Why an RDA for vitamin D? 24. January 2009 William Davis (10) The Food and Nutrition Board (FNB) of the Institute of Medicine is charged with setting the values for the Recommended Daily Allowances of various essential nutrients. However, when it comes to vitamin D, the FNB decided that "evidence is insufficient to develop an RDA and [an Adequate Intake, AI] is set at a level assumed to ensure nutritional adequacy."The National Institutes of Health Office of Dietary Supplements lists the AI's for various groups of people:14-18 years Male 200 IUFemale 200 IU 19-50 years Male 200 IUFemale 200 IU 51-70 years Male 400 IUFemale 400 IU 71+ years Male 600 IUFemale 600 IU A reconsideration is apparently being planned in near-future that will (hopefully) incorporate the newest clinical data on vitamin D. My question: Who cares what the FNB decides? Let me explain. I monitor blood levels of 25-hydroxy vitamin D to assess the 1) starting level of vitamin D without supplementation, and 2) levels while on supplementation, preferably every 6 months (during sunny weather, during cold weather). I have done for the past 3 years in over 1000 people. The requirement for vitamin D dose in adults, in my experience, ranges from as low as 1000 units per day to as high as 20,000 units per day, rarely more. The vast majority of women require 5000 units per day, males 6000 units per day to maintain a blood level in the desirable range. (I aim for 60-70 ng/ml.) A graph of the distribution of vitamin D needs in my area (Milwaukee, Wisconsin) is a bell curve, a curve more heavily weighted towards the upper vitamin D dose range. Need for vitamin D to achieve the same blood level is influenced by age, sex, body size, race, presence or absence of a gallbladder, as well as other factors. But needs vary, even among similar people. For instance, a 50-year old woman weighing 140 lbs might need 4000 units per day to achieve a blood level of 25-hydroxy vitamin D of 65 ng/ml. Another 50-year old woman weighing 140 lbs might need 8000 units to achieve the same level, and 4000 units might increase her level to only 38 ng/ml. Two similar women, very different vitamin D needs. The differences can be striking. Being a hormone--not a vitamin, as it was incorrectly labeled--vitamin D needs to be tightly regulated. We should have neither too little nor too much. I would liken it to thyroid hormones, which need to be tightly regulated for ideal health. Now the FNB, in light of new data, wants to set new AI's, or even RDA's, for vitamin D for the U.S. This is an impossible--impossible--task. There is no way a broad policy can be crafted that serves everyone. It is impossible to state that all men or women, categorized by age, require X units vitamin D. This is pure folly and it is misleading. The only rational answer for the FNB to provide is to declare that:It is not possible to establish the precise need for vitamin D in a specific individual because of the multiplicity of factors, only some of which are known, that determine vitamin D needs. Individual need can only be determined by assessing the blood level of 25-hydroxy vitamin D prior to initiation of replacement and periodically following replacement to assess the adequacy of replacement dose. Continuing reassessment is recommended (e.g., every 6-12 months), as needs change with weight, lifestyle, and age. Sure, it adds around $100-150 per year per person for lab testing to assess vitamin D levels. But the health gains made--reduced fractures, reduced incidence of diabetes, reduced colon, breast, and prostate cancer, less depression, reduced heart attack and heart procedures--will more than compensate.
Bargains for Armour Thyroid 23. January 2009 William Davis (10) We use Armour thyroid almost exclusively. I take it myself. I am thoroughly convinced that, for at least 70% of people requiring thyroid replacement, the added T3 component makes a world of difference compared to isolated T4: More energy, greater alertness, better mental clarity, better weight loss, larger effects on lipoprotein(a). However, there are substantial price disparities in different pharmacies. For instance, in Milwaukee, a one month supply of 1 grain (60 mg) tablets costs:Walgreen's: $36.00Walmart: $9.54That's a considerable price difference of nearly 400%. It therefore always pays to do a little bit of shopping.
Heart scan mis-information on WebMD 22. January 2009 William Davis (3) If you want information on how prescription drugs fit into your life, then go to WebMD. But, if you are looking for information that cuts through the bullcrap, is untainted by the heavy-handed tactics of the drug industry, or doesn't support the "a heart catheterization for everyone" mentality, then don't go there. A Heart Scan Blog reader turned up this gem on the WebMD site:Should I have a coronary calcium scan to check for heart disease?In their report, they list some reasons why a heart scan should not be obtained: Most of the time, a physical exam and other tests can give your doctor enough information about your risk for heart disease.You've got to be kidding me. What tests are they talking about? EKG? An EKG is a crude test that tells us virtually nothing about the coronary arteries or risk for heart attack. It is helpful for heart rhythm disorders and other abnormalities, but virtually useless for coronary disease unless a heart attack is underway or has already occurred. Cholesterol? What level of cholesterol tells you whether you have heart disease? Tim Russert, for instance, had the same cholesterol values 5 years before his death as on the day of his death. How would cholesterol have told his doctor that heart disease was present? Does an LDL cholesterol of 180 mg/dl tell you that someone has heart disease, while a value of 130 mg/dl does not?Stress test? You mean like the normal stress test Bill Clinton had 3 months before his near-fatal collapse? Stress tests are a gauge of coronary flow, not of coronary atherosclerosis. Huge amounts of coronary plaque can be present while a stress test--flow--remains normal.No, a physical exam does not uncover hidden heart disease. The annual physical is, in fact, a miserable failure for detection of hidden heart disease. You already know that your risk for heart disease is low or high. The test works best in people who are at medium risk but have no symptoms. This bit of fiction comes from a compromise statement in the American College of Cardiology and American Heart Association "consensus" document detailing the role of heart scans in heart disease detection. Because conventional thinkers don't like the idea of very early detection in seemingly "low risk" people, nor do they like the idea of diabetics and smokers getting a heart scan because it's "obvious" that they are already at high risk, the middle ground was taken: Scan only people at "intermediate risk." What the heck is "intermediate risk"? Are you intermediate risk? In real life, using standard criteria (e.g., Framingham scoring) to decide who is low-, intermediate-, or high-risk fails to identify over 1/3 of people with heart disease, while subjecting many without heart disease (plaque) to needless treatment (meaning statins, since that's the only real preventive treatment on most doc's armamentarium).Another fact: Heart scans are quantitative, not just normal or abnormal. Your heart scan score could be 5, it could be 150, it could be 500, or 5000---it makes a world of difference. The risk of someone with a score of 5000 is at very different risk than someone with a score of 5. It also provides much greater precision in determining a specific individual's risk. The test could give a high score even if your arteries aren't blocked. This might lead to extra tests that you don't need.This is true--if you doctor has no idea what he's doing. This is like saying that you should never take your car to the repair shop because all mechanics are crooks. If you have an unscrupulous cardiologist who tells you that your heart scan score of 25 means you are a "walking time bomb" and heart catheterization is necessary to determine whether you "need" a stent . . . well, this is no different than the shady mechanic who advises you that your car's engine needs to be rebuilt for $3000, when all you really needed was a few new spark plugs. Coronary plaque is coronary plaque, and all coronary plaque has potential for rupture (heart attack)--even if it doesn't block flow. This is true at a score of 10, or 100, or 1000--all plaque is potentially rupture-prone, though the more plaque you have, the greater the likelihood. Not all blocked arteries have calcium. So you could get a low calcium score and still be at risk. They're missing the point: ANY calcium score carries risk, so a low score should not be interpreted as having no risk. But, just because a procedure like stenting or bypass surgery is not necessary to restore flow, it does not mean that risk for plaque rupture is not present--it is. Any heart scan score should be taken seriously, meaning sufficient reason to engage in a program of heart disease prevention. Although not perfect, coronary calcium scoring remains the easiest, most accessible, and least expensive means for identifying and quantifying coronary atherosclerosis--whether or not WebMD and drug industry money endorse them.
