Is glycemic index irrelevant?



University of Toronto nutrition scientist, Dr. David Jenkins, was the first to quantify the phenomenon of "glycemic index," describing how much blood sugar increased over 90 minutes compared to glucose. The graph is from their 1981 study, The glycemic index of foods: a physiologic basis for carbohydrate exchange. The research originated with an effort to characterize carbohydrates for diabetics to gain better control over blood sugar.

Since Dr. Jenkins’ original work, thousands of clinical studies have been performed by others exploring this concept. The food industry has also devoted plenty of effort exploiting it (e.g., low-glycemic index noodles, low-glycemic index cereals, etc.).

Most Americans are now familiar with the concept of glycemic index. You likely know that table sugar has a high glycemic index (60), increasing blood sugar to a similar degree as white bread (glycemic index 71). Oatmeal (slow-cooked) has a lower glycemic index (48), since it increases blood sugar less than white bread.

A number of studies have shown that when low glycemic index foods replace high glycemic index foods (e.g., whole wheat bread in place of cupcakes), people are healthier: less diabetes, less heart attack, less high blood pressure. Books have been written about glycemic index, touting its benefits for health and weight control. Health-conscious people will try to substitute low-glycemic index foods for high-glycemic index foods.

So what’s not to like here?

There are several fundamental flaws with the notion that low-glycemic index foods are good for you:

1) Check your blood sugar after a low-glycemic index food like oatmeal. Most non-diabetic adults will show blood sugars in the 140 to 200 mg/dl range. The more central (visceral) fat you have, the higher the value will be. In other words, an apparently “healthy” whole grain food like oatmeal can generate extravagantly high blood sugars. Repeated high blood sugars of 125 mg/dl or greater after eating increase heart disease risk by 50%.

2) Foods like whole wheat pasta have a low glycemic index because the blood sugar effect over the usual 90 minutes is increased to a lesser degree. The problem is that it remains increased for an extended period of up to several hours. In other words, the blood sugar-increasing effect of pasta, even whole grain, is long and sustained.

3) Low-glycemic index foods trigger other abnormalities, such as small LDL particles, triglycerides, and c-reactive protein (a measure of inflammation). While they are not as bad as high-glycemic index foods, they are still quite potent triggers.

Low-glycemic index foods trigger the very same responses as high-glycemic index foods—they’re just less bad. But less bad does not equate to good. Low-glycemic index foods cause weight gain, trigger appetite, increase blood pressure, and lead to the patterns that cause heart disease.

High-glycemic index foods are bad for you. This includes foods made with white flour (bagels, white bread, pretzels). Low-glycemic foods (whole grain bread, whole wheat crackers, whole wheat pasta) are less bad for you—but they are not necessarily good.

Don’t be falsely reassured by foods because they are billed as “low-glycemic index.” View low-glycemic index foods as indulgences, something you might have once in a while, since a slice of whole grain bread is really not that different from a icing-covered cupcake.

Comments (20) -

  • W8liftinmom

    2/16/2010 12:24:18 AM |

    If high GI foods are bad and low GI foods are just less bad, then what does that leave that is good?  Protein and fat?  Sounds good to me!

  • Health Test Dummy

    2/16/2010 12:35:35 AM |

    I absolutely love this post!

    So many people don't understand this basic concept.

    I have had to expose several 'health conscious' individuals at various health food stores as to WHY that Agave Nectar is just nature's 'High Fructose Corn Syrup'. Along with the Ethanol poisoning from the Fructose, their insulin is spike through the roof for longer than if they just ate table sugar!

    Thank you for continuing to educate the masses on the truth, instead of these horrific 'wives tales' that just don't seem to die!

  • mongander

    2/16/2010 2:37:32 AM |

    I was diagnosed a type 2 diabetic 30 years ago.  Now at age 70, I've lost 60 pounds through exercise and avoiding processed foods.  My breakfast every morning is boiled oats-groats and whole barley.  My vision is 20/20 and my A1C is always under 6%.  My diet is mostly vegetarian except for salmon or mackerel in my salad.  I usually avoid wheat products except when travelling or on social occasions.

