AHA: Doctors don't have time for prevention

Doctors "don't have enough time to educate their patients and to stop and think about what measures the patient really needs," says Dr. Raymond Gibbons, new head of the American Heart Association.

Dr. Gibbons highlighted how the system reimburses generously for performing procedures, but reimburses relatively little (often just a few dollars) for providing preventive counseling. He claims to have several ideas for solutions.

Good for Dr. Gibbons. There's no doubt that the lack of truly effective preventive information and counseling is a systemic, built-in flaw in the current medical environment. It is especially true in heart disease.

Another problem: "If a doctor didn't say it, it must not be true." That's the attitude of many of my colleagues. Despite their broad and systematic failure to provide preventive counseling, most physicians (my colleagues the cardiologists especially) pooh-pooh information that comes from other sources. Yet, it's my prediction that much of healthcare will go the way of optometry--direct access to care, often delivered in non-healthcare settings like a store or mall. People are hungry for truly self-empowering health information. Too many physicians can't or won't provide it. You've got to turn elsewhere for it.

That's one of the main reasons I set up the Track Your Plaque program. It's direct access to self-empowering information. A flaw: You still require the assistance of a physician to obtain lab values, lipoproteins, and to monitor certain treatments (e.g., niacin at higher doses). If I knew of a way around this, I'd tell you. But right now I don't. We remain constrained by legal and moral obligations.

Nonetheless, phenomena like CT heart scanning and the Track Your Plaque program are just a taste of things to come.
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Niacin scams

Niacin scams

As most of you know, niacin (vitamin B3) is an important tool for many in the Track Your Plaque program.

Niacin:

--raises HDL cholesterol
--reduces small LDL
--reduces lipoprotein(a)

And it's the most potent agent we have for all three patterns, despite just being a vitamin. Niacin also reduces LDL cholesterol, VLDL, IDL, triglycerides; reduces heart attack risk dramatically either alone or in combination with other agents.

Unfortunately, some people who are either afraid of the "hot flush" side effect, or experience excessive degrees of it, have resorted to two preparations sold in stores that have none of these effects.

Most notorious is "No-flush" niacin, also known as inositol hexaniacinate. This compound is an inositol sugar molecule complexed with 6 ("hexa-") niacin molecules. Unfortunately, it exerts none of niacin's effects in the human body. No-flush niacin has no effect on HDL, small LDL, or Lp(a), nor on LDL or heart attack.

In short, no-flush niacin is a scam. It's also not cheap. I've met people who have spent hundreds of dollars on this agent before they realize that nothing is happening, including a flush.

Likewise, nicotinamide does not work. It sounds awfully close to the other name for niacin, nicotinic acid. But they are two different things. Like no-flush niacin, nicotinamide has no effect on HDL, small LDL, Lp(a), etc.

Though I've discussed this issue in past, somehow these two "supplements" seem to sneak back into people's consciousness. You walk down the health food store aisle and spy that bottle of X-brand No-flush niacin, promising all the benefits of niacin with none of the bother. Then you remember that rough night you spent a few months back when the hot flush lasted longer than usual. That's when some people end up buying this agent making extravagant--and false--promises.

For now, for all its imperfections, niacin is still a pretty darn good agent for these patterns. Remember that the best strategy to minimize the hot flush effect is to drink plenty of water. We generally recommend taking the dose at dinner along with water. If the hot flush occurs, drink two large glasses of water (total volume 16-24 oz). Nine times out of ten, the flush is gone. It also dissipates the longer you take niacin.

Comments (11) -

  • auntulna

    1/12/2009 11:06:00 PM |

    I've been taking Slo-niacin for more than six months, and about three times it must have broken down too fast. That is an intense hot pins and needles rush! Anyone else had that happen?

  • Grandma S.

    1/13/2009 2:37:00 PM |

    Dr. Davis,
    I do appreciate your blog and the information you provide. I am switching to SloNiacin!

  • stern

    1/13/2009 7:54:00 PM |

    it appears to me that the only    final decisive enemy for the heart is the LA sort LDL,all other are the indicators that your body inclines forward to get that enemy .all other encompassess high tryglicerides ,high ldl,low small hdl,c reactive proyien ,am i wright ?

  • Anonymous

    1/13/2009 9:46:00 PM |

    Niamax is also a slow release niacin.

    Is Niamax acceptable or does it also fall into the scam group?

  • Anonymous

    1/14/2009 12:27:00 AM |

    Please comment on a niacin product I have been using for years by Endurance Products,a sustained form of nicotinic acid that causes no flush (1000 mg daily) plus their regular version of immediate release (250 mg daily). Thanks...

  • martha

    2/4/2009 4:06:00 PM |

    Hi—
    My name is Martha and I am  a  writer working on a story about niacin for Better Homes & Gardens' Heart-Healthy Living magazine. I hope to interview Dr. Davis but also wanted to talk to people who are taking niacin for my story. If you are interested, please email me at marthajmiller@hotmail.com. My deadline is Feb. 16. Thanks
    -martha miller

  • IggyDalrymple

    2/28/2009 2:37:00 AM |

    My VA doc has been prodding me for years to take statins for my bad LDL/HDL ratio.  I finally took Dr Davis' advice and starting taking niacin and it worked.  My doc is now happy.