Heart disease prevention for the helpless, ignorant, or non-compliant 19. January 2009 William Davis (9) The media outlets are gushing with the "research"/marketing spinoff of the JUPITER trial, an analysis conducted by Dr. Erica Spatz of Yale University, that suggests that statin use should be expanded to many millions more Americans. USA Today: Study: 11M more should get statinsMedPage: JUPITER Findings Could Boost Statin Use by 20%Health Day: Millions More Americans Might Be Placed on StatinsWebMD: More May Benefit From Cholesterol Drugs: Study Shows More Would Qualify for Statin Treatment if Levels of C-Reactive Protein Are ConsideredYou may recall that the JUPITER trial (discussed previously in a Heart Scan Blog post) studied the cardiovascular event risk in people with "normal" LDL cholesterols (calculated, of course, not measured) of 130 mg/dl or less, along with increased c-reactive protein, a crude inflammatory measure, of 2.0 mg/dl or greater. A 54% (relative) reduction in cardiovascular events occured in the group taking Crestor 20 mg per day.What I see is a confluence of events that have brought us to the "statin drugs are necessary for everybody" mentality: --The low-fat diet advice of the last 40 years has increased non-fat or low-fat foods that increase LDL, since removing fat from the diet provokes small LDL particle production and increases the inflammatory measure, c-reactive protein (CRP). --The proliferation of "healthy whole grains" in the diet have also caused an enormous boom in small LDL particles, which is interpreted to the uninformed as "high cholesterol." It has also provoked CRP substantially. --The advice to reduce salt intake has brought a broad re-emergence of iodine deficiency. When thyroid hormone production flags due to lack of iodine, LDL cholesterol (both large and small) increase. --Our lives, which are increasingly conducted indoors, have worsened the already substantial vitamin D deficiency. While deficiency of vitamin D primarily reduces HDL cholesterol and increases triglycerides, it can also cause an increase in small LDL and a large increase in CRP. In other words, a collection of events have converged to provide the appearance of high LDL cholesterol and high CRP. This creates the appearance of a "need" for statin drugs. The JUPITER trial now exploits both the LDL-reducing and CRP-decreasing effects of statins.I view the foisting of Crestor via the JUPITER argument on the public as taking full advantage of the helpless situation many Americans find themselves in: Reduce fat intake, eat more healthy whole grains and . . . cholesterol and CRP skyrocket! "You need Crestor! See, I told you it was genetic," says the doctor after attending the nice AstraZeneca-sponsored drug dinner. The notion of using a drug like Crestor to suppress inflammatory patterns is absurd. There are far better, easier, cheaper ways to achieve this goal, along with dramatic reduction in cardiovascular risk. But, to the ignorant, the helpless, or non-compliant with real change in diet and lifestyle, then Crestor does serve a purpose. I can only hope that the excessive pushing of statin drugs on the public will sooner or later trigger a revolt.
Dangerous mis-information on vitamin D 16. January 2009 William Davis (12) Please be aware of the ignorant propagating information they have no business talking about. This is one such example, a newsletter from pop exercise guru, Denise Austin. Although I'm sure she means well, I have a problem with people who have little to no experience acting as experts, often simply repeating something they heard Toggle navigation Home Blog Home Archive Join Now Log in Wheat belly 23. July 2007 William Davis (31) You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer. How about "wheat belly"? That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta. (By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.) It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc. How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere. Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner. "But that's what they told us to eat after Dan left the hospital after his last stent!"Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc. I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world. As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program. If health won't motivate them, maybe money will 23. July 2007 William Davis (0) As part of our ongoing effort to educate everyone about the value of heart scans and how they can serve to start a program of heart disease prevention (or elimination), we occasionally distribute press releases on one facet of this discussion or another. Here's the one we released on our Cost Calculator, the one we developed that showed that $20 billion would be saved annually just by applying the program to men, ages 40-59. Accurate Detection and Prevention of Heart Disease Can Reduce Healthcare Costs, According to New Cost AnalysisA new cost analysis developed by cardiologist Dr. William Davis and his colleagues suggests that healthcare costs can be reduced by billions of dollars with the application of a simple program for heart disease detection and prevention.Milwaukee, WI (PRWEB) July 23, 2007 -- Billions of dollars in healthcare could be saved every year by applying a simple program of heart disease detection and prevention on a wide scale in the U.S., suggests a new cost analysis developed by cardiologist Dr. William Davis and colleagues. Davis and his colleagues are the developers of the Track Your Plaque program for heart disease detection and prevention.In the next 24 hours, 10,000 major heart procedures will be performed in hospitals across the U.S. The tab for this bill will top $400 billion in 2007 alone, nearly twice the sum spent on the war on cancer.As costs escalate at an alarming rate, tools for prevention of disease are also advancing. While drugs like Lipitor® make headlines and dominate direct-to-consumer TV ads, a quiet revolution is taking place among physicians and the public eager to find better answers, some of which also pose opportunities for stretching the healthcare dollar.“We’re essentially throwing away billions of dollars each and every year by ignoring the savings power of preventive strategies for heart disease,” proclaims Davis, a Milwaukee cardiologist. Davis is author of several books on heart disease detection and prevention, has been a vocal advocate for preventive strategies and is founder of www.cureality.com.Davis and his colleagues developed a cost model to predict how much money could be saved by the adoption of new preventive strategies on a broad scale in the U.S. “The cost savings are startling. If males in the 40–59-year-old age group, for instance, were to undergo a simple CT heart scan for early detection of coronary heart disease, followed by a purposeful yet focused program of prevention using widely available tools, our cost model shows that we would save the American public over $20 billion annually. Extending this calculation to the broader population would multiply savings several-fold.”Heart care is already the single largest healthcare category in the U.S. As costs go up by double-digit percentages, fewer people can afford healthcare. Those who can afford it spend an increasingly greater portion of their disposable income to maintain it. The Agency for Healthcare Research and Quality predicts that, at the current rate of growth, healthcare costs will balloon to absorb 20 percent of American Gross Domestic Product (GDP), about $4 trillion, in the next 10 years.Davis points out that reducing the annual U.S. expenditure for heart disease by 20 to 30 percent could save between $80 and $120 billion each year. That marginal savings exceeds the sum the U.S. spends on the domestic war on terror.Davis and his group have dubbed the conventional procedure-based approach to heart disease management the “crash and repair model” because of its focus on urgent procedural intervention that takes place in hospitals.The crash and repair model is costly. According to the American Heart Association, a heart catheterization (performed 3,553 times per day, seven days a week) costs an average of $24,893; a coronary bypass operation (performed 1,170 times every day, seven days a week) costs an average of $67,823 (hospital costs, 2004, the latest year for which data are available). These figures don’t incorporate long-term costs incurred in the years following the procedure or time lost from work.The relatively high payment to physicians and hospitals for performing high-tech heart procedures provides a disincentive to redirect patients to a less costly prevention model. The exceptional costs of high-tech, high-ticket heart procedures would become increasingly unnecessary if better heart disease preventive practices were delivered on a broad scale. “Like seatbelts, preventive measures for heart disease are more cost effective and extract a far lower toll in human suffering than the ‘crash and repair’ approach. Our cost calculations bear out the enormous savings possible. In fact, all of the tools necessary to deliver a method of early heart disease detection and prevention are already available throughout the U.S. We’ve just got to encourage physicians and the public to take advantage of them.”The cost calculator program can be found at http://cureality.com/library/fl_hh005bankrupt.asp on the cureality.com Web site.Track Your Plaque is an informational and educational Web site devoted to showing people how CT heart scans can be used as a starting point for a program of heart disease prevention and reversal. What role calcium supplements? 