  • Dr. William Davis

    2/16/2010 3:55:06 AM |

    Health Test: I love the "agave nectar is just nature's 'high-fructose corn syrup.'" Well said!

  • Anonymous

    2/16/2010 6:28:06 AM |

    What about Stevia? is stevia ok as a sugar substitute? please advise.

  • Alan

    2/16/2010 12:07:35 PM |

    I don't disagree with your comments on GI in general, although as an Aussie I believe  it should be noted that Jennie Brand-Miller had a great deal to do with the develpment of the GI/GL concept.

    As a type 2 diabetic I used the concept in a slightly different way. I used peak post-prandial testing to develop my own personal database of the effect of various foods on my own blood glucose levwels. In effect, a personal GL list.

    My main reason for commenting was this: "Check your blood sugar after a low-glycemic index food like oatmeal. Most non-diabetic adults will show blood sugars in the 140 to 200 mg/dl range." Although I agree that oatmeal would do that to me - probably worse than 11mmol/L(200mg/dL) I have doubts that it would do that to a non-diabetic. In my experience testing friends and relatives I have never tested anyone who had levels that high after a meal who was not subsequently diagnosed as a type 2. The non-diabetics I have tested, regardless of the carb load of the meal (usually a feast like Christmas) have never reached 8(144), let alone higher numbers.

    I would be interested to know if you have seen numbers like that personally in your clinical experience in non-diabetics, apart from those affected by medications like Prednisone. Or was the statement based on the experience of others?

    This is one of the few published examples that I am aware of showing post-prandial blood glucose levels in non-diabetics:
    http://www.diabetes-symposium.org/index.php?menu=view&chart=4&id=322

    Note particularly slides 17 and 27.

    Cheers, Alan
    http://loraldiabetes.blogspot.com/

  • Peter

    2/16/2010 12:30:38 PM |

    Why do you think the traditional extremely high carb Japanese diet
    left its population almost free of obesity and diabetes?

  • Renfrew

    2/16/2010 12:37:19 PM |

    Good post.
    In the last few years there has been a better parameter, called "Glycemic load" (GL).
    While GI is always the same, independent of HOW MUCH you eat, GL takes into account "portion size".
    This is important because if you are eating half an apple or 2 apples it will have the same GI regardless, but not the same GL.  

    Renfrew

  • Anonymous

    2/16/2010 12:44:11 PM |

    Asians eat lots of rice, and they're skinny. Therefore starch is good for you and should be consumed in large quantities. Buy my ebook, "The Edgy Contrarian Hipster Diet"!

  • Anonymous

    2/16/2010 12:58:53 PM |

    The Mercola mixed diet recommends eating occasional higher glycemic foods AFTER the rest of a meal...since this apparently blunts the insulin response.

    I've been indulging in oatmeal...eaten dry as a snack.  Also fruit.  Shame on me.

    Also beans as part of meals...not recommended (like wheat as far the effect on the gut?).  Not to mention the salted nuts roasted in hydrogenated oils.

    Still have some work to do.....

    I buy food only every 3 weeks or so...and I find that when I run out of "favorites" near the end of this period and am eating only lean meats...assorted veggies...olive oil...spices...I feel better.  Though I do seem to get a major itch to go buy some "junk food"...plus a kind of panic as far as running out of food.  

    Wondering WHY this is...since I do feel better...do I have addictions?  Need to go to a clinic to recover? Wink

    I may be addicted to the sugar rush???  The oatmeal rush? The bean rush?  The hydrogenated oil/nut rush?  

    Dependent on my food reactions?

  • Tony

    2/16/2010 1:18:46 PM |

    Hi Dr. Davis,

    If I remember correctly, in your book you recommend oat bran to decrease cholesterol.  Is that still the case?  (Many thanks for all the great work.)

  • Anonymous

    2/16/2010 2:31:46 PM |

    Thank you so much for this -- the proof is always in the testing and I abandoned many "low-GI" foods early on.  

