    I was surprised that the NMR test revealed some risk, while my standard panel did not. My doctor now wants to test me again in 4 months.

  • kenneth

    6/17/2011 1:39:19 PM |

    I've never been able to get my HDL above 36 (it's as low as 25). Triglycerides in me and my brother run 400-500 uncontrolled (neither of us is at all obese). I'm at 8 grams of fish oil now, 1 g of IR niacin and I've bumped up my Vitamin D to 8,000 a day, and I'm hoping that makes a difference at least with the HDL. My LDL and total cholesterol numbers are "normal" although god knows what a VAP or NMR would reveal. Would I be crazy to think about adding a bit of statin to this mix, ie 10 mg/day of atorvastatin or simvistatin? Has anyone had any luck with sytrinol or anything else? I'm not wheat free I know, but I have cut way down.

  • Anand

    6/17/2011 4:23:50 PM |

    Dr. Davis,
    What is your take on the AIM-HIGH trial ?
    My Lpa, measured at Berkeley is extremely elevated at 190 mg/ dl. Their assay is supposed to be isoform insensitive. I am on 20 mg crestor and 2 g niaspan along with 2g carnitine, 2500 IU vitamin d (level is 36) and 3 g EPA plus DHA.
    I do follow a low carb diet.
    I also have FH. Untreated my TC was 300 with LDL over 200.  I already have one stent in mid LAD despite being thin (BMI 23).
    I am wondering how to monitor my coronary arteries besides the standard stress test.

    An and

  • Lora

    6/17/2011 8:32:43 PM |

    Thank you for the information. My HbA1c when checked was 5.6. I had already started cutting back significantly on carbs a couple of weeks before that. I think endogenous glycation has been a significant factor for me. I've avoided white sugar for many years, but I used to quite frequently eat beans and whole grains, including whole grain oatmeal every morning. I discovered with a OneTouch UltraMini glucose monitor that my BG went into the 170s after eating that!  I haven't found any other food that sends my BG so high.  (And  I used to frequently eat the oatmeal along with fruit!) An hour after the drink in a glucose tolerance test my BG was 138 (then went to 79 an hour later).  My vitamin D when checked was 43.6 so not terrible, but showing room for improvement. I'ave been taking Member's Mark fish oil (which I read about on this web site) for quite awhile, but I’d been somewhat erratic with it before realizing my problem. I have a variant of "white coat" hypertension, which I've read is probably more harmful than it was once thought to be. Normally my BP is on the low side but stressful situations sometimes cause it to spike dramatically. My BMI has been 20 for years, used to be lower. I've never smoked. I wonder about carnitine b/c my diet has been largely, though not entirely, vegetarian for years. I definitely haven’t been getting enough exercise. Also, I've come across journal articles about Type D personality traits and think they may be a factor.  I have to get Lp(a), small LDL, and other sub-elements checked.    

    Thanks again! I have learned a lot from this web site.

  • Helen

    6/20/2011 7:11:33 PM |

    Lora -

    Yikes!  You sound almost exactly like me.  I don't really know what to do about the glucose spikes.  Low carb didn't help me.  I'm not trying to burst Dr. Davis' bubble or anything, just saying what was true for me.  Fish oil and niacin make my blood sugar spike more.  My blood pressure and resting heart rate are low, though.  Only occasionally do I get the white coat hypertension thing.  But otherwise, my cholesterol panel and blood sugar experiences mirror yours pretty well.

  • Lora

    6/22/2011 7:43:10 PM |

    Helen,

    Fortunately, decreasing or avoiding certain carbs does help me control my blood glucose. I bought a glucose monitor, as suggested by Dr. Davis. Ironically, I have discovered that some of the foods I used to make it a point to eat for health reasons (oatmeal, apple) spike my blood sugar the most.

  • SK

    6/25/2011 2:27:20 PM |

    We are big fans of fish oil.

