The world of intermediate carbohydrates

28. January 2011 William Davis (0)
There are clear-cut bad carbohydrates: wheat, oats, cornstarch, and sucrose. (Fructose, too, but in a class of bad all its own.)

Wheat: The worst. Not only does wheat flour increase blood sugar higher than nearly all other carbohydrates, it invites celiac disease, neurologic impairment, mental and emotional effects, addictive (i.e., exorphin) effects, asthma, irritable bowel syndrome, acid reflux, sleepiness, sleep disruption, arthritis . . . just to name a few.

Oats: Yeah, yeah, I know: "Lowers cholesterol." But nobody told you that oats, including slow-cooked oatmeal, causes blood sugar to skyrocket.

Cornstarch: Like wheat, cornstarch flagrantly increases blood sugar.It also stimulates appetite. That's why food manufacturers put it in everything from soups to frozen dinners.

Sucrose: Not only does sucrose create a desire for more food, it is also 50% fructose, the peculiar sugar that makes us fat, increases small LDL particles, increases triglycerides, slows the metabolism of other foods, encourages diabetes, and causes more glycation than any other sugar.

But there are a large world of "other" natural carbohydrates that don't fall into the really bad category. This includes starchy beans like black, kidney, and pinto; rices such as white, brown, and wild; potatoes, including white, red, sweet, and yams; and fruits. It includes "alternative" grains like quinoa, spelt, triticale, amaranth, and barley.

For lack of a better term, I call these "intermediate" carbohydrates. They are not as bad as wheat, etc., but nor are they good. They will still increase blood glucose, small LDL, triglycerides, etc., just not as much as the worst carbohydrates.

The difference is relative. Say we compare the one-hour blood glucose effects of 1 cup of wheat flour product vs. one cup of quinoa. Typical blood sugar after wheat product: 180 mg/dl. Typical blood sugar after quinoa: 160 mg/dl--better but still pretty bad.

Some people are so carb-sensitive that they should avoid even these so-called intermediate carbohydrates. Others can have small indulgences, e.g., 1/2 cup, and not generate high blood sugars.
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Is there something fishy about fish oil?

Is there something fishy about fish oil?

27. January 2010 William Davis (0)
To be sure, there's plenty of misinformation out there about fish oil. Take a look at the swill that passes for health information on Woman's Day: On Call with Dr. Sandy: Fish Oil and Mercury:



Reader Question: My doctor recommended that I take a fish oil supplement, but I'm concerned about mercury. Is there any way to tell which brands are lowest in mercury content?



On Call Response: When it comes to OTC supplements, the answer is no. Though most fish oil supplements sold by major brands are probably safe, there's really no way to tell what's in the bottle or how much mercury it might contain.



Perhaps Dr. Sandy should read the many independent analyses performed on nutritional supplement fish oil, including those at Consumer Lab and Consumer Report before she offers her blind criticisms.
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Is an increase in heart scan score GOOD?

Is an increase in heart scan score GOOD?

20. November 2007 William Davis (30)
In response to an earlier Heart Scan Blog post, I don't care about hard plaque!, reader Dave responded:

Hello Dr Davis,

Interesting post about hard and soft plaque. I recently had a discussion with my GP regarding my serious increase in scan score (Jan 2006 = 235, Nov 2007 = 419).

After the first scan we started aggressively going after my LDL, HDL and Trig...196,59,221

And have them down to 103, 65, 92 - we still have a way to go to 60/60/60 [The Track Your Plaque target values]-

So the increase is a surprise, but my doctor said that the increase could in part be cause some of the soft plaque had been converted to hard plaque and the scan would show that conversion.


Dave's doctor then responded to him with this comment:

"Remember that although your coronary calcium score has gone up, this does not mean that you are at greater risk than you were a year ago. Remember that the most dangerous plaque is the not-yet calcified soft plaque, which will not show up on an EBT [i.e., calcium score]. It is only the safe, calcified plaque that can be measured with the EBT. [Emphasis mine.] For your score to go up like it did, while your lipids came down so much, what had to happen was that lots of dangerous unstable plaque was converted to stable, calcified plaque. There are no accepted guidelines for interpreting changes in calcium scores over time, because the scores tend to go up as treatment converts dangerous plaque to safer plaque. We do know that aggressively lowering LDL reduces both unstable and stable plaque, and we know that risk can be further lowered by adjuvant therapy such as I listed above."


Huh?

This bit of conventional "wisdom" is something I've heard repeated many times. Is it true?

It is absolutely NOT true. In fact, the opposite is true: Dave's substantial increase in heart scan score from 235 to 419 over 22 months, representing a 78% increase, or an annualized rate of increase of 37%. This suggests a large increase in his risk for heart attack, not a decrease. Big difference!

Dr. Paulo Raggi's 2004 study, Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy in 495 participants addresses this question especially well. Two heart scans were performed three years apart, with a statin drug initiated after the first scan, regardless of score.

During the period of study, heart attacks occurred in 41 participants. When these participants were analyzed, it was found that the average annual increase in score over the three year period was 42%. The average annual rate of increase in those free of heart attack was 17%. The group with the 42% annual rate of increase--all on statin drugs--the risk of heart attack was 17.2-fold greater, or 1720%.

The report made several other important observations:

--20% of the heart attack-free participants showed reduction of heart scan scores, i.e., reversal. None of the participants experiencing heart attack had a score reduction.
--Only 2 of the 41 heart attacks occurred in participants with <15% per year annual growth, while the rest (39) showed larger increases.
--The intensity of LDL reduction made no difference in whether heart attacks occurred or not. Those with LDL<100 mg/dl fared no better than those with LDL>100 mg/dl.

Dr. Raggi et al concluded:

"The risk of hard events [heart attack] was significantly higher in the presence of CVS [calcium volume score] progression despite low LDL serum levels, although the interaction of CVS change and LDL level on treatment was highly significant. The latter observation strongly suggests that a combination of serum markers and vascular markers [emphasis mine] may constitute a better way to gauge therapeutic effectiveness than isolated measurement of lipid levels."

This study demonstrates an important principle: Rising heart scan scores signal potential danger, regardless of LDL cholesterol treatment. Yes, LDL reduction does achieve a modest reduction in heart attack, but it does not eliminate them--not even close.

These are among the reasons that, in the Track Your Plaque program, we aim to correct more than LDL cholesterol. We aim to correct ALL causes of coronary plaque, factors that can be responsible for continuing increase in heart scan score despite favorable LDL cholesterol values.

So, Dave, please forgive your doctor his misunderstanding of the increase in your heart scan score. He is not alone in his ignorance of the data and parroting of the mainstream mis-information popular among the statin-is-the-answer-to-everything set.

Just don't let your doctor's ignorance permit the heart attack that is clearly in the stars. Take preventive action now.
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Comments (30) -

  • Anonymous

    11/20/2007 5:41:00 PM |

    Dr Davis,

    What should Dave do?  He appears to have improved his LDL:HDL ratio as well as his total C to HDL ratio substantially, but his CAC score jumped significantly.  Maybe look at other risk factors?

    The info here gives no indication of median blood pressure for Dave.  LP(a)?  No indication of particle sizes. But, which of these or others would be most likely to be Dave's downfall in attempting to mitigate a future hard endpoint?

    I don't ask this lightly, I myself am trying to follow the TYP program and keep my high-for-my-age 29 CAC score from growning.  But, I'm frankly not looking forward to my rescan in about a year.  I'm a bit worried about the, "What if my scan shows a dramatic increase?  What then?"

    Thank you for the valuable information you provide.

    :LaughingCT

  • Dr. Davis

    11/20/2007 11:17:00 PM |

    I would urge Dave to follow all the principles of the Track Your Plaque program, including:

    1) Fish oil to provide minimum 1200 mg EPA + DHA per day

    2) Correction of all concealed lipoprotein patterns such as IDL and Lp(a)

    3) Vitamin D raised to 50 ng/ml--crucial!

    4) Normalization of blood pressure, including during exericse.

    5) Normal blood sugar (<100 mg/dl).

    Further efforts might be required, depending on the long-term effects on rate of plaque growth.

  • Ross

    11/21/2007 3:41:00 AM |

    My question is: how repeatable do you think the scores are on the CT scan?  Are they bulletproof (+/- 5% no matter where measured), consistent by analyst (+/- 5% with the same doctor analyzing the scan), or...?  

    I am currently visiting my brother in law, who is an FP doctor with a private practice.  One of his professional friends, a cardiologist who seems a cut above (thinks stenting is a cop-out), recently told him that he only trusted two centers in the mid-Ohio region to score a 16-slice CT scan accurately, and that even then, the variability was still too high for his taste.  Two numbers within 20% were within his expected error bars and weren't different enough to indicate any change to him.  Two different scan centers?  He wouldn't even compare the two scan scores.

    In my own job (software), I've had to manage human-measured numbers over and over again.  One observation keeps coming up: a single value doesn't mean much without an understanding of the accuracy of that value.  I really am curious about how you estimate confidence intervals on CT scan scores.