22. July 2007 William Davis (8) A frequent question in the Track Your Plaque program is whether taking calcium supplements to reduce risk for osteoporosis adds to calcium in arteries and raises CT heart scan scores. No, calcium supplementation does not add to coronary calcium. Thankfully, there is some wisdom to calcium metabolism. Calcium deposition or resorption is under independent local control in bone, as it is in the artery wall. Taking calcium has no effect on calcium deposition in your coronary arteries. However, there's a lot more to it. Taking calcium has only a modest effect on bone health. Most women can only hope to slow or stop calcium loss from bone by taking calcium supplements. Calcium supplements do not increase bone calcium. The reason why calcium supplementation works at all is, when calcium is absorbed into the blood, it provides a feedback signal to the parathyroid gland to shut down parathyroid hormone production, the hormone responsible for extracting calcium from bone. But the calcium itself does not end up deposited in bone. Likewise, calcium supplements have essentially no effect on the artery wall. But vitamin D controls calcium absorption and, curiously, appears to exert a dramatic effect on calcium depostion in coronary arteries. In fact, I would credit vitamin D as among the most important factors in regulating arterial health that I've encountered in a long time. Thus, bone health and arterial health do indeed intersect via calcium, but not through calcium supplements. Instead, the control exerted by vitamin D connects the seemingly unconnected processes. Vitamin K2 provides another unexpected juxtaposition of the two processes. Deficiency of K2, which is proving to be a lot more common than previously thought, permits an enzyme in bone to exert unrestrained calcium extraction. Deficiency of K2 in artery walls allow another enzyme to deposit calcium and grow plaque without restraint. Yet another intersection between bone health and coronary health that involves calcium, but as a passive participant. Stay tuned for a comprehensive Track Your Plaque Special Report on these topics coming in the next couple of weeks. I'm very excited about the emerging appreciation of calcium as an active ingredient in plaque, not a dumb, passive marker as previously thought. Vitamins D3 and K2 are among the keys to this phenomenon. "Heart scans" are not always heart scans 18. July 2007 William Davis (6) Beware of the media reports now being issued that warn that "CT heart scans" pose a risk for cancer.One report can be viewed at http://www.webmd.com/cancer/news/20070717/ct-heart-scan-radiation-cancer-risk. This was triggered by a Columbia University study of risk for cancer based on the dose of radiation used in CT coronary angiograms. Theoretically, exposure to the radiation dose of CT coronary angiography can raise risk for cancer by 1 in 143 women if radiated in their 20s just from that single exposure.If you've been following the Track Your Plaque discussion, as well as my diatribes in the Heart Scan Blog, you know that the media got it all wrong. The "heart scans" they are referring to are not the same as the heart scans that we discuss for the Track Your Plaque program. A conventional heart scan (of the sort we refer to) exposes the recipient to 4 chest x-rays of radiation if an EBT device is used, around 8-10 chest x-rays of radiation if a 64-slice CT scanner is used. For the quality of information we obtain from these screening heart scans, we feel that it's an acceptable exposure. The "heart scan" this study and subsequent reports refer to is not truly a screening heart scan, but a CT coronary angiogram, or CTA. CTAs are performed on the same CT or EBT devices, but involve far more radiation. CTA exposes the recipient to about 100 chest x-rays of radiation on a 64-slice device (more or less, depending on the way it is performed.) Just a couple of years ago, some centers were performing CTA on 16-slice devices, a practice I and the Track Your Plaque program vocally opposed, since up to 400 chest-rays of radiation were required! I even called a number of centers advising them that they were putting the public in jeopardy. CTAs also require injection of x-ray dye, just like any conventional angiogram. CTA on 64-slice CT scanners require the same radiation exposure as a conventional heart catheterization, an issue glossed over in most conversations. In other words, the test that many of my colleageus so casually recommend poses a similar risk.The message: the test I advocate for screening for coronary heart disease is a CT or EBT heart scan, not a CT coronary angiogram. CTA is a useful test and will get better and better as the engineers discover ways to reduce radiation exposure. But, in 2007, CTA is a diagnostic device, not a screening device. If you require an abdominal CT scan because your doctor suspects pancreatic cancer, or a CT scan of the brain because you might have a life-threatening aneurysm causing double-vision or seizures, it would be silly to not undergo the scan because of long-term and theoretical cancer risk. But undergoing a CT coronary angiogram for screening purposes is ridiculous with present technology. I've said it before and I will say it--shout it--again:CT coronary angiograms are not screening procedures; they are diagnostic procedures that should be taken seriously and do indeed pose measurable risk for cancer, a risk that is presently unacceptable for a screening test. You wouldn't undergo a mammogram to screen for breast cancer if it exposed you to 100 chest x-rays of radiation, would you? Screening tests should be safe, reliable, accurate, and inexpensive. CT coronary angiography is none of these things. Genuine heart scans--the kind the Track Your Plaque program talks about and relies on--is all of those things. Heavy traffic and heart scans 17. July 2007 William Davis (4) A German study just reported in Circulation showed a graded response of EBT heart scan scores and proximity to traffic. Living 50 meters (around 150 feet) from traffic increased the likelihood of a higher coronary calcium score by 63% compared to those living 200 meters (around 600 feet or two football fields) away from traffic.A sample news story can be found at http://healthday.com/Article.asp?AID=606431. The German investigators speculated that either the heightened exposure to exhaust fumes and/or the increased stress triggered by the constant noise might be the culprits behind the phenomenon. I think the study is interesting in a number of ways from the Track Your Plaque viewpoint:--Sometimes, there are factors that extend beyond lipoproteins, vitamin D restoration, optimism vs. pessimism, etc. that influence heart scan scoring. Are these factors powerful enough to overcome the adverse effects of traffic or other environmental effects? Can your proximity to traffic make or break your heart scan score-controlling efforts? This remains to be established. --How much of a role does the stress issue play? Is this just a variation of the optimism vs. pessimism theme? I know when I'm in traffic in a car or on a bicycle, it often feels like I am at the mercy of hordes of people in a hurry, the soccer Moms on cell phones, applying makeup and eating, the hormonal teenager, the occasional drunk. Living in the midst of it must be demoralizing, a sense that you are lost in a sea of uncaring humanity stripped of individuality. When I look outside my den window right now, I see the lawn that I cut and water and the flowers and evergreen trees I've planted over the years. It provides a sense of life, belonging, and earth. What if instead I saw anonymous cars buzzing by, dozens of unfamiliar faces every minute, none of which plays any palpable role in my life? --This simple observation will add to the healthy-consciousness and Green movements, since it is just one more piece of evidence that congestion and urbanization do indeed take their toll. In an obtuse way, I think this is one step closer to increasing disillusionment over the "over-processing" of human experience: processed foods, depersonalization and alienation in neighborhoods and homes, the dissolution of the American family. Lastly, notice how the conversation about CT (in this case, EBT) heart scanning has seamlessly worked its way into conversation? Just ten years ago, a long-winded explanation would have been required in press reports on just what CT heart scanning was. Now, the information is presented and--well, we all know what heart scanning is, right? A small study but one that comes at an important time. Good things will come from this one study. It will work its way into discussions about where to locate schools, how to situate homes in relation to heavy traffic, it will help "legitimize" this wonderful tool called heart scanning. How many medical tests beyond blood work can be easily performed in 4500 study participants? I always like to take some simple observation and see how it fits into developing trends. Few studies or other human-generated experiences by themselves change the world. Instead, it happens in little incremental bits and pieces. Digging for the truth 15. July 2007 William Davis (9) I remain continually amazed how difficult it can be to gain an understanding of what is true and what is not true. I am particularly worried about the messages provided by agencies that stand to make enormous gains by persuading us to believe their version of the "truth". For a moment, let's strip away the charitable covers of some financially-motivated organizations and see what they really look like:Hospitals: The dream of hospitals is to shift the proportion of patients towards those with the most profitable diseases in well-insured patients. Heart disease is among the best paying diseases. HOSPITALS WANT YOU TO HAVE HEART DISEASE. Doctors: Many (though not all) want to deal with diseases that pay well. Implanting a stent can pay several thousand dollars. Putting in a defibrillator can likewise pay handsomely, even better than stents. DOCTORS WANT TO STEER YOU TOWARDS PROCEDURES THAT REIMBURSE GENEROUSLY. Talk is cheap and pays poorly. Heart scans? Useless, since they're cheap. CT angiography? Now we're talking! $1800 dollars is a lot more interesting than $200 or so for a simple heart scan. CT angiograms also lead to catheterization, stents, hospitalizations. Drug manufacturers: The holy grail for drug manufacturers is a chronic condition that is present in large numbers of people. An antibiotic, for instance, is a drug manufacturers waste of time: Short courses of treatment in relatively few people. Cholesterol drugs, blood pressure drugs, drugs to modify personality or some aspect of behavior--these you take for years, decades, or a lifetime, and millions are persuaded they need them. DRUG COMPANIES WANT CHRONIC CONDITIONS (WHETHER OR NOT THEY'RE DISEASES) IN PEOPLE WHO SURVIVE FOR A LONG TIME, NOT SICK PEOPLE. Supplement manufacturers: What don't we need in the eyes of sellers of nutritional supplement? While a program like Track Your Plaque makes liberal use of supplements in a focused and, I believe, rational way, supplement sellers want you to take dozens or preparations of dubious value: milk thistle, hawthorne, ribose, hoodia, silymarin, hydroxycitric acid . . . Unlike the larger ambitions and bigger money of the pharmaceutical industry, the