    It sounds good, but ... I never had any success with it.  I thought it must be ME, and ended up feeling (more) sorry for myself.

  • Jeff

    2/16/2010 3:15:04 PM |

    "A slice of whole grain bread is really not that different from a icing-covered cupcake," except for the fiber, micronutrients, antioxidants, etc.

  • Dr. William Davis

    2/16/2010 4:06:46 PM |

    Alan--

    Yes, I've seen many, many people with either "normal" (<100 mg/dl or 5.5 mmol/L) or slightly increased blood glucose (100-110 mg/dl or 5.5-6.0 mmol/L) with high postprandial glucoses.


    Peter--

    I believe there are a number of reasons, including the use of rice in place of wheat. Being part Japanese, I am well aware of their eating habits which are not as high-carb as often made out. There are confounding factors, as well, including iodine content of the diet.

    Also, there are indeed fat, diabetic Japanese people, also. Diabetes is, in fact, a growing problem in Japan.

  • whatsonthemenu

    2/16/2010 7:17:14 PM |

    Dr. Davis is right about the Japanese diet.  Northeast Asians eat a bowl of rice or noodles at every meal, but that is the only high GI food at the table.  A typical Japanese, Korean, or Chinese meal includes fish or meat and non-starch vegetables.

    Moreover, type II diabetes is common among middle-aged Asians, who get the disease at lower BMIs than non-Asians.  

    I am wondering about the accuracy of identifying whole grain products as low GI.  The Easy GL Diet Handbook lists a GI of 37 for whole wheat pasta compared to 43 for regular pasta.  Likewise, brown rice and long-grain white rice have nearly identical GIs of 55 and 56, respectively.  Low GI is defined at around 55 or less, so pasta qualifies as low GI, but the difference between whole grain and refined varieties is not significant, especially when GI is converted to GL.  As the good doctor notes, it's best to avoid grains altogether.

  • Anonymous

    2/17/2010 4:11:16 AM |

    I did the test today
    And this are the results I had.

    After wake up: 86

    A bit over an hour after breakfast (rise with some vegetables, one egg, broccoli, and one cup of lapsang tea): 93

    30 Minutes after lunch (Portion of papaya, bowl of 'auyama' soup, half chicken breast with tomatoes and green peas, one boiled potato and salad with olive oil, one cup of lapsang tea): 111

    60 Minutes after lunch: 101

    Afternoon before eating some oats: 94

    30 Minutes after oats (quaker classics, soaked in water for 10 minutes with some almonds): 110

    60 Minutes after oats: 121

    30 Minutes after dinner (3/4 chicken breast same sauce as lunch, broccoli, salad, couple glasses of red wine): 109

    60 Minutes after dinner: 116

    90 Minutes after dinner: 92

    This opens many questions to me, like how much the time at which I had the oats affects. Or the fat I just had them with some almonds instead than as part of a whole meal

    Also as dinner seems to have more effect on my glucose than lunch even when lunch had  fruit and a potato I wonder if this is due to the black tea at lunch or to the time of the day.

    Also I wonder how much effect had the wine at dinner.

    I'll do some more tests when my fingers recover

  • Jonathan

    2/18/2010 9:35:22 AM |

    I would add to this post the fact that fructose has low GI, yet is more toxic and screws up the metabolism more than most other carbohydrates.  (E.g. causing fatty liver disease and insulin/leptin resistance; increasing hunger rather than satiating it.)  Food companies are motivated to add fructose to their products so they can claim a lower GI (hence the agave craze), but the fructose does more harm than most higher-GI carbs.

  • renegadediabetic

    2/18/2010 2:36:37 PM |

    I soon discovered that "low GI" foods, like oatmeal and other whole grains, still cause an unacceptable rise in my blood sugar.  Low GI may be a little better than high GI, but filtered cigarettes are a little better than non-filtered cigarettes.  Both are still bad.

    Glycemic load, which also takes into accout the number of carb grams, is much more relevant.  Non starchy veg, meat, & fat are about as low GI/GL as you can get.