  • Dr. Davis

    11/21/2007 3:55:00 AM |

    Hi, Ross--

    Excellent questions.

    Several thoughts:

    1) 16-slice scanners are, unfortunately, prone to wider error in heart scan scoring, perhaps as much as 20%. The variation in scoring on an EBT or 64-slice device is far less.

    2) Variation from scan to scan, when expressed as percent, depends to a great degree on the score itself. Lumping all scores together, variation should be no more than 8-9%. However,a low score of, say 2, then repeated at 4 means 100% variation. However, the same absolute difference of 2 but with a score of 1002 and repeated at 1004 is <1% variation. Therefore, higher scores assume much less percent variation, usually <5%.

    3) Variation among different reading physicians tends to be a minor issue, since much of the scoring is done by standard criteria determined by software, not the human eye. The only real source of human variation comes from disputable areas, such as the mitral valve (which can sometimes encroach into the coronary area and appear like plaque) and the mouth of arteries, which can be debated as being in the aorta or in the coronary arteries themselves. However, these disputable areas are issues in <5% of scans.

  • Tom

    11/21/2007 4:30:00 AM |

    It's interesting that a 29 year old is able to track his plaque. I'm in my 60's now and recently found your site AFTER bypass surgery and a calcium score >700 via a 64 slice scan.
    In reading past comments, those of us having had the heart procedure are now unable to follow our progress via the cac score. Until this post I had hoped to use your recommended blood tests for indication of progress, but if LDL reduction achieves a modest risk reduction, we are left without a specific guide.
    Question: Was the progress in blood tests in dave's case a result of statins ?

  • Dr. Davis

    11/21/2007 12:46:00 PM |

    That's why lipoproteins are so important--they provide other indicators. In my experience, people who have LDL cholesterol as the sole cause of heart disease are a very small minority. The vast majority of people have multiple causes beyond LDL.

    Also, about 50% of people can still get a heart scan score after bypass surgery if you find a center willing to do a detailed analysis. You will need to ask.

    Also, I don't know what Dave did, since he is a reader and everything he posted is above. Are you there, Dave?

  • Dr. Davis

    11/21/2007 5:41:00 PM |

    Hi, Paul--

    I think your doctor might be confusing heart scans with CT coronary angiograms. She is right in saying that CT angiograms (using X-ray dye) require a lot of radiation; 100 chest x-rays worth with present technology.

    However, a plain heart scan to generate a heart scan score requires 4 chest x-rays worth on an EBT device, 8-10 on an 64-slice multi-detector device.

    See the Track Your Plaque Special Report, Radiation and Heart Scans: The Real Story at http://trackyourplaque.com/library/fl_06-021radiation.asp.

  • Anonymous

    11/21/2007 6:01:00 PM |

    Regarding repeatability, there is a 2005 study by Serukov, Bland, and Kondos that shows that the repeatability is a function of the square root of the calcium score, and that volume score is more repeatable than Agatston score. The reference is

    “Serial Electron Beam CT Measurements of Coronary Artery Calcium: Has Your Patient's Calcium Score Actually Changed?” Alexander B. Sevrukov, J. Martin Bland and George T. Kondos, American Journal of Roentgenology 2005; 185:1546-1553
    http://www.ajronline.org/cgi/content/full/185/6/1546

    In this report, the standard deviation of the difference between two sequential calcium scored is

    SDAG130 = 2.515 *sqrt(avg score)
    SDVol130 = 1.758 *sqrt(avg score)

    This results in the following values, where SDA is the standard deviation for the Agatston score and SDV is the standard deviation for the volume score.

    Score-SDA--%SDA--SDV--%SDV
    5-----5.62---112%---3.93--79%
    10----7.95---79%----5.55--56%
    20----11.2---56%----7.86--39%
    50----17.7---35%----12.4--25%
    100---25.1---25%----17.5--18%
    200---35.5---17%----24.8--12%
    300---43.5---14%----30.4--10%
    400---50.3---12%----35.1---9%
    500---56.2---11%----39.3---8%
    600---61.6---10%----43.0---7%
    700---66.5----9%----46.5---7%
    1000--79.5----7%----55.5---6%

    These values show why many people use 15% as a breakpoint - only if the score has changed by more than 15% can it be said that the change is real. And this is only true for scores above 200 or so.

    Harry

  • Anonymous

    11/21/2007 7:17:00 PM |

    My cardiologist told me that EBT scanning is not recommended for anyone under the age of 30. Is this true? If so, how do I (29 years) reliably know that I am at risk?

    I discovered your blog recently. Since I have a very bad family history of diabetes, high blood pressure, and cholesterol, I decided to visit a cardiologist last month so that I can request for an EBT scan. He said that I'm too young for that, and has instead asked me to take a Carotid IMT and Stress test - are these tests reliable enough to provide insight on my risk? Could these tests return "false positive" values?

    I had found during a blood test I did this July only to find that my triglycerides were at 600!! The other cholesterol values were bad too - totalC-HDL-LDL-Tri (255-31-Not measurable-600)

    Since then I have found your blog, lost around 25 lbs and did a VAP recently (I asked for NMR and all I got from doctors - what? What the heck is that?) So I settled for a VAP, since they knew about it.

    I did a VAP along with a comprehensive blood test and the measures that came up high were.

    LIPID related:
    Total LDL-C Direct:130 (Normal<130)
    Real LDL-C:110 (N<100)
    Sum Total LDL-C: 130 (<130)
    Remnant LIPO (IDL+VLDL3): 30 (<30)
    HDL-2:9 (>10)
    VLDL3: 14 (<10)

    Non-LIPID related high values:
    Uric Acid: 8.3  (4.0-8.0)
    Fasting Glucose: 104 (65-99)
    Creatine Kinase Total: 631 (<=200)


    LP PLA2 is normal: 164 (115-245)
    HBA1C suggests prediabetic: 5.7 (Normal <6%)


    Due to my very high value of CK Total, I researched online and found that this can increase due to high exercise, and I had it repeated after taking rest, and it returned normal results. My doctor was really surprised about this and initially hesitant to fractionise my CK. I feel empowered that I am able to take charge of my health and preventative care with the
    information that is available online (of course, one needs to tread that carefully and make an informed decision due to various conflicting opinions out there).

    Sorry for the long post, Doc. I have a newfound awareness of my health thanks to your blog, and am very much interested in knowing your inputs. I just hope that more physicians in our country follow your noble path and understand the true value and empowerment of preventive care.

    - Philip

  • Dr. Davis

    11/21/2007 8:09:00 PM |

    Hi, Philip--

    In general, 29 is very young, perhaps too young, unless there is an outstanding family history (e.g., father with heart attack at age 37). Although your lipid/lipoproteins are concerning, it would be highly unusual to have anything but a zero heart scan score at your age.

  • Dr. Davis

    11/21/2007 8:14:00 PM |

    Hi, Harry--
    Thanks for the help!

  • Neelesh

    11/22/2007 4:51:00 AM |

    Hi Dr. Davis,
      I've just bought the Track Your Plaque book, waiting for its arrival. I've had a heart attack a year back.I'm 30 years old with no family history, non-alcoholic, non-smoker and vegetarian.
    The event was attributed to ectatic arteries(Type-III) and a very high level of LP(a)- between 120-130. The standard lipid profile was also marginally higher. If I had not insisted for an LP(a) test after reading Dr Agatston's South Beach Heart Program, I would have never found the LP(a) factor.
       I was stented during the hospitalization and now I'm wondering how effective the heart scan will be, given that the accuracy reduces  with stented arteries (http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_692-a)

    Thanks!
    -Neelesh

  • Dr. Davis

    11/22/2007 2:35:00 PM |

    Hi, Neeleesh--

    I do advocate heart scanning in people with stents, but I generally suggest that only the unstented arteries be scored. It's imperfect, excluding the most diseased artery, but it's proven a useful compromise, leaving you with two "scorable" arteries.

    The study you cite, however, is not about heart scans, it's about CT coronary angiography, a study that yields "percent blockage" sort of information, not an index of plaque.

    Beyond Lp(a), you should strongly consider vitamin D normalization.  By your first name, I take it you are from India/Pakistan or similar background, an ethnic origin that is associated with severe vitamin D deficiency.

  • Neelesh

    11/22/2007 3:00:00 PM |

    Thanks Dr. Davis. And yes, I'm from India.

  • wccaguy

    11/22/2007 3:13:00 PM |

    Dr. Davis,

    I found your answer to Neeleesh to be interesting in the extreme.  I have a  follow up question to it.

    I don't have specific references for the two facts I have heard but couldn't reconcile:

    1   India has high coronary artery disease incidence.

    2   Your answer to Neeleesh states that vitamin d levels are low in India and Pakistan.  And that would help much to explain the high rate of coronary artery disease in these countries.

    3   And yet India is close to the equator and so vitamin d levels should be relatively high because of sun exposure right?

    The question then is this:  What is the cause of the low vitamin d level in those countries?

    Thanks!

  • Dr. Davis

    11/22/2007 4:00:00 PM |

    It is interesting, isn't it?

