"Yes, Johnnie, there really is an Easter bunny"

30. November 2007 William Davis (13)
A Heart Scan Blog reader recently posted this comment:

You wouldn't believe the trouble I'm having trying to get someone to give me a CT Heart Scan without trying to talk me into a Coronary CTA [CT angiogram]. Every facility I've talked to keeps harping on the issue that calcium scoring only shows "hard" plaque...and not soft.

I also had a nurse today tell me that 30% of the people that end up needing a coronary catheterization had calcium scores of ZERO. That doesn't sound right to me. What determines whether or not someone needs a coronary catheterization anyway?


There was a time not long ago when I saw heart scan centers as the emerging champions of heart disease detection and prevention. Heart scans, after all, provided the only rational means to directly uncover hidden coronary plaque. They also offered a method of tracking progression--or regression--of coronary plaque. No other tool can do that. Carotid ultrasound (IMT)? Indirectly and imperfectly, since it measures thickening of the carotid artery lining, partially removed from the influences that create coronary atherosclerotic plaque. Cholesterol? A miserable failure for a whole host of reasons.

Then something happened. General Electric bought the developer and manufacturer of the electron-beam tomography CT scanner, Imatron. (Initial press releases were glowing: The Future of Electron Beam Tomography Looks Better than Ever.The new eSpeed C300 electron beam tomographic scanner features the industry’s fastest temporal resolution, and is now backed by the strength of GE Medical Systems. Imatron and GE have joined forces to provide comprehensive solutions for entrepreneurs and innovative medical practitioners.)

Within short order, GE scrapped the entire company and program, despite the development of an extraordinary device, the C-300, introduced in 2001, and the eSpeed, introduced in 2003, both yanked by GE. The C-300 and eSpeed were technological marvels, providing heart scans at incredible speed with minimal radiation.

Why would GE do such a thing, buy Imatron and its patent rights, along with the fabulous new eSpeed device, then dissolve the company that developed the technology and scrap the entire package?

Well, first of all they can afford to, whether or not the device represented a technological advancement. Second (and this is my reading-between-the-lines interpretation of the events), it was in their best financial interest. Not in the interest of the public's health, nor the technology of heart scanning, but they believed that focusing on the multi-detector technology to be more financially rewarding to GE.

GE, along with Toshiba, Siemens, and Philips, saw the dollar signs of big money with the innovations in multi-detector technology (MDCT). They began to envision a broader acceptance of these devices into mainstream practice with the technological improvements in CT angiography, a device (or several) in every hospital and major clinic.

Anyway, this represents a long and winding return to the original issue: How I once believed that heart scan centers would be champions of heart disease detection and reversal. This has, unfortunately, not proven to be true.

Yes, there are heart scan centers where you can obtain a heart scan and also connect with people and physicians who believe in prevention of this disease. I believe that Milwaukee Heart Scan is that way, as is Dr. Bill Blanchet's Front Range Preventive Imaging, Dr. Roger White's Holistica Hawaii, and Dr. John Rumberger's Princeton Longevity Center.

But the truth is that most heart scan centers have evolved into places that offer heart scans, but more as grudging lip service to the concept of early detection earned with sweat and tears by the early efforts of the heart scan centers. But the more financially rewarding offering of CT coronary angiograms, while a useful service when used properly, has corrupted the prevention and reversal equation. "Entry level" CT heart scans have been subverted in the quest for profit.

CT angiograms pay better: $1800-4000, compared to $100-500 for a heart scan (usually about $250). More importantly, who can resist the detection of a "suspicious" 50% blockage that might benefit from the "real" test, a heart catheterization? Can anyone honestly allow a 50% blockage to be without a stent?

CT angiograms not only yield more revenue, they also serve as an effective prelude to "downstream" revenue. By this equation, a CT angiogram easily becomes a $40,000 hospital procedure with a stent or two, or three, or occasionally a $100,000 bypass. Keep in mind that the majority of people who are persuaded that a simple heart scans are not good enough and would be better off with the "superior" test of CT angiography are asymptomatic--without symptoms of chest pain, breathelessness, etc. Thus, the argument is that people without symptoms, usually with normal stress tests, benefit from prophylactic revascularization procedures like stents and bypass.