supplement industry is often driven by the momentary craze and the quick payoff. THE SUPPLEMENT INDUSTRY IS LOOKING FOR SUCKERS.Food manufacturers: The holy grail for the food industry are foods that have high markups, are convenient (e.g., eaten right out of the box or package), and are purchased repeatedly. Even better, if a health claim can be added, it can ride the current wave of the public's health consciousness. Thus, Cocoa Puffs can be labeled "Heart Healthy". How about foods that have addictive potential and virtually ensure repeat sales? Eat some and you want more within 2-4 hours! As nutritionist Marion Nestle says, the mantra of the foods industry is "Eat More". It is my firm conviction that the epidemic of obesity in the U.S. is not due to laziness, video games, and computers. It is the fault of food manufacturers. FOOD MANUFACTURERS WANT US FAT AND HUNGRY AND WANT US TO STAY THAT WAY. What pays better, a 110 lb vegetarian woman who shops at the farmer's market and buys locally produced foods, or the 260 lb glutenous and always-hungry woman who fills her supermarket shopping cart with 15 cents worth of flour and sugar priced at $4.59 (cleverly disguised as a healthy breakfast cereal), instant mixes, convenient meals, energy bars, and chips? Government agencies: User fees for the FDA paid by drug companies have caused the FDA to be beholden to drug company pressures. The USDA, charged with crafting the food pyramid, was created to support the farm industry and distributors of their products, not to disseminate public health. The food pyramid is the watered down end result of food industry lobbying and threats, not the scientific advice of nutritionists. GOVERNMENT AGENCIES SERVE INDUSTRY FIRST, THE PUBLIC SECOND. Health websites: Read popular websites like WebMD for information and the conversation quickly steers towards drugs. "Natural treatments for cholesterol" talks about reducing saturated fat and then gushes about the wonders of statin drugs. Guess where 80% of WebMD's revenues come from? Yup, the drug industry. The same goes for many magazines, TV shows, and other media. MEDIA IS OFTEN THE TOOL OF BIG INDUSTRY. I'm sounding like a conspiracy theorist. I don't believe that I am, but I am skeptical of the messages we often receive from the media, advertisements, news reports, websites, etc. It's left to you and me to use our judgment and decide what is truth and what is someone's version of a message crafted towards their hidden agenda. I am hoping that the real truth will grow through a wiki-like phenomena driven and supervised by a collective knowledge that we all contribute towards. That will happen, most likely, on the internet. Just as Wikipedia overtook the revered Encylopedia Britannica in the blink of an eye at far less cost yet with greater depth and equivalent accuracy, so will it happen in health information. I'm uncertain of the eventual form this health-wiki will take, but it will shatter many smug and deeply-entrenched powers that at present continue to profit from mis-information. A new Track Your Plaque record: 63% reduction 14. July 2007 William Davis (3) Stress can booby-trap the best efforts at reducing your CT heart scan score. But Amy, our newest Track Your Plaque record holder, defied the effects of an overwhelmingly life stress to drop her heart scan score from 117 to 43--an amazing 63% reduction. Amy beat our previous record holder, Neal, who achieved a 51% reduction. Though Neal had dropped his score from 339 to 161, a drop of 178 and more than Amy's 74 point drop, on a percentage basis Amy holds the record. I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!Amy's complete story can be found in our latest Track Your Plaque Newsletter to be released later this week, as well as an upcoming feature on the www.cureality.com website. (We've got to toot our horn about successes like this!) The Ornish diet made me fat 13. July 2007 William Davis (16) I got that kind of question today that tempts me to roll my eyes and say, "Not again!""If I want to reverse my heart scan score, should I do the Ornish diet?" You know, the one by Dr. Dean Ornish: Dr. Dean Ornish's Program for Reversal of Heart Disease. I personally followed the Ornish program way back in the early 1990s. I reduced fat intake of all sorts to <10% of calories; eliminated all fish and meats, vegetable oils, and nuts; ate vegetables and fruits; and upped my reliance on whole grains. I used many of his recipes. I exercised by running 5 miles per day. (Far more than I do now!) I avoided sweets like candies and fruit juices. What happened? I gained 31 lbs, going from 155 to 186 lbs (I'm 5 ft 8 inches tall), my abdomen developed that loose, fleshy look, hanging over my beltline. My HDL plummeted to 28 mg/dl, triglycerides skyrocketed to 336 mg/dl, and I developed a severe small LDL pattern. I experienced a mental fogginess every afternoon. I felt tired and crabby much of the time. I sometimes struggled to suppress an irrational anger and frustration over the silliest things. I required huge amounts of coffee just to function day to day. Hundreds of my patients suffered similar phenomena.Few of us wear bell-bottomed jeans, tie-dyed t-shirts, or say "groovy". Rowan and Martin's Laugh-in is an "oldie", it's no longer cool to hold your index and middle fingers up in the "V" sign of peace. Even Ladybird Johnson has passed.So should go the misadventures of the ultra low-fat diet, as articulated by Dr. Ornish. His day came and went. We learned from our mistakes. Now let's do something better.Keep your eyes open for the New Track Your Plaque Diet. Do lower heart scan scores grow faster? 11. July 2007 William Davis (0) If Mary's heart scan score increases from 2 to 4 in one year, it represents a 100% increase in score. If Jane's heart scan score increases from 1002 to 1004 over the same period, it represents <1% increase, even though the true growth is the same: 2 points. This quirk of arithmetic needs to be factored in whenever you and your doctor try to puzzle out the meaning of an increasing CT heart scan score. Lower numbers, particularly those <100, can grow at seemingly much faster rates if viewed by percent per year increase. If no effort is taken to stop the growth in your coronary plaque, then scores of 10, 20, 30, or the like can easily grow 50-100% per year. In contrast, scores of 1000, 1500, and 2000 tend to grow at "slower" rates of 20% or so per year without corrective efforts, even though the absolute growth may be substantial. (Obviously, this bit of confusion can be best eliminated by reducing your heart scan score, but it doesn't always work out that way.)If we were all adept at advanced math, we should probably rely on logarithmic measures of plaque increase, rather than percent increase. Or, you can just keep in mind that the rate of plaque growth must always be viewed in the context of the absolute score. Mr. Salazar: Check your Lp(a) 9. July 2007 William Davis (8) Marathon star Alberto Salazar was just released from the hospital following a heart attack and a heart catheterization that led to a stent. The MSNBC version of the report can be viewed at http://www.msnbc.msn.com/id/19653682/.At 48 years old and holder of several American records for marathon times, Salazar's story is eerily reminiscent of Jim Fixx, who died at age 52 after writing a bestselling book, The Complete Book of Running. Thankfully, Salazar's story has a happier ending. Fixx died at a time when prevention of heart disease was quite primitive. Lipoprotein analysis was not broadly available to the public, CT heart scans had not yet been invented. Even statin drugs were just a gleam in the pharmaceutical industry's eye. But not so with Salazar. This Cuban-born marathoner experienced his heart attack at at a time when enormously useful steps can be taken to 1) document the extent of disease with a CT heart scan (the presence of a stent just means that one artery can't be "scored"), and 2) identify the causes of his disease.I suspect that the fact that yet another marathoner in the limelight will once again prompt the (likely non-sensical) conversation about long-distance running and the increased risk of heart disease. Unfortunately, I fear that the real cause will be left unidentfied and untreated: Lipoprotein(a), or Lp(a).It's almost certain that Fixx had Lp(a), given the fact that his dad had a heart attack at age 35. Running simply postponed the untreated inevitable.I hope Mr. Salazar is surrounded by doctors who have his true interests in mind (not just procedural excitement) and ask the crucial question: Why? The answer is almost certain to be Lp(a). << Older posts Newer posts >> Newer posts12...818283848586878889...123124Older posts Being regular is dangerous to your health Toggle navigation Home Blog Home Archive Join Now Log in Being regular is dangerous to your health 25. September 2011 William Davis (21) No, I'm not referring to your daily morning ritual in the bathroom. I'm talking about heart rate.Counterintuitively, a perfectly regular heart rate is a marker of poor health. People with perfect regularity of heart rate have more heart attacks, for instance.Regularity of heart rate occurs more commonly in people with hypertension and other metabolic derangements, and it signals increased risk for both heart attack and death. A perfectly regular heart rate, i.e., no variation in the time interval from beat to beat, suggests that the parasympathetic nervous system, the component of automatic ("autonomic") nervous system control that is associated with the relaxation response, feelings of well-being, quiet, and relaxation, is weak. It also means that the opposing sympathetic nervous sytem that regulates the "fight or flight," adrenaline-like response is allowed to be dominant. Dominance of the sympathetic over the parasympathetic system generates regularity of heart rate. Heart rate also tends to be faster, e.g., 85 beats per minutes rather than 55 or 60 beats per minute. So perfect regularity, as well as increased rate, is undesirable.What we want is irregularity of heart rate. But not irregularity that occurs chaotically with no rhyme or reason. More precisely, we want variability in heart rate. And we want variability to occur in synchrony with breathing, i.e., the respiratory cycle.The ideal response is:1) increase in heart rate with inspiration2) decrease in heart rate with expiration.Heart rate in healthy people typically varies 15-20 beats per minute within the respiratory cycle, e.g., 