    I believe part of the explanation is that, the darker your skin complexion, the more you are "protected" from intense and prolonged sun exposure. But, activation of 7-hydrocholesterol to 25-OH-vitamin D3 may require many hours more exposure. Thus, a fair skinned person might activate D within minutes, while a dark skinned individual might require hours.

    Another factor that has not been thoroughly explored but has potential for yielding enormous insights: Vit D receptor genotypes. That is, vitamin D deficiency may express itself in different ways in different populations. Some might get colon cancer, others multiple sclerosis, others coronary disease.

    I believe that the dark-skinned phenomenon becomes especially an issue when migrating to sun-deprived climates such as the northern U.S.

  • wccaguy

    11/22/2007 6:12:00 PM |

    Hi Doc,

    Your explanation makes sense.

    I did a quick google search and found experts on the problem in India attributing it to the increasing extent to which Indians were staying indoors and not "being active."

    But the vitamin D issue throws the whole question of "activity" into question doesn't it?  It might not be the activity per se but instead the amount of sunlight reduction.

    And if, per your explanation, darker skinned people need more time in the sun than lighter skinned people for Vitamin D3 to be "activated" then than a decrease in sunlight would have more effect on darker skinned people than lighter skinned people.

    Very interesting...  And perhaps INCREDIBLY good news!!!

    Because it means that there might be a cheap effective treatment for the coronary disease epidemic in India.

    Does all that make sense?

  • wccaguy

    11/22/2007 6:19:00 PM |

    Just to follow up one more point on this D3 question...

    I guess what we need to do is find a study which shows a correlation between degree of skin pigmentation and Vitamin D3 activation?

    (I'm not sure if the word "degree" is the right word, but perhaps the question is understood anyway?)

    Answering that question would certainly set up the basis for a scientific study right?

  • Dr. Davis

    11/23/2007 12:56:00 AM |

    Yes, it does. It could serve as the basis for a tremendously interesting study.

  • Dr. Davis

    11/23/2007 1:09:00 AM |

    There are indeed a few studies that document this effect, e.g., Factors that influence the cutaneous synthesis and dietary sources of vitamin D (abstract viewable at Arch Biochem Biophys. 2007 Apr 15;460(2):213-7.)

    However, I am not aware of any study that examines the effect of vitamin D supplementation specifically in this population that tracks coronary atherosclerosis. One British study  in Bangladeshi adults did demonstrate dramatic reduction in inflammatory markers with vit D replacement (Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? at http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12454321&ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum  ).

  • Dave K

    11/24/2007 12:21:00 AM |

    Hi Dr Davis,

    Sorry - I have been offline for a couple of days.  Interesting discussion.  I will try and add some detail lipid info.

    July 2007 Blood work showed

    My Lp(a) is 7
    IDL = 10
    VLDL=11
    HDL-2 = 15
    HDL-3 = 50
    VLDL C = 18
    VLDL1+2 = 7

    Currently taking fishoil 1700 mg of DHA+EHA
    Vitamin D 800mg - just incresed to 2000
    Baby Aspirin
    Multivitamin
    Crestor
    Just started Zetia after getting this last scan result
    Eat basic South Beach phase 3
    BMI - 27
    Glucose is 105
    Exercise 4X week...
    Lp-PLA2=120

    Blood pressure high-normal but I don't know about during exercise.  Cardilogist scheduled me for a stress test after this volume increase.

    I have not has a blood test for Vit D.

    Also - I had an angiograham after the first scan because I was having chests pains .... it turned up that I had no blockages whatsoever.  So we judged the chest pains as non cardiac.

    So I am following your list pretty close.  I guess I just have to wait to see how these changes do.  How long would you wait for another scan?

    Not sure what else to add - your website says to consider L-arginie...


    I do have a specific question.  In the scan report it shows where the calcium was found.  Don't know the software, but there was one spot where it showed in the early report that it didn't show in this report (of course there was several new areas) - could that have actually been a reversal at that spot?

  • Dr. Davis

    11/24/2007 1:25:00 AM |

    Small LDL and a deficiency of large HDL, along with modest excess weight, high blood sugar, high blood pressure all suggest you are (or were) likely over-dependent on processed carbohydrates like wheat products. Your pattern would likely respond vigorously to reduction or elimination of these foods and weight loss. Niacin can help this pattern. In our experience, normalization of vitamin D is crucial.

  • Dave K

    11/26/2007 5:51:00 AM |

    Dr Davis,

    Few more data ....

    Some of the treatments have only been for the last 6 months or so.  The Statin was first (of course) and it took almost a year to get something I could tolerate.  The we talked about Vit D (700) and fish oil (800 Omega 3).  After a full Lipid scan around 9 months ago - we decided to add more fish oil.  So the full dosage I listed is only 6 months old or so.

    Also - I love my red wine and I know the number says two glasses and i rarely do two - so its three or four ... which might be my next step....

    From your last response, I assume the VLDL and IDL levels are the ones you would target hardest at this point.

    Don't do a lot of sugar or wheat... Do eat Oatmeal everyday with rasins or blueberries.

    Oh and my other question was with this kind of increase how long would you wait for the next scan?

  • Dr. Davis

    11/26/2007 12:08:00 PM |

    Dave-

    I generally recommend waiting a year after all identifiable causes have been corrected. However, given your minimal doses of vit D, I usually have my patients wait at least six month after vitamin D blood levels are corrected.

  • Dave

    11/26/2007 8:01:00 PM |

    Dr Davis,

    Thank you ... keep up the great work and I'll keep reading... and tracking.

    Dave

  • G

    11/27/2007 12:39:00 AM |

    Neeleesh and DR. D,

    This Canadian physician appears to have a lot of indepth awareness of the diff phenotypes. He suggests (in the author's response) that D2 may not work as well in East Indians (may worsen glycemic control) versus D3 (the more biologically active vitamin D). Very fascinating!!

    http://www.cfp.ca/cgi/reprint/53/9/1435
    Repletion of vitamin D with vitamin D2 is common
    practice, and vitamin D2 can be used safely when monitored
    to achieve normal levels of 25(OH)D. This might
    take 2 to 3 months, as discussed in your letter and in my
    paper, because the half-life is about 2 weeks. Using vitamin
    D3 (1000 to 5000 IU) daily, depending on the level
    of deficiency, will also achieve this goal. I also agree
    that the goal is to achieve levels of 25(OH)D higher than
    100 nmol/L, preferably 100 to 125 nmol/L.
    My concern regarding vitamin D2 is that it is a synthetic
    analogue and might interact with the vitamin D
    receptor differently in various cell systems. It has been
    reported that vitamin D3 might improve glycemic control.
    7 Vitamin D2 has been reported to cause worsening
    of glycemic control in people of East Indian descent.8
    Is this because of vitamin D receptor polymorphism, or
    because of enhanced 24-hydroxylase enzyme activation,
    or is it due to how vitamin D2 interacts with the receptor?
    Until this has been sorted out, I feel safest using
    vitamin D3. There are about 2000 synthetic analogues
    of vitamin D. The search is on for one that can cross the
    blood-brain barrier to treat certain types of brain cancers
    without causing hypercalcemia.9 But then again,
    what other effects would this compound have? There
    are still so many unknowns.
    The first step is to recognize that most Canadians
    do not get enough vitamin D, especially in the winter
    months, because of where we live. This recognition
    might reduce the need for expensive drugs to treat
    various conditions and might improve the well-being of
    many Canadians.
    An ounce of prevention is worth a pound of cure.
    —Gerry Schwalfenberg MD CCFP
    Edmonton, Alta
    by e-mail

    here's the orig article which is one of the most excellent summaries I've seen so far -- great minds think alike -- they advise > 50ng/ml like DR. Davis as well!
    http://www.cfp.ca/cgi/reprint/53/5/841

  • Neelesh

    11/27/2007 4:05:00 AM |

    D,
    Interesting study indeed. Thanks for the information. I guess I have a lot of things to discuss with my cardiologist next week. Smile
    -Neelesh

  • chickadeenorth

    12/2/2007 11:16:00 PM |

    Hi to Gerry Schwalfenberg MD CCFP, do you know any Dr In Edtmn who practices Track your Plague, if so could you suggest names to help me. I live out by Jasper and need a skilled Dr in this treatment program, I would travel to Edtmn.Many thanks.
    chickadeenorth
    (hope its ok for me to ask this here)

  • cadoce66

    4/5/2008 8:37:00 PM |

    hi my aunts 63 yrs and she underwent an angioplasty with a medicated stent .. Shes on PLAVIX and her artery was 90% blocked and she had an evolving AWMI...
    Please advise what she should taketo prevent another blockage or heart attack!
    Thanks!

  • buy jeans

    11/3/2010 10:34:10 PM |

    So, Dave, please forgive your doctor his misunderstanding of the increase in your heart scan score. He is not alone in his ignorance of the data and parroting of the mainstream mis-information popular among the statin-is-the-answer-to-everything set.