    As for agave nectar, they still have to process it to extract it.  I'm not sure it's all that "natural."

  • buy jeans

    11/3/2010 3:13:22 PM |

    Low-glycemic index foods trigger the very same responses as high-glycemic index foods—they’re just less bad. But less bad does not equate to good. Low-glycemic index foods cause weight gain, trigger appetite, increase blood pressure, and lead to the patterns that cause heart disease.

  • Ivan

    7/2/2011 3:56:20 PM |

    I eat oats with milk and 2 tbsp of ground flax seeds every morning, and since I'm doing that every morning I lost 10 pounds, and I feel great. I don't crave for sweet anymore. So, I don't understand how low glycemic foods like oats can increase your weight?
    Few of my friends who implemented oats and flax seed in their diet had similar results.
    No one mentioned very valuable fiber that oats contain.

    Ivan
    Male, 37 y.o.

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Blood pressure with exercise

Blood pressure with exercise

Here's a frequently neglected cause for an increasing CT heart scan score: High blood pressure with exercise. Let me explain.

Paul's blood pressure at rest, sitting in the office or on arising in the morning, or at other relatively peaceful moments: 110/75 to 130/80--all in the conventional normal range.

We put Paul on the treadmill for a stress test. At 10 mets of effort (on the protocol used, this means 3.4 mph treadmill speed at 14 degree incline), Paul's blood pressure skyrockets to 220/105. That's really high.

Now, blood pressure is expected to increase with exercise. If it doesn't rise, that's abnormal and may, in fact, be a sign of danger. Normally, blood pressure should rise gradually in a stepwise fashion with increasing levels of exercise. But any blood pressure exceeding 170/90 is clearly too high with exercise. (Not to be confused with high blood pressures not involving exercise.) A handful of studies have suggested that a "breakpoint" of 170/90 also predicts heightened risk of heart attack over a long period.)

I see this phenomenon frequently--normal blood pressure at rest, high with exercise. This also suggests that when Paul is stressed, upset, in traffic congestion, under pressure at work, etc., his blood pressure is high during those periods, as well. I wouldn't be surprised to see other phenomena of underappreciated high blood pressure, like abnormally thick heart muscle (left ventricular hypertrophy), an enlarged thoracic aorta (visible on your heart scan), left atrium, perhaps even an abnormal EKG or abnormal kidney function (evidenced by an elevated creatinine on a standard blood panel).

Unfortunately, the treatments that reduce blood pressure are "stupid," i.e., they have no appreciation for what you are doing and they reduce blood pressure all the time, whether or not you're stressed, exercising, or sleeping.

Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

The message: Watch out for the blood pressures when you have a stress test. Or, if you have a friend who is adept at getting blood pressures, get a blood pressure immediately upon ceasing exercise. It should be no higher than 170/90.

Comments (10) -

  • Anonymous

    11/7/2007 8:57:00 PM |

    Dr. Davis,
    Sorry, this isn't about high blood pressure and exercise.  Do you believe there is a connection between high blood pressure and tinnitus?  Also, do you think that there are any vitamins or minerals that could relieve tinnitus?

  • Dr. Davis

    11/7/2007 10:02:00 PM |

    I know very little about tinnitus. However, I have seen some people get relief with niacin (immediate-release).

  • Sara

    5/5/2009 11:02:00 PM |

    Dr. Davis:

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop, or a slight rise in systolic but a slight drop in diastolic, even with moderately vigorous exercise; my doctor doesn't think it's a concern (he's only worried about it being high, and I run 115/75 on average when just sitting around), and I haven't been able to find anything on my own. I'd like to know more about what conditions it can signal, and that I should therefore ask my doctor about specifically.

  • blood pressure medications

    8/19/2009 9:02:48 AM |

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop,High blood pressure cure supplement, natural herbal remedy to lower & control high blood pressure. Use Alistrol everyday to help maintain healthy circulation and support cardio-vascular health.