    BUT, now we read this: "our findings are disconcerting as they suggest that ω-3 fatty acids, considered beneficial for coronary artery disease prevention, may increase high-grade prostate cancer risk, whereas trans-fatty acids, considered harmful, may reduce high-grade prostate cancer risk. " ???
    http://aje.oxfordjournals.org/content/173/12/1429.full

    thoughts???

  • SK

    6/25/2011 2:31:28 PM |

    OOopps,

    my mistake. let me post this at the right blog topic....

  • Gregory

    6/27/2011 1:34:08 AM |

    Lora,

    I too: a cup of muesli and fruit for breakfast for years. One day I tested: 179 after 1 hour. I now try to aim for 1 hr post prandial 110. No more muesli and fruit for breakfast!

  • Dr. Hasitha Dissanayake

    7/1/2011 5:02:37 PM |

    Dr. Davis, you have nicely described the high lipid levels and its impact on heart disease. Yes, as you have described the hight lipid level is not the only cause for heart diseases. Other major risk factors include smoking, hypertension and  diabetes. Further there are also number of minor risk factors for heart diseases as well, such as family history, sedentary life style, male gender etc.

    We should not make our minds by looking only at normal cholesterol panel. As you have described already vitamin D in important to produce more HDL and Omega-3 fatty acids. Any way vitamin A, C and E act as anti oxidants and also reduce the cancer risk. Visit http://agelag.blogspot.com

    Nice blog Dr. Davis... Keep on writing...

  • John

    7/21/2011 6:16:28 PM |

    WOW! all these numbers/letters and i've not a clue what most of them mean! i'm aware of the hdl/ldl numbers/levels , though not of the others. i happened across this site/blog from another nd/md's blog and i find this stuff to be mind-boggling! my health challenge: Late Nov. 2010, i had a stent placed in a major artery that i'm told was 90-95% blocked. while recovering in cath lab, i almost bled to death with a hemotopa ( ? ) the size of an orange, i was told upon my discharge by the nurse who saw it and literally saved my life. i've since been on plavix 75mg, 1x/day in which i've chosen to cut these in half and now take 1/2 pill at 12+ hours intervals or when i suddenly feel tired, pains and get scared. i should also tell you i've been diagnosed w/ peripheral neuropathy and experience many different types of stinging/pinching pain in various parts of by body. doing alot of computer work ( i work from home on the internety ) with one=finger hunt-n-pek typing also causes numbness and pain in my right hand. the very first day after the procedure,  i was given 7 - yes, 7! - plavix75mg. needless to say, the ensuing 4 weeks was hell for me and out of fear, i was back and forth to a heart hospital about 4 different ocassions. my entire right leg, groin, testacles and penis was purple/bluish and bruised. Now, i have not felt good since this stent was put in. i feel that the other type stent could have been used instead of the drug-alluding stent. I was also prescibed a statin of which I've NOT taken since finding out how ineffective and dangerous they are and that we actually need cholesterol especially for prpoer brain functioning. as i type now, i'm in discomfort. i recently started drinking a organic magnesium supplement called Natural Calm but aside from it cleaning me out, i feel no better at this point. I NEED HELP! i'm depressed and very irritable over the smallest things, at times. I have attempted to follow Dr. D'adamo's Eat right For your Blood type diet, but, since these supplements can be quite expensive ( i'm on a S.S. disability for Tourettes Syndrome ) i don't take them as often as i should so i really can't say whether or not they help. i've eaten breads my entire life and pizza as and still is my favorite ( i'm italian of course-Smile basically, i've been eating all foods my entire life that i shouldn't have been. i'm driving my wife and myself crazy and she does return the "favor' quite often. so now i read all this info. about vit. D and fish oils and i'm more confused than ever. being in NY, i'm aware of the vit. d ( lack of ) in relation to depression or SAD, etc.  i'm praying i find some nd/md who is willing and able to work with me to get me off this plavix and gabapentin 300mg ( 3 caps, 2x per day or as i feel they are needed ). my cardi says that after 1 year he'll be able to take me off the plavix, but, honestly, i feel this drug is killing me. oh...i also have the beginnings of Barretts Esophagus ( very small, i'm told ) and my gastro and cardi feel the combination of Plavix 75mg, Protonix 40mg, enteric coated Reg. strength aspirin ( of which i take 1-2  Baby aspirin instead, very rarely ),
    gabapentin 300mg is safe for me and outweighs the 30% or so possibility of having a blood clot at the stent. I've also thin blood to begin with ( type 0+ ) and i'm just feeling miserable! i do have a good day here and there, but mostly my days are spent very uncomfortable, irratable, depressed, tired and angry. I used to be healthy and exercised but now if i get out to walk a while, that's about it. i've never weighed in at more than 185 with much of my life weighing between 155-170. i am 5'7" and had always been considered to have broad shoulders and was husky as a young child. i'm hoping to get some relief and my good health back. i thank you for reading this and letting me vent. i apologize for any typos and the inconsistencies.