  • SES

    3/3/2009 10:29:00 PM |

    There are so many people commenting on the side effects of statins I wonder if there are side effects to something like Niaspan. Hot flashes are not what I am talking about.

  • Mary P

    4/28/2009 6:23:00 AM |

    I was talking to a dietitian friend about your strong feelings about no-flush niacin. I'm confused because she pointed me towards a recent European Food Standards Agency report that states that inositol hexanicotinate is bioavailable to humans and a source of niacin (they say, on average, 70% of an oral dose is absorbed into the blood stream).

  • buy jeans

    11/2/2010 7:40:15 PM |

    Nicotinamide--Also called niacinamide. While the nicotinamide/niacinamide forms of vitamin B3 can be used to treat B3 deficiency ("pellagra"), they do not reproduce the lipid and lipoprotein effects of niacin. For our purposes, they are useless.

  • Troy Honaker

    1/4/2011 5:00:05 AM |

    Niacin does have a tendency to have a prickly flushing effect on the skin.  This is normal to my knowledge.  It's not really a "side effect," it's just niacin doing its job.  I have never known it to be dangerous.  It is temporary.

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Factory hospitals

Factory hospitals

Twenty years ago, the American farming industry experienced a dilemma: How to grow more soybeans, corn, or wheat from a limited amount of farmland, raise more cattle and hogs in a shorter period of time, fatter and ready for slaughter within months rather than years?













(Image courtesy Wikipedia)

The solution: Synthetically fertilize farmland for greater crop yield; “factory farms” for livestock in which chickens or pigs are crammed into tiny cages that leave no room to turn, cattle packed tightly into manure-filled paddocks. As author Michael Pollan put it in his candid look at American health and eating, The Omnivore’s Dilemma:


To visit a modern Concentrated Animal Feeding Operation (CAFO) is to enter a world that for all its technological sophistication is still designed on seventeenth-century Cartesian principles: Animals are treated as machines—“production units”—incapable of feeling pain. Since no thinking person can possibly believe this anymore, industrial animal agriculture depends on a suspension of disbelief on the part of the people who operate it and a willingness to avert one’s eyes on the part of everyone else. . .


Pollan goes on to argue that the cultural distance inserted between the brutal factory farm existence of livestock and your dinner table permits this to continue:


“. . .the life of the pig has moved out of view; when’s the last time you saw a pig in person? Meat comes from the grocery store, where it is cut and packaged to look as little like parts of animals as possible. The disappearance of animals from our lives has opened a space in which there’s no reality check on the sentiment or the brutality . . .”


The same disconnect has occurred in healthcare for the heart. The emotional distance thrust between the hospital-employed primary care physician, the procedure-driven cardiologist, the crammed-into-a-niche electrophysiologist (heart rhythm specialist) or cardiothoracic surgeon whose principal concerns are procedures—with an eye always towards litigation risk—mimics factory farms that now litter the landscape of the Midwest. The hospitals and doctors who deliver the process see us less as human beings and more as the next profit opportunity.

The “factory hospital” has allowed the subjugation of humans into the service of procedural volume, all in the name of fattening revenues. Never mind that people are not (usually) killed outright but subjected to a succession of life-disrupting procedures over many years. But whether livestock in a factory farm or humans in a factory hospital, the net result to the people controlling the process is identical: increased profits.

The system doesn’t grow to meet market demand, but to grow profits. The myth that allows this growth is perpetuated by the participants who stand to gain from that growth.

See hospitals for what they are: businesses. Despite most hospitals retaining "Saint" in their name, there is no longer anything saintly or charitable about these commercial operations. They are ever bit as profit-seeking as GE, Enron, or Mobil.

Comments (8) -

  • Jenny

    11/9/2008 2:48:00 PM |

    Dr. Davis,

    Have you read the book, Hippocrates' Shadow? You have a lot in common with the physician who wrote it and I think it would be very productive for you to contact him and discuss strategies together.

    I blogged about the book in detail at my Diabetes Update Blog a few days ago.

    We patients can't do much about this, but physicians working together could.

  • Zbigniew

    11/9/2008 8:43:00 PM |

    adequate analogy Smile, but what we get here is a gloomy picture with little hope - while thanks to blogs like yours we may be more lucky than those poor animals.

    So the punchline should be something like "educate, read, b/c if everyone takes care of themselves then everyone will be taken care of"

    best regards,

  • steve

    11/10/2008 2:35:00 PM |

    would be interested in your views of Crestor study, and statins in general: when should they be used, etc?

    thank you

  • Anonymous

    11/11/2008 12:31:00 AM |

    Thanks Jenny, for mentioning the book, Hippocrates'Shadow. This sounds very interesting and I can hardly wait to find a copy.  
    Another great book is "How Doctor's Think, by Jerome Groopman,M.D.
    Dr. Davis, I appreciate this wonderful blog and your excellent advice. You restore some of my lost confidence in the medical profession.