  • Anonymous

    6/20/2010 8:06:42 AM |

    Just chiming in on the enzyme called serrapeptase. I have the capsules and only use it when any of my dogs get bitten by a centipede. As soon as they come into the house squirming and licking the bitten paw, I give them one capsule and w/in a few minutes, they stop squirming and licking and fall asleep. So I think it works even if the stomach acid might destroy some of it. BTW, I used to take 1000 mgs of bromelain at night before bed and once when I was taking it regularly for about a week, I took a cholesterol lab test and my results came back showing a big decrease in my LDL and Total cholesterol numbers. The only change I could think of that might have caused the decrease was taking the bromelain.

  • Brian

    9/15/2010 10:26:52 AM |

    I have the same problem as Paul. Low/Good blood pressure while sitting around, but extremely high blood pressure after/during exercising, going up stairs, playing the trumpet, etc.

    Although I understand and agree with all of the natural remedies you listed for lowering blood pressure (exercise, lower carbs, etc), why do you recommend low saturated fat intake? Are there any sources/studies that indicate that saturated fat has a direct effect on BP, and if so, that it's a bad thing? And would these studies take into account other variables such as carbohydrates and trans fats?

    Any information you have would be GREATLY appreciated! Thanks.

    Brian

  • buy jeans

    11/3/2010 3:11:53 PM |

    Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

  • Brian

    11/3/2010 3:31:04 PM |

    I can understand the weight loss, exercise, and reduction of carbs (although not just processed, IMO) as well as magnesium and Vitamin D supplementation, but why the lower saturated fat? If you're trying to link lower sat fat intake to weight loss, I'd have to ask for a good source of information before I would believe you. In my practical experience in weight loss, I have lost tons of weight even though lots of my calories came from fat, and fat is needed for energy.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

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Feel that nudge in your back?

Feel that nudge in your back?

You feel that nudge in your back? That's your local hospitals competing for your bypass surgery business.

Just this morning while watching a morning news show, I saw three advertisements for hospital bypass surgery programs. One ad featured a man in his 50s telling his story:"The cardiologist determined immediately that I needed a triple bypass operation. My family and I are very grateful to _____ hospital!"

In what other field is failure celebrated so prominently? When I see these ads, I hear "My doctors failed to provide early detection and then prevent what became a life-threatening condition, even though heart disease is a chronic process that requires decades to develop." What if our man said instead,"I had a heart scan and my score was high. So I was shown why I had so much plaque. They then showed me how to control and even reduce the amount of plaque I had. I'm living safely and symptom-free without need for surgery or procedures."

Of course, the hospital is out $60,000-100,000 for the surgery. How else could they afford ad campaigns costing several million dollars a year? See these advertisements for what they are: Marketing generated by profit-seeking businesses competing for your dollars--lots of them.
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Calculus of the cardiologist

Calculus of the cardiologist

I call this the "calculus of the cardiologist":

Heart procedures = big money

More procedures = more big money

You do the math. If you do more procedures, you get more money.
What if your patients don't need more procedures? That's easy. You lower the bar on reasons to do procedures. You scare the pants off people and lead them to think that all heart disease or questions about heart disease are potentially life-threatening. You could even appear to be doing the patient a big favor. "My Lord! This is potentially dangerous. We need to perform a procedure without delay!"

There are incentives beyond direct cash payment. A patient of mine today showed me a memo to employees in his company that showed why certain hospitals are targeted for care. The criteria for choosing centers was based on number of procedures performed. In other words, the more procedures performed at a hospital, the more procedures will be directed there. Of course, this makes sense at some level. More procedures can also mean greater skill.

But have we lost sight of the fact that the mission is not more procedures and more money, but to get rid of a disease? If the intensity of effort devoted to heart procedures were re-directed to early detection, prevention, and reversal of disease, we'd have half the hospitals we now have. We'd also chop a huge chunk out of the national healthcare budget.

Comments (1) -

  • Anonymous

    11/3/2006 1:29:00 AM |

    Dr. Davis,
    Another well-written post!  

    Joe

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I need to do more procedures!

I need to do more procedures!