There are no data whatsoever to support this practice. People who have no symptoms attributable to heart disease and have normal stress tests do NOT benefit from heart procedures like heart catheterization. They do, of course, benefit from asking why they have atherosclerotic plaque in the first place, followed by a preventive program to correct the causes.

So, beware: It is the heart scan I believe in, a technique involving low radiation and low revenue potential. CT angiograms are useful tests, but often offered for the wrong reasons. If we all keep in mind that the economics of testing more often than not determine what is being told to us, then it all makes sense. If you want a simple heart scan, just say so. No--insist on it.

Take trust out of the equation. Don't trust people in health care anymore than you'd trust the used car salesman with "a great deal."

Finally, in answer to the reader's last comment about 30% of people needing heart catheterizations having zero calcium scores, this is absolute unadulterated nonsense. I'm hoping that the nurse who said this was taken out of context. Her comments are, at best, misleading. That's why I conduct this Heart Scan Blog and our website, www.cureality.com. They are your unbiased sources of information on what is true, honest, and not tainted by the smell of lots of procedural revenue.
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Comments (13) -

  • Anonymous

    11/30/2007 8:13:00 AM |

    Hmmn - reminds me of a book I read called "Coronary: A True Story of Medicine Gone Awry," recommended by you, Dr. Davis.  Unnecessary procedures for profits.

    It's a scary world out there in medical land.

  • Anne

    11/30/2007 12:35:00 PM |

    The local heart hospital has a "Heartsaver CT" http://www.heartsaverct.com/index.aspx?CORE_ElementID=HSCT_AHH_Home

    Is this the same as the CT Heart Scan?

  • Anonymous

    11/30/2007 1:11:00 PM |

    I saw another car Bill had worked on this month.  My father and I have an auto hobby shop were we'll bang away on making our own hot rod cars and from time to time a friend or friend of a friend in this case will ask to bring a car by for inspection.  The guy has been having many problems with his hot rod and for repairs had been taking it to Bill's place.  I had an idea of what to expect.  Sure enough Bill had done it again.  Bill's scam is that he will splice a weaker gage wire into a hidden unseen area.  The weak gage can not handle the power load for long and once the wire melts and the part stops working, he explains that the engine part broke, new parts need to be ordered and of course that intales hours of labor costs.  
        

    After reading this blog it reminded me of scammer auto shops.  Hospitals have their scams too.    I wish I could walk into a doctor’s office and expect that only the best, least expensive, treatment will be offered me - but I now know that isn't the case.  I can't be lazy.  I need to educate myself in the basics of medical care to ensure I receive the best treatment for me.  Thanks for being a good teacher Dr. Davis.

  • Dr. Davis

    11/30/2007 1:23:00 PM |

    Yes, it looks like it is the real thing, a simple heart scan, judging from their comment that "There are no needles, no dyes, no injections and no exercise." CT angiograms require needles, dye, and injections.

  • Mike

    11/30/2007 3:27:00 PM |

    The CT angiogram makers are generating lots of reports on how great their machines are.

    http://www.theheart.org/viewArticle.do?primaryKey=830205&nl_id=tho28nov07

  • Dr. Davis

    11/30/2007 3:41:00 PM |

    They certainly are. Big bucks, big marketing.

    I do believe, in all honesty, that the new devices really represent great advances in diagnostic imaging. It's their mis-use and over-use that I object to. Of course, the manufacturers keep their lips closed about it because overuse drives more sales.

  • Paul Kelly - 95.1 WAYV

    11/30/2007 5:00:00 PM |

    Hi Dr. Davis,

    I've learned from reading your blog that typically 20% of TOTAL PLAQUE is calcified or "hard". Is that a steadfast rule - or is that an average? What if someone has a calcium score of zero (or close to it)? Can it be assume that that person also has very little in the way of "soft" plaque?