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Track Your Plaque and non-commercialism

Track Your Plaque and non-commercialism

29. April 2007 William Davis (6)
If you're a Track Your Plaque Member or viewer, you may know that we have resisted outside commercial involvement. We do not run advertising on the site, we do not allow drug companies to post ads, we do not covertly sponsor supplements. We do this to main the unbiased content of the site.

We've seen too many sites be tempted by the money offered by a drug company only to see content gradually drift towards providing nothing more than cleverly concealed drug advertising. I personally find this deceptive and disgusting. Ads are ads and everyone knows it. But when you subvert content, secretly driven by a commercial agenda, that I find abhorrent.

That said, however, I do wonder if we need the participation of some outside commercial interests to help our members. In other words, many (over half) of the questions and conversations we have with people is about what supplement to take, or what medication to take. While we cannot offer direct medical advice online (nor should we) because of legal and ethical restrictions, I wonder if could facilitate access to products.

Many people struggle, for instance, with trusted sources for l-arginine, vitamin D, fish oil. Other people struggle with finding a heart scan center because of the changing landscape of the CT scanning industry. Could we somehow provide a clear-cut segment of the website that clearly demarcates what is commercial and non-Track Your Plaque-originated, yet at least provides a starting place for more info?

Ideally, we would have personally tried and investigated everything there is out there applicable to the program. But that's simply impossible at this stage.

I feel strongly that we will never run conventional ads on the site. Nor will we ever permit any outside commercial interest to dictate what and how we say something. The internet world is full of places like that. Look at WebMD. I find the site embarassing in the degree of commercial bias there. We will NEVER sell out like that, regardless of the temptation. People with heart disease are all conducting a war with the commercial forces working to profit from them--hospitals, cardiologists, drug companies, medical device companies (yes, even they advertise to the public, e.g., implantable defibrillators--no kidding). Genuine, honest, unbiased information is sorely needed and not from some kook who either knows nothing about real people with real disease, or has a hidden agenda like selling you chelation.

I'd welcome any feedback either through this Blog or through the contact@cureality.com.
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Comments (6) -

  • Warren

    4/29/2007 6:02:00 PM |

    I agree with the need for some sort of unbiased but brand/manufacturer-oriented guidance.  I guess my question would be, if this content is not based on your specific experience, what criteria would you apply to determine how to assure some level of credibility?  With advertising, the criteria is generally willingness to pay the price of the advertising.  If you want to maintain higher standards than that, won't it require someone with either understanding or technical expertise or direct experience to assess whether the producer is credible and trustworthy?

    As it stands, I am looking for someone whose opinion I can trust regarding which supplement suppliers to turn to.  I have been impressed and surprised by the degree of your willingness to tell it the way you see it, including naming names of product manufacturers that you have found to supply products that seem to work for your patient population.  I hope you'll keep that up no matter what.  And I'm interested in how this idea develops.

  • Dr. Davis

    4/29/2007 8:31:00 PM |

    Thanks for the helpful thoughts.

    I wonder if a user comment method would work. In other words, say a product manufacturer makes a claim and sells their product to you (Track Your Plaque would not sell it), there will be comments from people who have tried the product and their supplier before.

    Such a system would not be as certain as providing our own stamp of endorsement (which we could still do, of course), but it would encourage an open conversation. Hopefully, any undesirable products would be rapidly identified as such.

    My concern is that, with hundreds or thousands of products out there, we end up saying "We've never tried it" all too often.

  • Eugene

    5/1/2007 3:38:00 AM |

    Dr. Davis for as much time and effort that is put in the TYP program, why not i'am sure the snake oil salesman would not want his product under the gun like people on this progran would do, frank discussions on supplements is not a bad thing as a example i'am the person who asked you about PGX fiber, its called WellBeX and is marketed by Natural Factors, one more example would be i use a insulin mimetic R-alpha lipoic acid with biotin (also a very good antioxidant) i can buy the brand name Insulow or i can use a different brand (Glucophase),for less money that does the same thing, being a type 2 i test all of the time and sometimes go days eating the same thing at the same time i know that i can get between 10 and 12 points with either one.  i know their are a lot of supplements but we only talk about a few, and like i said before why not, my biggest concern on buying supplements are they selling what they say they are selling or is it different item that will not work, or is made up with a different material than is is advertized. why not get some add revenue, their are good products out their, Upsher-Smith Slo Niacin, Endurance's Endur-acin SR both are good nicotinic Acid products, Insulow makes a good product, one more example would be the Vitamin Shoppe sells a  good Vitamin D softgel under their store brand this is a good product, but they also sell under their store brand a no flush Niacin in their heart supplement area , this product is worthless for the TYP program, I would say start with the products, that we know, and expand a little at a time, also how about Direct access testing for blood work, i use Lab Corp to get my NMR lipoprofile i'am sure that their are others full speed ahead, I think increased revenue could have some good outcomes
    Eugene

  • Dr. Davis

    5/1/2007 11:54:00 AM |

    Great thoughts.

    I think, if and when we proceed with such a process, that we:

    1) Have some sort of checklist for approval of quality, price, availability, purity, etc. and provide our stamp of approval.

    2) Convey our comments in addition to info provided by the manufacturer or distributor.

    3) Permit all the Track Your Plaque participants to leave their own comments, much like Amazon does with books.

  • Anonymous

    5/4/2007 3:42:00 AM |

    A record holder in plaque reduction has now been acheived.  What brand of supplements was the member using? What brand of fish oil? This is when a recommendation would be welcomed!!

  • Dr. Davis

    5/4/2007 11:36:00 PM |

    Nothing magical: He used Sam's Club fish oil.

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Dr. Jarvik, is niacin as bad as it sounds?

Dr. Jarvik, is niacin as bad as it sounds?

20. October 2007 William Davis (5)
A popular health newsletter, Everyday Health, carried this headline:

A Cholesterol-Busting Vitamin?
Did you know that niacin, one of the B vitamins, is also a potent cholesterol fighter?
Find out how niacin can help reduce choleseterol.

At doses way above the Recommended Dietary Allowance — say 1,000–2,500 mg a day (1–2.5 grams) — crystalline nicotinic acid acts as a drug instead of a vitamin. It can reduce total cholesterol levels by up to 25%, lowering LDL and raising HDL levels, and can rapidly lower the blood level of triglycerides. It does so by reducing the liver’s production of VLDL, which is ordinarily converted into LDL.


I'd agree with that, except that it is rare to require doses higher than 1000-1500 mg per day unless you are treating lipoprotein(a) and using niacin as a tool for dramatic drops in LDL. But for just raising HDL, shifting HDL into the healthy large class, reducing small LDL, and for reduction of heart attack risk, 1000-1500 mg is usually sufficient; taking more yields little or no further effect.

But after that positive comment comes this:

Niacin is safe — except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. . . However, it has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.


Strange. After a headline clearly designed to pull readers in, clearly stating niacin's benefits, the article then proceeds to scare the pants off you with side-effects.

But look to the side and above the text: Ah . . . two prominent advertisements for Lipitor, complete with Dr. Robert Jarvik's photo. "I've studied the human heart for a lifetime. I trust Lipitor to keep my heart healthy."

Niacin bad. Lipitor good. Even celebrity doc says so. Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."

Who is Dr. Jarvik, anyway, that he serves as spokesman (or at least figurehead) for this $13 billion dollar a year drug? Of course, he is the 1982 inventor of the Jarvik artificial heart, surely an admirable accomplishment. But does that qualify him to speak about heart disease prevention and cholesterol drugs?

Jarvik has never--never--actually prescribed Lipitor, since he never completed any formal medical training beyond obtaining his Medical Doctor degree, nor has he ever had a license to practice medicine. He does, however, continue in his effort to provide artificial heart devices, principally for implantation as a "bridge" to transplantation, i.e., to sustain a patient temporarily who is dying of end-stage heart failure.

So where does his expertise in heart disease prevention come from? It's beyond me. Perhaps it was the thousands of dollars likely paid to him. That will make an "expert" out of just about anybody.

Robert Bazell, science reporter, for CNBC, made this report on the Jarvik-Lipitor connection in his March, 2007 report, Is this celebrity doctor's TV ad right for you?

Mr. Bazell writes:

On May 16, 1988, an editorial in the New York Times dubbed the artificial heart experiments, “The Dracula of Medical Technology.”

“The crude machines,” it continued, “with their noisy pumps, simply wore out the human body and spirit.”

Since then, in a series of start-up companies, Jarvik has continued his quest to make an artificial heart — as have several other firms. One competitor recently won FDA approval to sell its device for implantation in extreme emergencies.

Perhaps Jarvik’s chances of success with another artificial heart account for his willingness to serve as pitchman for Pfizer. I inquired, without success, to find the going rate for a semi- celebrity like Jarvik to appear in such ads. Thomaselli of Advertising Age said whatever it is, it is “infinitesimal” compared to Pfizer’s expenditures of $11 billion a year on advertising, much of it for Lipitor.

Why spend so much marketing Lipitor?

Because Lipitor is only one of six drugs in the class called statins that lower cholesterol. Many cardiologists say that for the vast majority of people any one of these drugs works just as well as the other. Two of them, Mevacor and Zocor, have already lost their patent protection so they cost pennies a day compared to $3 or more a day for Lipitor.