I sat next to a cardiology colleague of mine last evening at a dinner. He was lamenting the fact that, because of changes in hospital affiliations of his several-member cardiology group, he'd seen a drop in the volume of heart catheterizations he was performing.

"I'm used to doing 5 cases a day! Now I'm down to 3 or 4 a day." He went on to tell me how he's working to increase his volume. "I'm branching out into doing carotid stents and anything I can find in the legs." He also described how he was cultivating referring physicians to send him more procedural patients.

Now, this colleague, I believe, is a hard-working, conscientious physician. But his attitude reflects the perverse logic of many physicians: I need to do more procedures, not because it benefits patients, but because that's what I want to do--to be busy, make more money, acquire more experience, build my ego, etc.

Doing more procedures has nothing to do with an altruistic goal of doing more good for society. It is purely for selfish reasons. Beware of this shockingly common, pervasive attitude. There's a proper time and place for heart procedures, or any procedure, for that matter. But feeding your doctor's ambitions is not a good reason.
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How much omega-3s are enough?

How much omega-3s are enough?

The basic dose we advocate for the Track Your Plaque program is 1200 mg per day of EPA + DHA, the essential omega-3 fatty acids.

1200 mg EPA+DHA is generally obtainable by taking 4 capsules of 1000 mg of fish oil, since the majority of preparations contain 180 mg EPA and 120 mg DHA per capsule.

But how will you know if a higher dose wouldn't be even better?

The principal parameter to look at is triglycerides. If triglycerides remain above 60 mg/dl, we usually consider increasing fish oil.

Another measure that's very important is intermediate-density lipoprotein, or IDL, also called "remnant lipoproteins" on a VAP panel. Persistence of any IDL or remnant lipoproteins is reason to consider more fish oil. Most commonly, if there is some persistence of either, we increase fish oil to 6000 mg per day of a standard preparation, or 1800 mg/day of EPA+DHA.

The only time we see persistence of IDL or remnant lipoproteins with this higher dose is when triglycerides are really high. If starting triglycerides are, for instance, 500 mg/dl, then even this higher dose may be insufficient. This is when more highly concentrated preparations of fish oil may be necessary, occasionally even the prescription form, Omacor. (We currently use Omacor only when high doses of EPA+DHA are required, most because of its outrageous cost. Two capsules per day costs around $120 per month; three capsules per day to provide 1800 mg/day of EPA+DHA costs $180 per month. I think this is outrageous and so we use it only when absolutely necessary.)

You might even argue that a higher dose of 1800 mg EPA+DHA, or 6000 mg of a standard capsule, might be preferable for more assured reduction of heart attack risk--even when triglycerides and IDL are perfectly under control. I wouldn't argue with you. But you won't observe any measurable feedback that tells you that a heightened effect is being obtained. I take that dose myself, in fact, despite the fact that elimination of wheat products and weight loss was sufficient to drop my triglycerides to the target level. I figure it's a small additional effort for added peace of mind.

Comments (7) -

  • Anonymous

    5/8/2007 7:46:00 PM |

    I have just joined the Track Your Placque Site.  I take fish oil daily, 3200 EPA/1600 DHA.  At this dose my AA/EPA score is 2.14.  When I had LDL electrophoesis done, my pattern was A pattern and I was not on the fish oil at that time.  I am wondering whether it would be better to have an NMR test or a VAP test, or both?

  • Dr. Davis

    5/9/2007 1:57:00 AM |

    Hi,
    In general, I prefer the NMR. However, the electrophoretic test you already had should provide more information than just breaking your LDL pattern down into types "A" or "B". The real numbers to pay attention to are the LDL subclasses III and IV. Add up those numbers to determine how much small LDL you really have (in percent). Anything more than 10% we regard as sigificant.

  • Mike

    5/9/2007 8:00:00 PM |

    Is there any reduction in triglycerides from taking flax seed or other non-EPA/DHA sources of omega-3s?

  • Anonymous

    5/10/2007 12:18:00 AM |

    Thank you.  The report is broken down into the various LDL subclasses.  This information is helpful.