    Thanks!

    Paul

  • Dr. Davis

    11/30/2007 5:12:00 PM |

    Speaking generally, people with zero heart scan scores have heart attack rates of near zero (if asymptomatic).

    The likelihood of detecting pure "soft" plaque in someone without symptoms and a zero heart scan score is <5%. It does happen, particularly when certain severe risks for heart disease are present (e.g., very high LDL/small LDL). It is exceptional, however.

  • noreen

    12/1/2007 12:55:00 AM |

    Since I can't afford the current local price of a 64 slice CT scan ($1100), I've decided to get a lipoprotein breakdown to determine my risk.   I can use your "treatment" protocol of supplements to try and achieve the 60-60-60 values when I see the results.   Is this a good plan?

  • Dr. Davis

    12/1/2007 1:47:00 PM |

    Hi, Noreen--

    I'm afraid that you may regret not getting the scan a few years from now. After you've successfully corrected lipoproteins, you may want to know if you've also successfully controlled plaque growth, the MORE IMPORTANT parameter.

    Have you thought about looking elsewhere for a scan? In Milwaukee, for instance, scans can be obtained for as little as $79. (Though the low-priced scans also come with a sales pitch for CT coronary angiography. Just say "no thanks.")

  • mike V

    12/1/2007 8:49:00 PM |

    I am 72 and pretty healthy.
    This year I have been seeing a cardio because of some nocturnal palpitations. He has subjected me to a series of tests-sleep-ultrasound-both negative, and a nuclear stress test which gave a hint of possible blockage. He recommended either an angiography or a CTA scan. I chose the latter, and was rated "normal".
    I asked if this meant normal for my age. He said "no, normal for any age, I couldn' find any trace of hard or soft plaque". Yes he is part of a large group.

    My father died of a second heart attack at 76.
    I have taken vitamin D, fish oil, magnesium, pantethine, flaxseed, co-Q10, lutein, olive oil, for some years.
    I am trying hard not to feel smug, but should I feel safe?
    We are still working on the nocturnal palpitations which seem to be dependent on sleep position.
    I have bradycardia, and no other obvious health 'problems'.

  • Harry35

    12/2/2007 12:30:00 AM |

    With regard to the 20% value for calcified plaque, if you look at figure 1 from Rumberger’s classic 1995 paper (Circulation. 1995;92:2157-2162.), it shows the plaque area and calcium areas for each of 13 hearts that were examined on autopsy. If you take the points in this graph and determine the areas for each heart, the data shows that the calcium area and calcium percentage increases with plaque area. Unfortunately the paper doesn’t say what the calcium scores were for each heart, only the calcium areas and total plaque areas. However, over the range of plaque areas of the 13 hearts, the percentage of calcium in plaque increased from 0% to 14% for the 9 hearts with with plaque areas less than 150 square mm to 14% to 28% for the hearts with the plaque areas greater than 230 square mm. So from that we can conclude that the 20% value is an average, and that the calcium percentage increases as more and more plaque accumulates.

    Harry35

  • Anonymous

    3/5/2010 5:20:16 PM |

    Sehr interessant!

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Cheers to flavonoids

Cheers to flavonoids

28. October 2007 William Davis (14)
The case in favor of healthful flavonoids seems to grow bit by bit.

Flavonoids such as procyanadins in wine and chocolate, catechins in tea, and those in walnuts, pomegranates, and pycnogenol (pine bark extract) are suspected to block oxidation of LDL (preventing its entry into plaque), normalize abnormal endothelial constriction, and yield platelet-blocking effects (preventing blood clots).

Dr. Roger Corder is a prolific author of many scientific papers detailing his research into the flavonoids of foods, but wine in particular. He summarizes his findings in a recent book, The Red Wine Diet. Contrary to the obvious vying-for-prime-time title, Dr. Corder's compilation is probably the best discussion of flavonoids in foods and wines that I've come across. Although it would have been more entertaining if peppered with more wit and humans interest, given the topic, its straightfoward, semi-academic telling of the story makes his points effectively.