60 bpm at end-exhalation, 80 bpm at end-inspiration. Restoration of increased heart rate variability is associated with reduced blood pressure, reduced blood sugars (HbA1c), reduced inflammatory markers and cortisol (associated with stress), even an increase in DHEA levels. Feelings of well-being and calm also develop. Among the strategies to consider to restore heightened heart rate variability and slowed heart rate include:--Omega-3 fatty acid supplementation--Exercise--Weight loss--Deep breathing exercises--Meditation, prayer, and biofeedbackFor our Track Your Plaque purposes, we are folding in the HeartMath strategies, i.e., use of a heart rate monitor that calculates heart rate variability in the context of respiratory cycle. If you've not already done so, take a look at the two Special Reports devoted to this topic on the Track Your Plaque website. Related posts More on the American Heart Association Check Mark program Take a look at the list of foods on the American Heart Association's (AHA) Check Mark endorsement pr... Being regular is dangerous to your health No, I'm not referring to your daily morning ritual in the bathroom. I'm talking about heart rate.Cou... The “Heart Healthy” scam Like many scams, this one follows a predictable formula. It is a formula widely practiced among food... Comments (21) - Tim Huntley 9/25/2011 2:06:58 PM | Dr. Davis,I have spent about 6 months taking daily HRV measurements using a Suunto t6d watch and analyzing the output with a software tool from Kubios. From my n=1 experience, the most meaningful long-term impact to improved HRV has been regular exercise. A lot of the research studies I looked at are in agreement with the other factors you mentioned above; however some of the factors tend to be more transitory (breathing, meditation, etc. ) and create a change during the time that you are working on them vs. the more lasting effects from exercise.I would be happy to share more specifics from my experience if you are interested....Tim me@me.com 9/25/2011 3:20:56 PM | Dear "Dr. Davis"i'd love to read more !warmlyinterested one Geoffrey Levens, L.Ac. 9/25/2011 4:20:46 PM | The folks at Heart Math have had this mastered for years. Books, classes, seminars, and they sell a portable and a computer based biofeedback device for training "coherence". I am not affiliated with them in any way and do not sell their products but I do think it is a pretty good way to get into the whole arena of meditation and of very directly training HRV. Diana 9/25/2011 8:01:23 PM | This is really interesting, because it goes along exactly with what I learned in studying midwifery - that hearing an absolutely regular/non-variable heartbeat on a fetoscope is a sign of a seriously compromised baby. Interesting that that carries on into the adult world! LINDA 9/25/2011 9:19:57 PM | (The FASEB Journal. 2011;25:971.10)© 2011 FASEB ________________________________________971.10Daily apple consumption promotes cardiovascular health in postmenopausal women Sheau C Chai, Shirin Hooshmand, Raz L Saadat and Bahram H Arjmandi Nutrition, Food & Exercise Sciences, Florida State University, Tallahassee, FL Animal findings suggest that apple and its components, e.g. apple pectin and polyphenols improve lipid metabolism and lower the production of proinflammatory molecules. To our knowledge, the present study is the first that evaluated the cardioprotective effects of daily consumption of apple for one year in postmenopausal women. Qualified women (160) were randomly assigned to one of the two dietary intervention groups: dried apple (75g/day) or comparative control dried fruit. Fasting blood samples were collected at baseline, 3-, 6-, and 12-month to measure various parameters. Our findings indicate that the additional daily caloric intake of ~240 from dried apple not only do not increase body weight but rather lower it by 1.5 kg without altering habitual dietary intake. In this study, apple consumption significantly reduced serum levels of TC and LDL by 14% and 23%, respectively. The daily apple consumption also profoundly improved atherogenic risk ratios in addition to lowering serum levels of lipid hydroperoxide (33%) and C-reactive protein (32%). In conclusion, incorporation of apple into regular diet is encouraged because of its highly favorable effects in reducing the risk factors for cardiovascular disease. Grant Funding Source: Partly supported by USDA Table of ContentsThis Article1. FASEB J. April 2011 25 (Meeting Abstract Supplement) 971.10 1. » Meeting Abstract LINDA 9/25/2011 10:27:18 PM | Effects on ThyroidThe National Institutes of Health (NIH) note that although little scientific data is available about the effects of flax on the thyroid, some experts in natural medicine advise that patients avoid flaxseed in cases of hypothyroidism. (See Resource 2) The Univeristy of Maryland Medical Center also suggests that patients with thyroid disorders stay away from flaxseed and other foods that may interfere with thyroid function. (See Reference 3)GoitrogensThiocyanite, a substance found in flax products and other foods, such as apricots, rye, millet and broccoli, might act as a goitrogen-that is, it may block the uptake of iodine in the thyroid gland. When your diet is too rich in goitrogens and too low in iodine, it can cause the thyroid gland to swell and form a lump, or goiter. However, the typical diet in the United States contains enough iodine that problems like goiter have been practically eliminated, so goitrogens should not be a concern for the average American. (See Reference 2, pages 100-101)Read more: Flaxseed and Thyroid Disease | eHow.com http://www.ehow.com/facts_5629982_flaxseed-thyroid-disease.html#ixzz1Z0N1SV8j Dr. William Davis 9/26/2011 12:37:25 PM | I didn't know that, Diana! That's very interesting, a phenomenon consistent in widely variable situations. Dr. William Davis 9/26/2011 12:38:51 PM | Hi, Geoffrey--My experience with HeartMath goes back around 15 years, long ago that I still remember using Holter monitors, shipping the tape to LA, and waiting for the analysis to come back--long delay, no real-time feedback. The new do-it-yourself device really changes the entire equation: real-time feedback, much faster results. Dr. William Davis 9/26/2011 12:41:32 PM | Hi, Tim--I'd love to hear more! Specifically, what is the heart rate feedback like on your watch? Is it a visible signal? You are absolutely correct: Many effects are transitory. However, the more you do it, the more you habituate the response, the more likely it becomes "coherence" occurs spontaneously. Teresa 9/26/2011 4:14:34 PM | HeartMath exercises are more than regular breathing. They advocate activating a positive feeling, such as gratitude or appreciation, during the breathing exercises. This helps maintain the increased heart rate variability. Here is a link to one of their techniques. http://www.heartmath.com/personal-use/quick-coherence-technique.htmlThis is a summary of some of the scientific concepts of HeartMath. It is an older publication, but still interesting to read. http://www.heartmath.org/research/science-of-the-heart/introduction.htmlMore research studies are listed here.http://www.heartmath.org/research/research-library/research-library.html#educational-researchWhile the computer programs and gadgets are helpful, they are not essential to learning and being successful with the techniques.TeresaP.S. I am not affiliated with HeartMath in any way except that I have a relative who works for them. I don't make any money off of them. Bill 9/26/2011 8:03:36 PM | With regard to your play on "being regular", apart from being grain free with not one lapse for 4 years, I have been squatting for 5 years and believe it's natural and very beneficial. Strongly recommend! Dr. William Davis 9/27/2011 2:53:40 AM | Hi, Teresa--Yes, there are many ways to achieve enhanced parasympathetic tone, HeartMath coherence being one of them. You could meditate for months to years, you could perform thermal biofeedback. What I like about HeartMath is its immediate accessibiity. Rita 9/27/2011 10:44:58 AM | This is just a housekeeping issue. I used to get your posts via email but not for months now. When I try to re-subscribe, Feedburner says I am already subscribed, but still no posts come to email. Can you get this fixed? Thanks. Makro 9/28/2011 12:21:30 PM | Dr. Davis - OT question:When is WB showing up in the Kindle store? Looking forward to giving it a read. MaryB 9/28/2011 1:11:31 PM | This is very interesting information. It parallels the test they do for Diabetic Neuropathy. If the heartbeats are the same on inhale and exhale you have it pretty bad. The closer they are to the same, the worse the Neuropathy is found to be. They use an EKG test and compare the peaks... If I understand correctly. This sounds like it relates to what you are discussing Dr. Davis... am I correct MaryB 9/28/2011 1:14:19 PM | hmmm did you read the article? LOL This is not about constipation but heartbeats. Lance Strish 9/28/2011 11:41:33 PM | DrGreger talked about heart rate variability in 2009 oncehttp://www.youtube.com/watch?v=sK0PHQLpw4U&feature=BFa&list=PL53AA35449C7DD652&lf=PlayList#t=4m-http://tinyurl.com/drgregerPDF Dr. William Davis 9/29/2011 1:02:36 AM | Yes, indeed, MaryB: Absolutely correct. Diabetes, in particular, can lead to a marked lack of heart rate variability and its health consequences. Dr. William Davis 9/29/2011 1:03:11 AM | Hi, Makro--It should already be there. Are you outside the U.S.? Dr. William Davis 9/29/2011 1:04:56 AM | Hi, Rita--Sorry. Thought this was fixed. I'll have it looked into. Ginger 1/1/2013 4:16:09 AM | Any info on stopping PVC's? I don't do caffiene, very little sugar, i do deep breathing and meditation. I'm dairy free and don't eat gluten. 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Wheat belly 23. July 2007 William Davis (31) You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer. How about "wheat belly"? That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta. (By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.) It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc. How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere. Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner. "But that's what they told us to eat after Dan left the hospital after his last stent!"Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc. I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world. As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program.