In 2010, when Lipitor loses its patent protection, it, too, will cost pennies a day, and Pfizer will no longer need Dr. Robert Jarvik.



So, is niacin so bad after all? Or is this Everyday Health report just another clever piece of advertising for Pfizer?
Tags :

Comments (5) -

  • jpatti

    10/20/2007 8:43:00 PM |

    When you're diabetic, so many drug choices wind up being about that.  For instance, I was switched to carvedilol (at my request) as it's the only beta-blocker that doesn't raise bg and actually seems to improve insulin resistance.

    I think it is true that niacin at doses therapeutic enough to effect lipid panels is a drug, not a vitamin.  This isn't to say it's bad, but that it has to be evaluated as a drug.  And the best I've been able to find wrt to niacin use in diabetics is that 1-1.5 g of extended release only raises bg slightly.  

    However, the increased A1c, even if slight, bothers me.  Even in non-diabetics, A1c is highly correlated with heart disease; very slight changes seem to be significant.  So it is difficult to decide if the increased glycolyation of blood proteins outweighs the benefits of niacin.  

    Have you seen improvements in heart scan scores in diabetics treated with niacin?

  • Dr. Davis

    10/21/2007 12:59:00 AM |

    Yes, dramatic reductions in heart scan scores, in fact.

    I think that the glucose/niacin interaction needs to be evaluated individually, since it can vary enormously from one person to another, though usually small to minimal.

  • over&out

    10/21/2007 11:16:00 PM |

    1500 niacin has lowered my LP(a)from 90 to 28. Also alternate between 10mg and 5mg daily of Lipitor to keep LDL & Trigs about 35. Cardiologist says "less trains = less passengers". HDL at 60-70. Found Immediate release worked best for me. Reading good things about that combo on PUBMED.com. Doing it for 5 yrs now. Thanx for your helpful posts, a must read for me every day. Over&Out

  • Ruth

    11/18/2007 9:11:00 PM |

    I just want to thank you for you site.  I was actually doing some research for a criminal justice class and found more info than I was looking for, I will be back to your site, I have parents in their 80's and my mom is diabetic, I found info on here that will help her, my stepdad and my mother in law.  Have a wonderful day!

  • buy jeans

    11/4/2010 6:35:01 PM |

    Niacin bad. Lipitor good. Even celebrity doc says so. Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."

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Victim of Post-Traumatic Grain Disorder

Victim of Post-Traumatic Grain Disorder

20. June 2009 William Davis (14)
Heart Scan Blog reader, Mike, shared his story with me. He was kind enough to allow me to reprint it here (edited slightly for brevity).



Dr. Davis,

I was much intrigued to stumble onto your blog. Heart disease, nutrition, and wellness are critically important to me, because I’m a type 2 diabetic. I’m 53 and was diagnosed as diabetic about 5 years ago, though I suspect I was either diabetic or pre-diabetic 5 years before that. Even in a metropolitan area it's next-to-impossible to find doctors sympathetic to any approach beyond the standard get-the-A1c-below 6.5, get LDL <100, get your weight and blood pressure normal, and take metformin and statins.

I’m about 5’10-and-a-half and when I was young I had to stuff myself to keep weight on; it was an effort to get to 150 pounds, and as a young man, 165 was the holy grail for me. I always felt I’d look better with an extra 10-15 pounds.
I ate whatever I wanted, mostly junk, I guess, in my younger years.

When I hit about age 35, I put on 30 pounds seemingly overnight. As I moved toward middle age I became concerned with the issue of heart health, and around that time Dr. Ornish came out with his stuff. I was impressed that he’d done a
study that supposedly showed measurable decrease in atherosclerotic plaque, and had published the results of his research in peer-reviewed journals. It looked to me as though he had the evidence; who could argue with that? I tried his plan on and off, but as so many people note, an almost-vegan diet is really tough. It was for me, and I could never do it for any length of time. But given that the “evidence” said that I should, I kept trying, and kept beating up on myself when I failed. And I kept gaining weight. I got to almost 200 pounds by the time I was 40 and have a strong suspicion that that’s what caused my blood sugar to go awry, but my doctor at the time never checked my blood sugar, and as a relatively young and healthy man, I never went in very often.

I’ve had bouts of PSVT [paroxysmal supraventricular tachycardia, a rapid heart rhythm] every now and again since I was 12 or so. I used to convert the rhythm with Valsalva, but as I moved into my forties, occasionally my blood pressure would be elevated and it made me nervous to do the procedure because it was my understanding that it spikes your blood pressure when you do it. So I began going to the ER to have the rhythm converted, which they do quite easily with adenosine. On one of my infrequent runs to the ER to get a bout of PSVT converted, they discovered my blood glucose was 500 mg/dL, and I’d never experienced any symptoms! They put me in the hospital and gave me a shot of insulin, got it town to 80 mg/dL easily,
diagnosed me as diabetic, and put me on 500 mg. metformin a day.

I was able to get my A1c down to 7, then down to 6.6, and about that time I read a number of Dr. Agatston’s books, and began following the diet, and pretty quickly got my A1c down to 6.2, and my weight down, easily, to 158. That was fine with my doctor; he acted as though I was in good shape with those numbers. Soon I ran into Dr. Bernstein’s material, and came face to face with a body of research that suggested I needed to get the A1c down to below 5! That was both discouraging and inspiring, and frankly it’s been difficult for me to eat as lo-carb as I appear to need to, so I swing back and forth between 6.2 and 6.6. I know I need to work harder, be more diligent in my carb control, and I see with my meter that if I eat low-carb I have great postprandial and fasting blood sugars, but since I don’t particularly get any support or encouragement from
either my doctor or my wife for being so “radical,” it’s hard to pass the carbs by.

One thing that always confused me was that though I saw on my meter that BG [blood glucose] readings were better with a lo-carb diet, and though I saw the preliminary research suggesting that lo-carb could be beneficial in controlling CVD, I didn’t understand why Ornish had peer-reviewed research demonstrating reversal of atherosclerosis on a very-lowfat diet. How could two opposing approaches both help? I wondered if it were possible that one diet is good for diabetes, and the
other good for heart health. That would mean diabetics are screwed, because they always seem to end up with heart disease.

From time to time I’d look for material that explained this seeming contradiction. I was determined to try to stay lo-carb, simply because I saw how much better my blood sugars are when I eat lo-carb; but it’s hard in the face of this or that website that tells you about all the dangers of a lo-carb diet and that touts the lo-fat approach. That tends to be the conventional wisdom anyway.

Finally in one of those searches I came across your material, and saw you offer what was at last an explanation of what Ornish had discovered--it wasn’t a reversal of atherosclerotic plaques he was seeing; it was that his diet was improving endothelial dysfunction in people who had had high fat intakes.

Odd as it may seem to you, that little factlet has been enough to allow me to discard entirely the lingering ghost of a suspicion that I ought to be eating very-lowfat. In fact, I was very excited to see your claim that your approach can reverse atherosclerotic plaque.

It would be nice to find a doctor who’d be supportive of your approach. My doctor isn’t much interested in diet or
nutrition. He just wants my weight in the acceptable range, my blood pressure good, and my LDL 100 or below (which I know isn’t low enough). He’s not particularly interested in getting a detailed lipid report. I hope I can talk him into ordering one so that it’s more likely I can get it covered by my insurance.

I very much appreciated the links you gave to Jenny’s diabetes websites, and I’ve resolved to get even better control of my BG by being more diligent with my diet. I’m planning on joining your site, reading your book, and following your advice. I just have this sort of deflating feeling that it would have been better if I’d stumbled upon this before I had diabetes. Still, it’s nice to have a site that offers to laypeople the best knowledge available concerning how to take care of their heart.



Mike is yet another "victim" of the "eat healthy whole grains" national insanity, the Post-Traumatic Grain Disorder, or PTGD. The low-fat dietary mistake has left many victims in its wake, having to deal with the aftermath of corrupt high-carbohydrate diets: diabetes, heart disease, and obesity.

We should all hope and pray that "low-fat, eat healthy whole grains" goes the way of Detroit gas guzzlers and sub-prime mortgages.
Tags :

Comments (14) -

  • Gretchen

    6/20/2009 2:03:19 PM |

    I don't think Ornish has ever shown that his diet results in plaque regression. What he showed was that his total program, including diet, exercise, stress reduction, giving up smoking, and lots of peer support reduced plaque. Then everyone ascribes the results to the diet alone.

    This is analogous to the studies that lump red meat into a diet group that includes cold cuts, sausages (including chicken sausage) and a lot of other things and then blame the red meat for the poorer results.

    You never see headlines saying "Chicken (sausage) is bad for you."

  • Peter

    6/20/2009 3:05:10 PM |

    I appreciate that letter, because I also try to keep on current research and it's hard to know which research to believe, since there's a fair amount of research that supports whole grains and a fair amount that supports a low carbohydrate diet.  I'm not a true believer type, so I'm looking forward to better research.  I notice that in Gary Taubes's book he says there has been no trustworthy research comparing the low carb and the whole food/whole grain diets, and I'm looking forward to it when it comes out.