  • puddle

    11/11/2008 3:30:00 AM |

    Thank you, again.  And again.

  • [...] (11)  http://www.newsobserver.com/2012/04/22/2016905/north-carolinas-urban-hospitals.html (12)  http://blog.trackyourplaque.com/2008/11/factory-hospitals.html  (13)  http://online.wsj.com/article/SB10001424127887323829104578623720451833006.html (14) [...]

  • [...] (11)  http://www.newsobserver.com/2012/04/22/2016905/north-carolinas-urban-hospitals.html (12)  http://blog.trackyourplaque.com/2008/11/factory-hospitals.html (13)  http://online.wsj.com/article/SB10001424127887323829104578623720451833006.html (14) [...]

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Cranberry Sauce

Cranberry Sauce

Happy Thanksgiving 2012, everyone, from all the staff at Track Your Plaque!

Here’s a zesty version of traditional cranberry sauce, minus the sugar. The orange, cinnamon, and other spices, along with the crunch of walnuts, make this one of my favorite holiday side dishes.

There are 31.5 grams total “net” carbohydrates in this entire recipe, or 5.25 grams per serving (serves 6). To further reduce carbs, you can leave out the orange juice and, optionally, use more zest.

1 cup water
12 ounces fresh whole cranberries
Sweetener equivalent to 1 cup sugar (I used 6 tablespoons Truvía)
1 tablespoon orange zest + juice of half an orange
½ cup chopped walnuts
1 teaspoon ground cinnamon
½ teaspoon ground nutmeg
¼ teaspoon ground cloves

In small to medium saucepan, bring water to boil. Turn heat down and add cranberries. Cover and cook at low-heat for 10 minutes or until all cranberries have popped. Stir in sweetener. Remove from heat.

Stir in orange zest and juice, walnuts, cinnamon, nutmeg, and cloves.

Transfer mixture to bowl, cool, and serve.


Comments (3) -

  • Kathryn

    12/1/2012 9:01:14 PM |

    Wow, sounds good but that is a LOT of Truvia.  The same amount of real stevia would render that inedible.  I've never tried Truvia, so maybe it isn't as sweet as the real stuff.  I like KAL brand stevia.

    BTW, i was excited to learn that you're going to be on Oz on Monday.  Smile  I think your message should be carried to all the Land.  i hope it does get thru (i know TV shows have a tendency to edit so that the message gets diluted or even lost).  Best wishes!  (Well, i suppose it has already been filmed, still.)

  • JT

    1/6/2013 2:25:40 PM |

    Ah Christ, it seems I ate to much fiber yesterday!  Not to take the lords name in vain this Sunday morning just the fiber rich foods have me run down this morning.  But with that said, I think the defective gut will be alright.  That's a nice change!  The gut will thump and pulsate, and make all kinds of fussing through out the day I'm sure, but the typical sickness I would experience seems to be fading on the latest diet.  Kind of nice, to say the least.  Figure eventually fiber foods will be possible for me to eat again.  Not that I'm all that excited about this, a carrot or cucumber doesn't excite, but it would be oh so nice to broaden the monotone diet a bit more from what it currently is.  

    Congrats on the success of the books!  Very nice and wonderful that word is making its way out to "alternative" ideas to improve ones health, particular with the problems that wheat can have on ones health.  Alterative might not be the correct word to use anymore.  These ideas seem to be becoming more mainstream.  There are a good number of unhealthy people out there, that want help, and are motivated to try new ideas.  As can  be seen with your book, many are finding relief from condition they were all to often told by other health care professionals that their condition could not be treated and must be dealt with for life.  For me personally a big motivation for why I spread the word to others about dietary ideas to address heart disease, and now other health issues, was desperation.  I can remember how very sick I was at one time, home bound largely, in a great deal of pain, and desperate for relief.  Back in the internet days often times I would finding myself not wanting to approach others with dietary information to help with conditions.  It was information that would seem foreign to them.  Then simply I would often think of what I've gone through, how sick I had been, and believe maybe this information can help.    

    Well, it's time for me to move on to new pastures.  With being slightly healthier and having more energy here of late, there are other items on the mind.  I've had people seem to suggest ways to make a living continuing this work/hobby, but to be honest I do not believe that possible.  I never have carried much for the attention.  And there are safer hobbies to participate in.  Possibly I can get into cloths tailoring, making my own cloths.  That would be fun I would have to imagine.  

    Oh, I guess to mention too, someday you might hear about me again.  If I do recover there is a good chance I'll write a book, pamphlet, web sight, what have you, detailing about how I solved my stomach issues and hopfully heart plaque also.  It's a shame that from my experience hospitals seem to care so little about dietary ideas.  It isn't strictly correct, but often times I feel as if I've had to invent the wheel for addressing my gut condition.  In an ideal world, that shouldn't have been the case.

  • Helen Howes

    3/27/2013 10:36:53 PM |

    Has this blog died?  It used to be interesting. the last few entries seem just to be over-sweet recipes..
    Sad, really..

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