If health won't motivate them, maybe money will 23. July 2007 William Davis (0) As part of our ongoing effort to educate everyone about the value of heart scans and how they can serve to start a program of heart disease prevention (or elimination), we occasionally distribute press releases on one facet of this discussion or another. Here's the one we released on our Cost Calculator, the one we developed that showed that $20 billion would be saved annually just by applying the program to men, ages 40-59. Accurate Detection and Prevention of Heart Disease Can Reduce Healthcare Costs, According to New Cost AnalysisA new cost analysis developed by cardiologist Dr. William Davis and his colleagues suggests that healthcare costs can be reduced by billions of dollars with the application of a simple program for heart disease detection and prevention.Milwaukee, WI (PRWEB) July 23, 2007 -- Billions of dollars in healthcare could be saved every year by applying a simple program of heart disease detection and prevention on a wide scale in the U.S., suggests a new cost analysis developed by cardiologist Dr. William Davis and colleagues. Davis and his colleagues are the developers of the Track Your Plaque program for heart disease detection and prevention.In the next 24 hours, 10,000 major heart procedures will be performed in hospitals across the U.S. The tab for this bill will top $400 billion in 2007 alone, nearly twice the sum spent on the war on cancer.As costs escalate at an alarming rate, tools for prevention of disease are also advancing. While drugs like Lipitor® make headlines and dominate direct-to-consumer TV ads, a quiet revolution is taking place among physicians and the public eager to find better answers, some of which also pose opportunities for stretching the healthcare dollar.“We’re essentially throwing away billions of dollars each and every year by ignoring the savings power of preventive strategies for heart disease,” proclaims Davis, a Milwaukee cardiologist. Davis is author of several books on heart disease detection and prevention, has been a vocal advocate for preventive strategies and is founder of www.cureality.com.Davis and his colleagues developed a cost model to predict how much money could be saved by the adoption of new preventive strategies on a broad scale in the U.S. “The cost savings are startling. If males in the 40–59-year-old age group, for instance, were to undergo a simple CT heart scan for early detection of coronary heart disease, followed by a purposeful yet focused program of prevention using widely available tools, our cost model shows that we would save the American public over $20 billion annually. Extending this calculation to the broader population would multiply savings several-fold.”Heart care is already the single largest healthcare category in the U.S. As costs go up by double-digit percentages, fewer people can afford healthcare. Those who can afford it spend an increasingly greater portion of their disposable income to maintain it. The Agency for Healthcare Research and Quality predicts that, at the current rate of growth, healthcare costs will balloon to absorb 20 percent of American Gross Domestic Product (GDP), about $4 trillion, in the next 10 years.Davis points out that reducing the annual U.S. expenditure for heart disease by 20 to 30 percent could save between $80 and $120 billion each year. That marginal savings exceeds the sum the U.S. spends on the domestic war on terror.Davis and his group have dubbed the conventional procedure-based approach to heart disease management the “crash and repair model” because of its focus on urgent procedural intervention that takes place in hospitals.The crash and repair model is costly. According to the American Heart Association, a heart catheterization (performed 3,553 times per day, seven days a week) costs an average of $24,893; a coronary bypass operation (performed 1,170 times every day, seven days a week) costs an average of $67,823 (hospital costs, 2004, the latest year for which data are available). These figures don’t incorporate long-term costs incurred in the years following the procedure or time lost from work.The relatively high payment to physicians and hospitals for performing high-tech heart procedures provides a disincentive to redirect patients to a less costly prevention model. The exceptional costs of high-tech, high-ticket heart procedures would become increasingly unnecessary if better heart disease preventive practices were delivered on a broad scale. “Like seatbelts, preventive measures for heart disease are more cost effective and extract a far lower toll in human suffering than the ‘crash and repair’ approach. Our cost calculations bear out the enormous savings possible. In fact, all of the tools necessary to deliver a method of early heart disease detection and prevention are already available throughout the U.S. We’ve just got to encourage physicians and the public to take advantage of them.”The cost calculator program can be found at http://cureality.com/library/fl_hh005bankrupt.asp on the cureality.com Web site.Track Your Plaque is an informational and educational Web site devoted to showing people how CT heart scans can be used as a starting point for a program of heart disease prevention and reversal.
What role calcium supplements? 22. July 2007 William Davis (8) A frequent question in the Track Your Plaque program is whether taking calcium supplements to reduce risk for osteoporosis adds to calcium in arteries and raises CT heart scan scores. No, calcium supplementation does not add to coronary calcium. Thankfully, there is some wisdom to calcium metabolism. Calcium deposition or resorption is under independent local control in bone, as it is in the artery wall. Taking calcium has no effect on calcium deposition in your coronary arteries. However, there's a lot more to it. Taking calcium has only a modest effect on bone health. Most women can only hope to slow or stop calcium loss from bone by taking calcium supplements. Calcium supplements do not increase bone calcium. The reason why calcium supplementation works at all is, when calcium is absorbed into the blood, it provides a feedback signal to the parathyroid gland to shut down parathyroid hormone production, the hormone responsible for extracting calcium from bone. But the calcium itself does not end up deposited in bone. Likewise, calcium supplements have essentially no effect on the artery wall. But vitamin D controls calcium absorption and, curiously, appears to exert a dramatic effect on calcium depostion in coronary arteries. In fact, I would credit vitamin D as among the most important factors in regulating arterial health that I've encountered in a long time. Thus, bone health and arterial health do indeed intersect via calcium, but not through calcium supplements. Instead, the control exerted by vitamin D connects the seemingly unconnected processes. Vitamin K2 provides another unexpected juxtaposition of the two processes. Deficiency of K2, which is proving to be a lot more common than previously thought, permits an enzyme in bone to exert unrestrained calcium extraction. Deficiency of K2 in artery walls allow another enzyme to deposit calcium and grow plaque without restraint. Yet another intersection between bone health and coronary health that involves calcium, but as a passive participant. Stay tuned for a comprehensive Track Your Plaque Special Report on these topics coming in the next couple of weeks. I'm very excited about the emerging appreciation of calcium as an active ingredient in plaque, not a dumb, passive marker as previously thought. Vitamins D3 and K2 are among the keys to this phenomenon.