  • Dr. Davis

    5/10/2007 12:28:00 AM |

    Mike-
    No, unfortunately not. Only fish oil exerts the sort of triglyceride and lipoprotein correcting effects that we need.

  • Anonymous

    5/12/2007 10:12:00 PM |

    Dr., what do you think of Krill oil? Is it better than "regular" fish oil?

  • Dr. Davis

    5/13/2007 3:25:00 AM |

    We've actually had a fairly extensive conversation on this question on the Track Your Plaque Forum. Fish oil is tried and true, and the advantages of krill oil--purportedly containing less pesticide residues (no less mercury since fish oil does not contain mercury) and virtually pure DHA--are not fully worked out. However, if you choose to give it a try, let us know what kind of results you get.

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Carotid plaque can be shrunk

Carotid plaque can be shrunk

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

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

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


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

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

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

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

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

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

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

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


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

Comments (1) -

  • buy jeans

    11/3/2010 7:35:40 PM |

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

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Can you break the “Rule of 60”

Can you break the “Rule of 60”

In the Track Your Plaque program, we aim for conventional lipid values (LDL cholesterol, HDL cholesterol, and triglycerides) of 60—60—60, i.e., LDL 60 mg/dl, HDL 60 mg/dl or greater, triglycerides 60 mg/dl. Most participants do indeed reach these target values.

When I tell this to colleagues, they’re stunned. “You can’t possibly get those numbers in most people.” And I can sympathize with their plight. After all, they are stuck with relatively lame tools: statin drugs, the American Heart Association diet. I’d be surprised if they ever achieved 60—60—60.

But can you drop your heart scan score even if you don’t reach the 60—60—60 targets? Yes, you can. The Rule of 60 is only a guideline, a tool that helps more people achieve our goals. The Rule of 60 does not guarantee reversal (drop in heart scan score), nor does not achieving the targets completely destroy your chances.

We have had many people drop their scores even if they haven’t reached the targets. On the other hand, we’ve also had people who failed at first, only to see success once they achieved the 60 mg/dl targets.

But which one are you? That’s the problem. We possess limited capacity to predict who will or who will not drop their scores from the start. We know that there are factors that stack the odds in your favor (e.g., optimism, lack of Lp(a), ideal weight, vitamin D >50 ng/ml, etc.). We know that there are factors that make it tougher (overweight, Lp(a), pessimistic attitude, underappreciated hypertension, higher heart scan scores, etc.) But at the start, we just don’t know who truly needs to adhere to the Rule of 60. So we suggest that everyone, at least in the beginning, aim to achieve it.

I had an exception the other day. Rich did everything by the Track Your Plaque book. However, a starting low HDL of 27 only rose to 37 after one year of effort—way below our 60 mg/dl target. Yet a repeat heart scan showed 23% reduction.

Why would Rich be so successful despite a persistently very low HDL? There may be a number of reasons. One explanation could be that conventional measures of HDL fail to distinguish between what HDLs truly work and what do not. Look at ApoA1 Milano; remember this story? The people in the secluded mountain village of Limone-Sul-Garde in northern Italy have HDL cholesterols of 8-15 mg/dl yet do not experience excess vascular atherosclerosis, suggesting that what little HDL they have is super-effective.

Yes, large HDL seem to be more healthy and effective than small HDL, but perhaps there’s more to it. However, nobody has a HDL effectiveness test ready for us to use.

In the meantime, we continue to suggest that the Track Your Plaque Rule of 60 be considered as a means of making plaque reversal as likely as possible. You and your doctor can always adjust in future, depending on your heart scan score results.

Comments (1) -

  • Anonymous

    7/8/2008 4:45:00 AM |

    "The people in the secluded mountain village of Limone-Sul-Garde in northern Italy have HDL cholesterols of 8-15 mg/dl yet do not experience excess vascular atherosclerosis, suggesting that what little HDL they have is super-effective."

    Isn't further investigation warranted?  Some other dietary factor
    or lifestyle habit may be the reason and not because "what little HDL they have is super-effective."
    this assumption could be missing something previously unknown.

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