  • Tom

    6/20/2009 5:44:16 PM |

    Yes, my guess is that *stress reduction* is key to the Ornish plan. The other components are really just contributors to this overall result, with the exception of the vegetable diet, which probably doesn't help.

    I don't write an excellent blog or care for any patients. Perhaps I may therefore indulge my speculations, safe in the knowledge that those who wish to ignore me will feel free to do so:


    Stress is normally thought of as something unpleasant that we try to avoid. And indeed it is, partly we do try to avoid it.

    But in truth we are addicted to stress. We interpret a rapidly beating heart, high blood pressure, racing thoughts, etc, as pleasurable.

    And they are. Or at least they seem to be (hangovers aside), from the perspective of the part of us that experiences them.

    Trouble is they are damaging to the whole. For example, pleasure/stress numbs subtle feelings which might otherwise yield clues to solving our personal problems. Our immune systems our temporarily dampened (presumably an evolutionary adaptation).

    Only relaxation and meditation (which we all do to a certain extent, whether we realise it or not), allow the mind to re-integrate and experience the deeper, forgotten joy of being alive.

    I believe that here, and not in calorie burning, lies the secret benefit of exercise: diverting attention into the body and away from the frenetic mind.

    I have no evidence for this that I can share, only a limited amount of fallible personal experience. But let me say that I have *felt* my blood pressure go down after a meditation session.

    And upon standing up afterwards, I've become dizzy, which is a symptom of hypotension!

  • Anne

    6/20/2009 6:36:35 PM |

    In a totally uncontrolled study of one, here are the results.

    While on the American Heart Association diet my lipids peaked in 2003. I even tried the Ornish diet for a short time, but found it impossible.
    Total Cholesterol: 201
    Triglycerides: 263
    HDL: 62
    LDL: 86

    After I stopped eating gluten(I am very sensitive) my lipid panel improved slightly. This past year I started eating to keep my blood sugar under control by eliminating sugars and other grains. Now this is my most recent lab:
    Total Cholesterol: 162
    Triglycerides: 80
    HDL: 71
    LDL: 75

    Not perfect, but getting there. I think I had a very serious case of post traumatic grain disorder.

  • TedHutchinson

    6/20/2009 9:39:05 PM |

    Gary Taubes recent lecture
    For those who haven't yet read
    Gary Taubes Good Calories Bad Calories
    this talk is based on just a fraction of the research he discusses in greater detail in the book.
    There are earlier version of this lecture online, this version is slicker, more jokes, and you can use the thumbnail slides to move around faster.
    Slides 41~49 are the crux of the matter.
    Interesting to hear what he says right at the end of slide 48.

  • Dr. William Davis

    6/21/2009 2:24:20 AM |

    Anne--

    I love it!

    I'd like to post your numbers in a future Heart Scan Blog post.

    Thanks for sharing. Your experience is bound to help others also "see the light."

  • Kateryna

    6/21/2009 3:24:36 AM |

    Dr. Davis:

    I'm 59 years old, was very sick, and if I had waited as others do for scientists to come to a consensus about diet and nutrition and for studies to be done, I would have died 13 years ago.

    If you value your health a short 1 month trial of a grain free diet will tell you immediately if it's right for you especially if you have health issues. Don't be afraid to experiment.

    As I said, I'm 59 and I'm still overweight, but I have resolved almost all my health issues by eliminating all sugar, processed foods and all grains and here are my latest lipids:

    Total: 182
    LDL: 95
    HDL: 65
    Trigs: 104
    Ratio: 2.6

    Also not perfect, but I know it will only get better as it has been for years.

  • Anonymous

    6/21/2009 4:25:40 AM |

    Some of the readers of this blog should be gluten free and not just wheat free. How to find which ones?
    IMO, Mike's difficulty in keeping on weight as a younger man indicates he should consider further testing for gluten intolerance or perhaps other food intolerances.

  • Anne

    6/21/2009 12:46:12 PM |

    Dr. Davis, you have my permission to post my numbers, use my name and use my picture.

    Thank you for thinking outside the box. I have coronary artery disease and had bypass in 2000 and I don't want to do that again ever. By incorporating TYP guidelines into my life, I feel I have greatly decreased  my odds of having more heart problems.

  • Anonymous

    6/21/2009 5:33:26 PM |

    I tried moving back to meat and giving up wheat/grains.  My blood lipid chemistry did not improve and I have to remind myself, a meat based diet is how I got here in the first place (2002) and why my father and his brothers had heart attacks at relatively young ages.

    Until I see a pier reviewed study showing grains are causal to heart disease, I'm going back to what has kept me from suffering the same fate as my father. No animal products in my diet.

    I'm off to make a few seitan steaks for the bbq

  • Grandma S.

    6/22/2009 12:11:12 AM |

    Anne,
    I am very impressed with your results.  Having trouble getting my husband's & my LDLs that low.  Would like to know in more detail how you are doing it, can you email me? Thank You!

  • Dr. Usha C

    7/22/2009 7:02:29 PM |

    Homeopathy Diet Planning
    Homeopathy together with proper diet can make wonders in medical field creating ability to treat most diseases effectively.

    For more information log on to
    http://homeopathydiets.blogspot.com/

  • simvastatin side effects

    5/23/2011 7:41:44 AM |

    Only relaxation and meditation (which we all do to a certain extent, whether we realise it or not), allow the mind to re-integrate and experience the deeper, forgotten joy of being alive.

  • Vegan4life

    5/8/2013 10:49:01 AM |

    Well said, Anonymous!  Going VEGAN (and not merely vegetarian) is best for ones health, mind and spirit - and vital for anyone who has heart and/or weight problems, type-2 diabetes, high blood pressure, bad cholesterol, asthma, etc., or a family history thereof.

    "Anonymous says:

    June 21, 2009 at 11:33 pm

    I tried moving back to meat and giving up wheat/grains. My blood lipid chemistry did not improve and I have to remind myself, a meat based diet is how I got here in the first place (2002) and why my father and his brothers had heart attacks at relatively young ages.

    Until I see a pier reviewed study showing grains are causal to heart disease, I'm going back to what has kept me from suffering the same fate as my father. No animal products in my diet... "

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Flat tummy . . . or, Why your dietitian is fat

Flat tummy . . . or, Why your dietitian is fat

19. December 2008 William Davis (19)
When I go to the hospital, I am continually amazed at some of the hospital staff: 5 ft 4 inch nurses weighing over 200 lbs, etc.

But what I find particularly bothersome are some (not all) hospital dietitans--presumably experts at the day-to-day of healthy eating--who waddle through the halls, easily 40, 50, or more pounds overweight. It is, to say the least, credibility-challenging for an obese dietitian to be providing nutritional advice to men or women recovering after bypass or stent while clearly not in command of nutritional health herself.

What's behind this perverse situation? How can a person charged to dispense "healthy" nutritional information clearly display such clear-cut evidence of poor nutrition?

How would you view a success coach dressed in rags? Or a reading coach who can barely read a sentence?

Easy: She follows her own advice.

Hospital dietitians are essentially forced to adhere to nutritional guidelines of "official" organizations, such as the American Heart Association and the USDA. There is some reason behind this. Imagine a rogue dietitian decides to advocate some crazy diet that yields dangerous effects, e.g., high-potassium diets in people with kidney disease. There is a role for oversite on the information any hospital staff member dispenses.

The problem, of course, doesn't lie with the dietitian, but with the organizations drafting the guidelines. For years, the mantra of hospital diets was "low-fat." More recently, this dated message has begun--only begun--to falter, but now replaced with the "healthy, whole grain" mantra. And that is the advice the hapless dietitian follows herself, unwittingly indulging in foods that make us fat.

Sadly, the "healthy, whole grain" message also contributes to heart disease via drop in HDL, increased triglycerides, a huge surge in small LDL, rise in blood sugar, increased resistance to insulin, tummy fat, and diabetes. Yes, the diet provided to survivors of heart attack increases risk.

The "healthy, whole grain" message also enjoys apparent "validation" through the enormous proliferation of commercial products cleverly disguised as healthy: Cheerios, Raisin Bran, whole grain bread, whole wheat pasta, etc. The "healthy, whole grain" message, while a health disaster, is undoubtedly a commercial success.

I'll bet that our fat dietitian friend enjoys a breakfast of healthy, whole grains in skim milk, followed by a lunch of low-fat chicken breast on two slices of whole grain bread, and ends her day with a healthy meal of whole wheat pasta. She then ascribes her continually climbing weight and size 16 figure to slow metabolism, lack of exercise, or the once-a-week piece of chocolate.

Wheat has no role in the Track Your Plaque program for coronary plaque control and reversal. In fact, my personal view is that wheat has no role in the human diet whatsoever.

More on this concept can be found at:

What's worse than sugar?