"Heart scans" are not always heart scans 18. July 2007 William Davis (6) Beware of the media reports now being issued that warn that "CT heart scans" pose a risk for cancer.One report can be viewed at http://www.webmd.com/cancer/news/20070717/ct-heart-scan-radiation-cancer-risk. This was triggered by a Columbia University study of risk for cancer based on the dose of radiation used in CT coronary angiograms. Theoretically, exposure to the radiation dose of CT coronary angiography can raise risk for cancer by 1 in 143 women if radiated in their 20s just from that single exposure.If you've been following the Track Your Plaque discussion, as well as my diatribes in the Heart Scan Blog, you know that the media got it all wrong. The "heart scans" they are referring to are not the same as the heart scans that we discuss for the Track Your Plaque program. A conventional heart scan (of the sort we refer to) exposes the recipient to 4 chest x-rays of radiation if an EBT device is used, around 8-10 chest x-rays of radiation if a 64-slice CT scanner is used. For the quality of information we obtain from these screening heart scans, we feel that it's an acceptable exposure. The "heart scan" this study and subsequent reports refer to is not truly a screening heart scan, but a CT coronary angiogram, or CTA. CTAs are performed on the same CT or EBT devices, but involve far more radiation. CTA exposes the recipient to about 100 chest x-rays of radiation on a 64-slice device (more or less, depending on the way it is performed.) Just a couple of years ago, some centers were performing CTA on 16-slice devices, a practice I and the Track Your Plaque program vocally opposed, since up to 400 chest-rays of radiation were required! I even called a number of centers advising them that they were putting the public in jeopardy. CTAs also require injection of x-ray dye, just like any conventional angiogram. CTA on 64-slice CT scanners require the same radiation exposure as a conventional heart catheterization, an issue glossed over in most conversations. In other words, the test that many of my colleageus so casually recommend poses a similar risk.The message: the test I advocate for screening for coronary heart disease is a CT or EBT heart scan, not a CT coronary angiogram. CTA is a useful test and will get better and better as the engineers discover ways to reduce radiation exposure. But, in 2007, CTA is a diagnostic device, not a screening device. If you require an abdominal CT scan because your doctor suspects pancreatic cancer, or a CT scan of the brain because you might have a life-threatening aneurysm causing double-vision or seizures, it would be silly to not undergo the scan because of long-term and theoretical cancer risk. But undergoing a CT coronary angiogram for screening purposes is ridiculous with present technology. I've said it before and I will say it--shout it--again:CT coronary angiograms are not screening procedures; they are diagnostic procedures that should be taken seriously and do indeed pose measurable risk for cancer, a risk that is presently unacceptable for a screening test. You wouldn't undergo a mammogram to screen for breast cancer if it exposed you to 100 chest x-rays of radiation, would you? Screening tests should be safe, reliable, accurate, and inexpensive. CT coronary angiography is none of these things. Genuine heart scans--the kind the Track Your Plaque program talks about and relies on--is all of those things.
Heavy traffic and heart scans 17. July 2007 William Davis (4) A German study just reported in Circulation showed a graded response of EBT heart scan scores and proximity to traffic. Living 50 meters (around 150 feet) from traffic increased the likelihood of a higher coronary calcium score by 63% compared to those living 200 meters (around 600 feet or two football fields) away from traffic.A sample news story can be found at http://healthday.com/Article.asp?AID=606431. The German investigators speculated that either the heightened exposure to exhaust fumes and/or the increased stress triggered by the constant noise might be the culprits behind the phenomenon. I think the study is interesting in a number of ways from the Track Your Plaque viewpoint:--Sometimes, there are factors that extend beyond lipoproteins, vitamin D restoration, optimism vs. pessimism, etc. that influence heart scan scoring. Are these factors powerful enough to overcome the adverse effects of traffic or other environmental effects? Can your proximity to traffic make or break your heart scan score-controlling efforts? This remains to be established. --How much of a role does the stress issue play? Is this just a variation of the optimism vs. pessimism theme? I know when I'm in traffic in a car or on a bicycle, it often feels like I am at the mercy of hordes of people in a hurry, the soccer Moms on cell phones, applying makeup and eating, the hormonal teenager, the occasional drunk. Living in the midst of it must be demoralizing, a sense that you are lost in a sea of uncaring humanity stripped of individuality. When I look outside my den window right now, I see the lawn that I cut and water and the flowers and evergreen trees I've planted over the years. It provides a sense of life, belonging, and earth. What if instead I saw anonymous cars buzzing by, dozens of unfamiliar faces every minute, none of which plays any palpable role in my life? --This simple observation will add to the healthy-consciousness and Green movements, since it is just one more piece of evidence that congestion and urbanization do indeed take their toll. In an obtuse way, I think this is one step closer to increasing disillusionment over the "over-processing" of human experience: processed foods, depersonalization and alienation in neighborhoods and homes, the dissolution of the American family. Lastly, notice how the conversation about CT (in this case, EBT) heart scanning has seamlessly worked its way into conversation? Just ten years ago, a long-winded explanation would have been required in press reports on just what CT heart scanning was. Now, the information is presented and--well, we all know what heart scanning is, right? A small study but one that comes at an important time. Good things will come from this one study. It will work its way into discussions about where to locate schools, how to situate homes in relation to heavy traffic, it will help "legitimize" this wonderful tool called heart scanning. How many medical tests beyond blood work can be easily performed in 4500 study participants? I always like to take some simple observation and see how it fits into developing trends. Few studies or other human-generated experiences by themselves change the world. Instead, it happens in little incremental bits and pieces.
Digging for the truth 15. July 2007 William Davis (9) I remain continually amazed how difficult it can be to gain an understanding of what is true and what is not true. I am particularly worried about the messages provided by agencies that stand to make enormous gains by persuading us to believe their version of the "truth". For a moment, let's strip away the charitable covers of some financially-motivated organizations and see what they really look like:Hospitals: The dream of hospitals is to shift the proportion of patients towards those with the most profitable diseases in well-insured patients. Heart disease is among the best paying diseases. HOSPITALS WANT YOU TO HAVE HEART DISEASE. Doctors: Many (though not all) want to deal with diseases that pay well. Implanting a stent can pay several thousand dollars. Putting in a defibrillator can likewise pay handsomely, even better than stents. DOCTORS WANT TO STEER YOU TOWARDS PROCEDURES THAT REIMBURSE GENEROUSLY. Talk is cheap and pays poorly. Heart scans? Useless, since they're cheap. CT angiography? Now we're talking! $1800 dollars is a lot more interesting than $200 or so for a simple heart scan. CT angiograms also lead to catheterization, stents, hospitalizations. Drug manufacturers: The holy grail for drug manufacturers is a chronic condition that is present in large numbers of people. An antibiotic, for instance, is a drug manufacturers waste of time: Short courses of treatment in relatively few people. Cholesterol drugs, blood pressure drugs, drugs to modify personality or some aspect of behavior--these you take for years, decades, or a lifetime, and millions are persuaded they need them. DRUG COMPANIES WANT CHRONIC CONDITIONS (WHETHER OR NOT THEY'RE DISEASES) IN PEOPLE WHO SURVIVE FOR A LONG TIME, NOT SICK PEOPLE. Supplement manufacturers: What don't we need in the eyes of sellers of nutritional supplement? While a program like Track Your Plaque makes liberal use of supplements in a focused and, I believe, rational way, supplement sellers want you to take dozens or preparations of dubious value: milk thistle, hawthorne, ribose, hoodia, silymarin, hydroxycitric acid . . . Unlike the larger ambitions and bigger money of the pharmaceutical industry, the supplement industry is often driven by the momentary craze and the quick payoff. THE SUPPLEMENT INDUSTRY IS LOOKING FOR SUCKERS.Food manufacturers: The holy grail for the food industry are foods that have high markups, are convenient (e.g., eaten right out of the box or package), and are purchased repeatedly. Even better, if a health claim can be added, it can ride the current wave of the public's health consciousness. Thus, Cocoa Puffs can be labeled "Heart Healthy". How about foods that have addictive potential and virtually ensure repeat sales? Eat some and you want more within 2-4 hours! As nutritionist Marion Nestle says, the mantra of the foods industry is "Eat More". It is my firm conviction that the epidemic of obesity in the U.S. is not due to laziness, video games, and computers. It is the fault of food manufacturers. FOOD MANUFACTURERS WANT US FAT AND HUNGRY AND WANT US TO STAY THAT WAY. What pays better, a 110 lb vegetarian woman who shops at the farmer's market and buys locally produced foods, or the 260 lb glutenous and always-hungry woman who fills her supermarket shopping cart with 15 cents worth of flour and sugar priced at $4.59 (cleverly disguised as a healthy breakfast cereal), instant mixes, convenient meals, energy bars, and chips? Government agencies: User fees for the FDA paid by drug companies have caused the FDA to be beholden to drug company pressures. The USDA, charged with crafting the food pyramid, was created to support the farm industry and distributors of their products, not to disseminate public health. The food pyramid is the watered down end result of food industry lobbying and threats, not the scientific advice of nutritionists. GOVERNMENT AGENCIES SERVE INDUSTRY FIRST, THE PUBLIC SECOND. Health websites: Read popular websites like WebMD for information and the conversation quickly steers towards drugs. "Natural treatments for cholesterol" talks about reducing saturated fat and then gushes about the wonders of statin drugs. Guess where 80% of WebMD's revenues come from? Yup, the drug industry. The same goes for many magazines, TV shows, and other media. MEDIA IS OFTEN THE TOOL OF BIG INDUSTRY. I'm sounding like a conspiracy theorist. I don't believe that I am, but I am skeptical of the messages we often receive from the media, advertisements, news reports, websites, etc. It's left to you and me to use our judgment and decide what is truth and what is someone's version of a message crafted towards their hidden agenda. I am hoping that the real truth will grow through a wiki-like phenomena driven and supervised by a collective knowledge that we all contribute towards. That will happen, most likely, on the internet. Just as Wikipedia overtook the revered Encylopedia Britannica in the blink of an eye at far less cost yet with greater depth and equivalent accuracy, so will it happen in health information. I'm uncertain of the eventual form this health-wiki will take, but it will shatter many smug and deeply-entrenched powers that at present continue to profit from mis-information.