  • Lawrence

    9/30/2011 12:38:03 PM |

    Dear Dr William Davis
    In May of 2009 my wife had a brain aneurism and stroke.  (Then 52)
    Two years on she is extremely well due to a very skilled neurosurgeon. It has come to light that my wife has type 2 diabetes, high blood pressure and high cholesterol.
    Her medications are 1000mg of Metformin twice daily with meals.
    160mg of Diovan  mornings.
    25 mg HCTZ mornings.
    We are supplementing her meds with 1000mg of fish oil and now 2000iu of Vitamin D.
    A month ago we started using the Heart Technology Heart Tech formula two scoops  a day.
    Approx one month after starting the Heart Tech Formula my wife has had some blood work done.
    The results are as follows:
    A1C 7.1
    Lipoprotein A 23 nmol/L
    Vitamin D, 25 Hydroxy (vd25)  33ng/ml.
    C-reactive Protein HS 0.80 mg/dl.
    Cholesterol 236 md/dl.
    HDL 48 mg/dl.
    Triglyceride  181 mg/dl.
    VLDL  36 mg/dl.
    LDL 152 mg/dl.
    Non –HDL  188
    LDL/HDL ratio 3.17.
    My wife was originally taking Simvastain 25mg per day but our PCP stopped this due to some nasty side effects, he has since suggested we start  Lipitor, but after reading so many worrying articles regarding Lipitor and other statin usage  we are very reluctant to start using the Lipitor.
    I wonder if you would mind discussing our options and what you would consider my wife’s risk of Heart Attack and stroke are and if you feel the use of vitamin C, lysine etc in the Heart Tech will help with her risk.  I am new to the site so have not found my way around yet.
    Thank you.
    Lawrence

  • Dr. William Davis

    10/1/2011 2:04:52 PM |

    Hi, Lawrence--

    I would strongly urge you and your wife to 1) read the many posts on this blog about the exact situation your wife is experiencing and, 2) if interested in more information, consider going to the Track Your Plaque website, where many discussions are conducted on these issues every day.

    Your wife's pattern is a clear-cut example of carbohydrate excess and/or genetic susceptibility and vitamin D deficiency. All of this is readily, easily, and safety correctable with no drugs.

  • Lawrence

    10/1/2011 9:33:03 PM |

    Dear Dr William Davis
    I suppose in some ways being diagnosed with type 2 has been a good thing, in spite of my wife mild brain damage she is starting to realize that she has to cut out all the rapid acting carbohydrates that she used to exist on. It has taken me some time to find the right approach to helping control her BG, but she is now starting to see the better BG reading so is responding to the good feedback. We are increasing our dose of Vitamin D3 to 10000 IU.  We plan to continue with the Heart Tech, my feeling is her LPa would have been much higher if she had not had a month of the Heart Tech formula prior to her blood draw.
    I will certainly log in to Track Your Plague, thank you for taking the time to respond to my questions, it’s very reassuring that you feel she will respond to the Track Your Plaque.
    Lawrence

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