The Wheat-Deficiency Syndrome


Nutritional approaches: Large vs. Small LDL

Are you wheat-free?
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Comments (19) -

  • Brock Cusick

    12/20/2008 5:26:00 PM |

    Dr. Davis,

    In your clinical practice, do you see good results from patients who continue to eat oats and/or brown rice as long as they cut out sugar, wheat and corn?  

    I ask because Dr. Weston Price's research found examples of cultures that used these grains (oats and rice) while continuing to exhibit signs of good health. He did not have access to modern diagnostics however, so perhaps he missed some indicators.

    Kind regards,

    Brock Cusick

  • baldsue

    12/20/2008 7:16:00 PM |

    Each time I contemplated seeking advice from a dietitian, I changed my mind after I saw the dietitian and decided I was doing well enough on my own.  Never felt like I could believe or trust dietary advice from someone whose BMI was obviously higher than my own.

    And I love my new flat stomach.

  • Anonymous

    12/20/2008 9:44:00 PM |

    My father had surgery 7 years ago at a well known Indianapolis hospital. During visitation I could not help but notice how overweight (some obese) the female receptionists and nurses were. They all looked to be in their early to mid 30s.I was speechless.

  • Anonymous

    12/21/2008 7:40:00 AM |

    that's what can happened even to a best-selling author of diet books http://tinyurl.com/8d4d4m

    in my country there's a saying "a shoemaker that walks on bare feet"

  • Anonymous

    12/21/2008 7:42:00 PM |

    http://www.ncbi.nlm.nih.gov/pubmed/19083495

    Long-term consumption of a carbohydrate-restricted diet does not induce deleterious metabolic effects

  • Leniza

    12/22/2008 5:51:00 PM |

    I don't think that overweight dieticians (and nurses, and doctors)even follow their own advice. Not that that advice isn't garbage anyway, but I doubt that whole grains and lots of fruit and lean meats make up the bulk of their diets. It's probably more the case that these people aren't following the rules they give their patients (not that the rules would work, anyway). "Knowing" something and choosing to do it are two different things. I completely agree with you on sugar and wheat, but that doesn't mean I'm not going to indulge without guilt during the holidays (I don't have any health problems, though.)

    It's like with smoking. People KNOW it's bad for them, but they still do it. I know several doctors who tell their patients to quit smoking, but who smoke like chimneys themselves. I used to work with a PULMONARY PATHOLOGIST who was a chain smoker.

  • Jean-Luc Boissonneault

    12/22/2008 7:40:00 PM |

    Thank you, I'm so glad you said this! This makes me sick! I say practice what you preach or don't preach at all. At my personal training centre, my trainers are all in good shape. I tell them it's like a hopelessman giving financial advice.

  • Anonymous

    12/23/2008 3:27:00 PM |

    Dr. Davis, thought you'd find this interesting:

    http://www.sciencedaily.com/releases/2008/12/081215184308.htm

    Journal reference:

       1. Piconi et al. Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness.

    The FASEB Journal, 2008; DOI: 10.1096/fj.08-119578

  • Ricardo Carvalho

    12/29/2008 1:16:00 PM |

    Dear Dr. Davis, I suppose the WHO wants everyone to be fat, don't they?! Nutritionists simply follow these poor recommendations. Who's fault? -> http://www.euro.who.int/nutrition/20030321_1

  • extropolitca

    12/29/2008 11:03:00 PM |

    WHO is right in his recommendation.
    Right with the mean of the people living on Earth.
    I'm italian, living in Italy.
    Mediterranean diet (the real deal) is very good if you are a peasant in agricultural job doing hard work (4.000 Kcal/day). Than you can eat your pound or two a day of bread plus salami, cheese and olive oil and fruits, be full, lean and healthy.

    You move to city, start to work in an office, cut all to 2.000 kCal/day proportionally and you find yourself hungry, gaining fat and lacking minerals and vitamins with the same diet.

  • Juhana Harju

    1/1/2009 1:22:00 PM |

    This is a naughty blog entry... but I agree. Smile I have been pondering the same question.

    While I approve the use of whole grains, I agree with Extropolitcan's view that reduced energy expenditure should lead to changes in diet. We should probably use more nutrient dense foods. I would also like to promote the idea of moderation, which is really a beautiful and positive idea, not appreciated enough in our Western culture.

    Wishing everyone a Happy New Year,

    Juhana Harju
    BMI 22

  • Anonymous

    11/25/2009 5:35:44 PM |

    I've seen more fat doctors than fat dietitians. I'm a dietitian and I'm at a perfect body weight, AND I follow my own advice, which is to eat in moderation. This is an extremely unfair stereotype to make. Between doctors and nurses thinking they know all about nutrition with minimal education in it, and patients asking for advice and then telling you that you're wrong right to your face, it's no wonder clinical nutrition has such a high burnout rate and low rate of job satisfaction.

  • Anonymous

    5/13/2010 1:52:39 AM |

    I'm a fat dietitian, and we fat dietitians know how much we are hated.

    I find it interesting that the topic of "dietitians that follow their own advice" had to be written with such contempt. Consider the message your readers came away with...many commented on their contempt of fat people rather than grasping the diet advice you are promoting. "A naughty post" BMI 22 wrote. Why naughty? Because ridiculing someone for being fat is still acceptable behavior in this part of the world, even though we know we should not "throw stones". Consider promoting your message without inciting the contempt of others.

    In addition, consider how being fat can't be hidden, the way other characteristics can. For example, what physical characteristics are required of a realtor, plumber, grocery clerk, insurance salesperson? It might not matter if they were fat since they are not dispensing "health" advice, but consider all of the unseen ways they might deviate from the norm.

  • Anonymous

    7/6/2010 6:47:04 PM |

    I'm a dietitian as well, and although not "fat", I find it challenging to maintain weight. This not because of any "bad" advice I'm giving, it's just the way life is sometimes.

    That said---I hope that someday you are publicly ridiculed for something you struggle with. I hope you are ridiculed for your imperfections, which I'm sure you have. Dietitians aren't any more perfect than anyone else. Just because we understand the physiology behind things doesn't mean that life is any easier for us. Maybe the "fat dietitian" in the hallway has things going on in her life that you don't know about, and you should keep your "fat" mouth shut about it.

  • buy jeans

    11/4/2010 6:34:29 PM |

    Sadly, the "healthy, whole grain" message also contributes to heart disease via drop in HDL, increased triglycerides, a huge surge in small LDL, rise in blood sugar, increased resistance to insulin, tummy fat, and diabetes. Yes, the diet provided to survivors of heart attack increases risk.

  • Michael Scott

    10/1/2011 2:31:15 AM |

    I'm 69 and have been on Atkins, level one, for a little more than eleven years.  I now consider myself a "former" overeater because as long as I remain below twenty grams of carbs per day, I'm totally in control of my eating.  Even after eleven years I understand that my chances of ever being able  to eat more than 20 grams of carbs per day will never happen!  Like an alcoholic, whenever I reach my "carb limit" I have to stop at that point.  I can't eat even a single bite of any grain products without "falling off the wagon".  A single bite of bread or pizza crust and I become an alcoholic with food!  I'm just amazed that more dietitians  are not overweight eating grains.  Anyone who can eat grains and still remain under 400 pounds has my admiration.

    Mike Scott

  • Dr. William Davis

    10/1/2011 1:45:47 PM |

    Hi, Mike--

    Your experience is something like my personal experience, though my carbohydrate cutoff is around 30 grams per day. Some of us are just not equipped to handle the high insulin requirement, while others can get away with much more. Find your individual path and stick to it!

  • Michael Scott

    10/1/2011 3:21:52 PM |

    This information is for the dietitian who suggested eating in moderation.  Is this the same advice we give to an alcoholic?  Do we tell them to drink in moderation?   About the only advice an over eater receives from a doctor or dietitian is:  Starve yourself for the rest of your life and don't forget to kill yourself exercising!  Now we all know that these may not be their exact words, but trust me that is exactly what an over eater hears just before going into “full panic mode”.  When my eating was “totally out of control”, I had as much chance of stopping at one slice of bread as a “down and out” alcoholic has of stopping after one drink!  Until we all understand this, there is almost no long term hope for a “fat” person.  We do not suggest that an alcoholic drink in moderation for a very good reason.  How can we advise someone with a major eating disorder to eat the very foods they are addicted too.  Had I not given up whole grains, fruit and any high carb vegetables, I would now be 400 pounds.  I learned this thanks to Dr. Atkins.  If not for him I wouldn't be here now.  How many 400 pound, 69 year old men do you know?  Moderation of grains/alcohol will never work.  

    Michael Scott (again)

  • Dr. William Davis

    10/2/2011 2:44:08 PM |

    Well said, Michael!

    You make a crucial point: How many 400 pound, 69 year old men do you know?

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Dr. David Grimes reminds us of vitamin D

Dr. David Grimes reminds us of vitamin D

3. November 2009 William Davis (13)
In response to the Heart Scan Blog post, Fish oil makes you happy: Psychological distress and omega-3 index, Dr. David Grimes offered the following argument.