A new Track Your Plaque record: 63% reduction 14. July 2007 William Davis (3) Stress can booby-trap the best efforts at reducing your CT heart scan score. But Amy, our newest Track Your Plaque record holder, defied the effects of an overwhelmingly life stress to drop her heart scan score from 117 to 43--an amazing 63% reduction. Amy beat our previous record holder, Neal, who achieved a 51% reduction. Though Neal had dropped his score from 339 to 161, a drop of 178 and more than Amy's 74 point drop, on a percentage basis Amy holds the record. I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!Amy's complete story can be found in our latest Track Your Plaque Newsletter to be released later this week, as well as an upcoming feature on the www.cureality.com website. (We've got to toot our horn about successes like this!)
The Ornish diet made me fat 13. July 2007 William Davis (16) I got that kind of question today that tempts me to roll my eyes and say, "Not again!""If I want to reverse my heart scan score, should I do the Ornish diet?" You know, the one by Dr. Dean Ornish: Dr. Dean Ornish's Program for Reversal of Heart Disease. I personally followed the Ornish program way back in the early 1990s. I reduced fat intake of all sorts to <10% of calories; eliminated all fish and meats, vegetable oils, and nuts; ate vegetables and fruits; and upped my reliance on whole grains. I used many of his recipes. I exercised by running 5 miles per day. (Far more than I do now!) I avoided sweets like candies and fruit juices. What happened? I gained 31 lbs, going from 155 to 186 lbs (I'm 5 ft 8 inches tall), my abdomen developed that loose, fleshy look, hanging over my beltline. My HDL plummeted to 28 mg/dl, triglycerides skyrocketed to 336 mg/dl, and I developed a severe small LDL pattern. I experienced a mental fogginess every afternoon. I felt tired and crabby much of the time. I sometimes struggled to suppress an irrational anger and frustration over the silliest things. I required huge amounts of coffee just to function day to day. Hundreds of my patients suffered similar phenomena.Few of us wear bell-bottomed jeans, tie-dyed t-shirts, or say "groovy". Rowan and Martin's Laugh-in is an "oldie", it's no longer cool to hold your index and middle fingers up in the "V" sign of peace. Even Ladybird Johnson has passed.So should go the misadventures of the ultra low-fat diet, as articulated by Dr. Ornish. His day came and went. We learned from our mistakes. Now let's do something better.Keep your eyes open for the New Track Your Plaque Diet.
Do lower heart scan scores grow faster? 11. July 2007 William Davis (0) If Mary's heart scan score increases from 2 to 4 in one year, it represents a 100% increase in score. If Jane's heart scan score increases from 1002 to 1004 over the same period, it represents <1% increase, even though the true growth is the same: 2 points. This quirk of arithmetic needs to be factored in whenever you and your doctor try to puzzle out the meaning of an increasing CT heart scan score. Lower numbers, particularly those <100, can grow at seemingly much faster rates if viewed by percent per year increase. If no effort is taken to stop the growth in your coronary plaque, then scores of 10, 20, 30, or the like can easily grow 50-100% per year. In contrast, scores of 1000, 1500, and 2000 tend to grow at "slower" rates of 20% or so per year without corrective efforts, even though the absolute growth may be substantial. (Obviously, this bit of confusion can be best eliminated by reducing your heart scan score, but it doesn't always work out that way.)If we were all adept at advanced math, we should probably rely on logarithmic measures of plaque increase, rather than percent increase. Or, you can just keep in mind that the rate of plaque growth must always be viewed in the context of the absolute score.
Mr. Salazar: Check your Lp(a) 9. July 2007 William Davis (8) Marathon star Alberto Salazar was just released from the hospital following a heart attack and a heart catheterization that led to a stent. The MSNBC version of the report can be viewed at http://www.msnbc.msn.com/id/19653682/.At 48 years old and holder of several American records for marathon times, Salazar's story is eerily reminiscent of Jim Fixx, who died at age 52 after writing a bestselling book, The Complete Book of Running. Thankfully, Salazar's story has a happier ending. Fixx died at a time when prevention of heart disease was quite primitive. Lipoprotein analysis was not broadly available to the public, CT heart scans had not yet been invented. Even statin drugs were just a gleam in the pharmaceutical industry's eye. But not so with Salazar. This Cuban-born marathoner experienced his heart attack at at a time when enormously useful steps can be taken to 1) document the extent of disease with a CT heart scan (the presence of a stent just means that one artery can't be "scored"), and 2) identify the causes of his disease.I suspect that the fact that yet another marathoner in the limelight will once again prompt the (likely non-sensical) conversation about long-distance running and the increased risk of heart disease. Unfortunately, I fear that the real cause will be left unidentfied and untreated: Lipoprotein(a), or Lp(a).It's almost certain that Fixx had Lp(a), given the fact that his dad had a heart attack at age 35. Running simply postponed the untreated inevitable.I hope Mr. Salazar is surrounded by doctors who have his true interests in mind (not just procedural excitement) and ask the crucial question: Why? The answer is almost certain to be Lp(a).
Being regular is dangerous to your health 25. September 2011 William Davis (21) No, I'm not referring to your daily morning ritual in the bathroom. I'm talking about heart rate.Counterintuitively, a perfectly regular heart rate is a marker of poor health. People with perfect regularity of heart rate have more heart attacks, for instance.Regularity of heart rate occurs more commonly in people with hypertension and other metabolic derangements, and it signals increased risk for both heart attack and death. A perfectly regular heart rate, i.e., no variation in the time interval from beat to beat, suggests that the parasympathetic nervous system, the component of automatic ("autonomic") nervous system control that is associated with the relaxation response, feelings of well-being, quiet, and relaxation, is weak. It also means that the opposing sympathetic nervous sytem that regulates the "fight or flight," adrenaline-like response is allowed to be dominant. Dominance of the sympathetic over the parasympathetic system generates regularity of heart rate. Heart rate also tends to be faster, e.g., 85 beats per minutes rather than 55 or 60 beats per minute. So perfect regularity, as well as increased rate, is undesirable.What we want is irregularity of heart rate. But not irregularity that occurs chaotically with no rhyme or reason. More precisely, we want variability in heart rate. And we want variability to occur in synchrony with breathing, i.e., the respiratory cycle.The ideal response is:1) increase in heart rate with inspiration2) decrease in heart rate with expiration.Heart rate in healthy people typically varies 15-20 beats per minute within the respiratory cycle, e.g., 60 bpm at end-exhalation, 80 bpm at end-inspiration. Restoration of increased heart rate variability is associated with reduced blood pressure, reduced blood sugars (HbA1c), reduced inflammatory markers and cortisol (associated with stress), even an increase in DHEA levels. Feelings of well-being and calm also develop. Among the strategies to consider to restore heightened heart rate variability and slowed heart rate include:--Omega-3 fatty acid supplementation--Exercise--Weight loss--Deep breathing exercises--Meditation, prayer, and biofeedbackFor our Track Your Plaque purposes, we are folding in the HeartMath strategies, i.e., use of a heart rate monitor that calculates heart rate variability in the context of respiratory cycle. If you've not already done so, take a look at the two Special Reports devoted to this topic on the Track Your Plaque website.