Dr. Grimes is a physician in northwest England at the Blackburn Royal Infirmary, Lancashire. He is author of the wonderfully cheeky 2006 Lancet editorial, Are statins analogues of vitamin D?, questioning whether the benefits of statin drugs simply work by way of increased vitamin D blood levels.


There is a fashionable interest in Omega-3 fatty acids, and these become equated with fish oil.

But fish oil is much more. Plankton synthesise the related squalene (shark oil) which, in turn, is converted into 7-dehydrocholesterol (7-DHC). The sun now comes into play and it converts 7-DHC into vitamin D (a physico-chemical process).

Small fish eat plankton, large fish eat small fish, and we eat large fish. So vitamin D passes through the food chain.

This has been a vital source of vitamin D for the the Inuits and also for the Scots and other dwellers of northwest Europe. (Edinburgh is on the same latitude as Hudson Bay and Alaska, further north than anywhere in China). In these locations there is not adequate sunlight energy to guarantee synthesis of adequate amounts of vitamin D, again by the action of sunlight on 7-DHC in the skin.

When the Scots moved from coastal fishing villages to industrial cities such as Glasgow, they became seriously deficient in vitamin D, and so the emergence of rickets. This was followed by a variety of other diseases resulting from vitamin D deficiency: tuberculosis, dental decay, coronary heart disease, and even multiple sclerosis and depression (the Glasgow syndrome).

And so it was with the Inuits. When their diet changed from fish for breakfast, fish for lunch, fish for dinner, they became deficient of vitamin D and they developed diseases characteristic of industrial cities, where there is indoor work for long hours, indoor activities, and atmospheric pollution.

It is the vitamin D component of fish and fish oils that is important.

I recently saw an elderly lady from Bangladesh living in northwest England. I would have expected her to have a very low blood level of vitamin D, as her exposure to the sun was minimal. However the blood level was 47ng/ml, not 4 as expected. She eats oily fish from Bangladesh every day, showing its value as a source of vitamin D with subsequent good health. I expect her blood levels of omega-3 fatty acids would also be high.

But it is unfashionable vitamin D that is important, not fashionable omega-3.

David Grimes
www.vitamindandcholesterol.com


Excellent point. The health effects of omega-3 and vitamin D are intimately intertwined when examining populations that consume fish.

In this study of Inuits, it is indeed impossible to dissect out how much psychological distress was due to reduced vitamin D, how much due to reduced omega-3s. My bet is that it's both. Thankfully, we also have data examining the use of pure omega-3 fatty acids in capsule (not intact fish) form, including studies like GISSI Prevenzione.

Nonetheless, Dr. Grimes reminds us that both vitamin D and omega-3 fatty acids from fish oil play crucial roles in mental health and other aspects of health, and that it's the combination that may account for the extravagant health effects previously ascribed only to omega-3s.
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Comments (13) -

  • moblogs

    11/3/2009 9:29:35 AM |

    Dr. Grimes is a great man. He took a bit of time out to answer a few of my questions by email.

  • Anonymous

    11/3/2009 2:19:24 PM |

    Thank you for the great site. I have learned much from coming here. I recently purchased some vitamin D3 and krill oil. What would be the proper dose per day?
    Thank you.

  • Anne

    11/3/2009 2:45:52 PM |

    Dear Dr Davis,

    I had no idea that fish contained a lot of vitamin D, I knew they contained some but I didn't think it was a lot - maybe this explains my continuing over high 25(OH)D results  - currently 250 nmol/L (100 ng/dl). I only take 2,000 IU D3 per day but I eat lots of oily fish ! I eat a can of sardines every day and large portions of salmon and seabass several times per week. If this is why my 25(OH)D is so high that would be something important to inform my endocrinologist about.

    Anne

  • Adolfo David

    11/3/2009 10:01:30 PM |

    Ummm, but vitamin D elevates HDL cholesterol and statins do not elevate HDL. This analogy is confusing for me at this point, isnt it?

    It has been great to find this blog, I support time ago Omega3 EPA DHA and Vitamin D3 supplementation and also I am LEF member time ago, in whose magazine I have read great articles by Dr Davis. Congratulations from Europe.

  • Adolfo David

    11/3/2009 10:06:39 PM |

    Thinking about that analogy, well statins could active vitamin D receptors with no increase in vitamin D in blood.

    For example, resveratrol can activate vitamin D receptors at least in cancer cells and obviously resveratrol does not increase HDL nor vitamin D (of Steroid Biochemistry and Molecular Biology, february 2003)

  • Dr. William Davis

    11/3/2009 11:39:17 PM |

    Yes, I think that trying to attribute ALL statins' effects to an increase in vitamin D is a stretch. But I believe there's credible evidence to suggest that at least some of the statin effect is due to D.

    Personally, I'd rather take vitamin D and use little or not statin.

  • Michelle

    11/4/2009 1:15:22 AM |

    Great post! This seems to be another example of what can happen when nutrients are taken/studied on their own, instead of in their original context.  I don't discount the credibility of supplements, but so often it seems whole foods are the best.

  • blogblog

    11/5/2009 12:54:21 PM |

    Had Dr Grimes spent two minutes researching the facts he would have realised his theory is highly implausible. Fish oil contains negligible Vitamin D. You would need to consume a whopping 100g of sardine oil every day to get a mere 332iu of vitamin D. http://www.nutritiondata.com/facts/fats-and-oils/633/2 (based on USDA data). However eating large quantities of fish would supplement vitamin D levels.

    Rural Scots and Inuits would have obtained ample vitamin D (up to 8000iu/day) by spending time outside during Spring-Summer-Autumn. The body stores vitamin D for 3-4 months.

    The effects of fish oil and vitamin D are almost certainly separate although some synergistic effect may be present.

  • blogblog

    11/5/2009 1:31:45 PM |

    One of my university biochemistry lecturers said to me many years ago  'nutritional epidemiology is BS because it doesn't account for genetic differences'.

    Inuits don't need high intakes of vitamin D because most of them have the bb allele of the vitamin D receptor. This mutation is also common in other Asian populations This means they use vitamin D extremely efficiently. People with the bb allele have a significantly lower incidence of rickets, osteoporosis and prostate cancer (and presumably depression and heart disease).

    Nocturnal mammals have extremely low vitamin D needs due to extremely efficient vitamin D metabolism. Fruit bats have no detectable serum vitamin D.

  • Dr. William Davis

    11/5/2009 4:06:38 PM |

    Hi, Blogblog--

    I believe Dr. Grimes is referring only to consumption of fish, not fish oil capsules.

    I wasn't aware of the VDR polymorphism in Inuits. Thanks for that insight.

  • buy jeans

    11/4/2010 5:12:42 PM |

    When the Scots moved from coastal fishing villages to industrial cities such as Glasgow, they became seriously deficient in vitamin D, and so the emergence of rickets. This was followed by a variety of other diseases resulting from vitamin D deficiency: tuberculosis, dental decay, coronary heart disease, and even multiple sclerosis and depression (the Glasgow syndrome).

  • Dr David S Grimes

    8/15/2011 9:46:35 PM |

    If you would like to know a bit more about Vitamin D, you could look at 3 three recent lectures that I gave in London in the Spring of 2011. They are available on You Tube :

    Vitamin D clinical experience
    http://www.youtube.com/watch?v=y_mCewkvoFc

    Vitamin D and cancer
    http://www.youtube.com/watch?v=qoXZHhKjVvU&feature=related

    Vitamin D and pregnancy – inheritance
    http://www.youtube.com/watch?v=TIo9a56nOwI&feature=related

    David Grimes

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Second heart scan and heart attack risk

Second heart scan and heart attack risk

9. January 2007 William Davis (0)
At first, Joe felt disappointed, defeated, and frightened. After his heart scan, a radiologist at the center told him that his score of 264 was moderately high. He told Joe that he was at moderate risk for heart attack and that a nuclear stress test was going to be required.

This left Joe feeling confused. After all he'd had a heart scan 18 months earlier and his score was 278, 5% higher.

I reassured Joe that the radiologist had not been aware that Joe had a prior heart scan. The radiologist didn't know that Joe's heart scan score had actually been reduced.

In fact, Joe's risk for heart attack was not moderate--it is now very low, since his score was 5% lower. While growing plaque is active plaque, shrinking plaque is inactive plaque and thereby at far less risk for heart attack.

I wrote about this phemonenon in a previous Blog: When is a heart scan score of 400 better than 200? at http://heartscanblog.blogspot.com/2006_09_01_archive.html. When you've had more than one scan, the risk for heart attack suggested by the score takes a back seat to the rate of change of your score. In other words, even though Joe's score of 264 represented a moderate risk (of approximately 3% per year, roughly 30% over 10 years), this no longer held true, since it actually represented a 5% decrease over a previous score.

Joe's risk for heart attack is probably close to zero. ALWAYS view your second (or any subsequent) heart scan score in the context of your previous score, not in isolation.

Track Your Plaque newsletter subscribers: We will detail more of Joe's story in the coming January 2007 newsletter. If you'd like to read or subscribe to the newsletter, go to http://www.cureality.com/f_scanshow.asp.
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