Among the important observations Corder makes is that regions of the world with the greatest longevity also correspond to regions with the highest procyanidin flavonoids in their wines.




Regading the variable flavonoid content of various wines, he states:

Although differences in the amount of procyanidins in red wine clearly occur because of the grape variety and the vineyard environment, the winemaker holds the key to what ends up in the bottle. The most important aspect of the winemaking process for ensuring high procyanidins in red wines is the contact time between the liquid and the grape seeds during fermentation when the alcohol concentration reaches about 6 percent. Depending on the fermentation temperature, it may be two to three days or more before this extraction process starts. Grape skins float and seeds sink, so the number of times they are pushed down and stirred into the fermenting wine also increases extraction of procyanidins. Even so, extraction is a slow process and, after fermentation is complete, many red wines are left to macerate with their seeds and skins for days or even weeks in order to extract all the color, flavor, and tannins. Wines that have a contact time of less than seven days will have a relatively low level of procyanidins. Wines with a contact time of ten to fourteen days have decent levels, and those with contact times of three weeks or more have the highest.

He points out that deeply-colored reds are more likely to be richer in procyanidins; mass-produced wines that are usually "house-grade" served at bars and restaurants tend to be low. Some are close to zero.

Wines rich in procyanidins provide several-fold more, such that a single glass can provide the same purported health benefit as several glasses of a procyanidin-poor wine.

So how do various wines stack up in procyanidin content? Here's an abbreviated list from his book:

Australian--tend to be low, except for Australian Cabernet Sauvignon which is moderate.

Chile--only Cabernet Sauvignon stands out, then only moderate in content.

France--Where to start? The French, of course, are the perennial masters of wine, and prolonged contact with skins and seeds is usually taken for granted in many varieties of wine. Each wine region (French wines are generally designated by region, not by variety of grape) can also vary widely in flavonoid content. Nonetheless, Bordeaux rate moderately; Burgundy low to moderate (except the village of Pommard); Languedoc-Roussillon moderate to high (and many great bargains in my experience, since these producers live in the shadow of its norther Bordeaux neighbors); Rhone (Cote du Rhone) moderate to high, though beware of their powerful "barnyard" character upon opening; decanting is wise.

Italy--Much red Italian wine is made from the Sangiovese grape and called variously Chianti, Valpolicella, and "super-Tuscan" when blended with other varietals. Corder rates the southern Italian wines from Sicily, Sardinia, and the mainland as high in procyanidins; most northern varieties are moderate.

Spain--Moderate in general.

United States--Though his comments are disappointingly scanty on the U.S., he points out that Cabernet Sauvignon is the standout for procyanidin content. He mentions only the Napa/Sonoma regions, unfortunately. (I'd like to know how the San Diego-Temecula and Virginian wines fare, for instance.)

The winner in procyanidin content is a variety grown in the Gers region of southwest France, a region with superior longevity of its residents. The wines here are made with the tannat grape within the Madiran appellation; wines labeled "Madiran" must contain 40% or more tannat to be so labeled (such is a quirk of French wine regulation). However, among the producers Dr. Corder lists are Chateau de Sabazan, CHateau Saint-Go, Chateau du Bascou, Domaine Labranche Laffont, and Chateau d'Aydie. (A more complete can be found in his book.)

How does this all figure into the Track Your Plaque program? Can you succeed without red wine? Of course you can. I doubt you could do it, however, without some attention to flavonoid-rich food sources, whether they come from spinach, tea, chocolate, beets, pomegranates, or red wine.

Though my wife and I love wine, I confess that I've never personally drank or even seen a French Madiran wine. Any wine afficionados with some advice?
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Comments (14) -

  • Anonymous

    10/28/2007 3:02:00 PM |

    There is a dietary supplement called "Resvinatrol Complete" which labels as the red wine alternative. The product description says "Resveratrol is a natural ingredient found in grapes, red wine, purple grape juice, peanuts and some berries with important anti-inflammatory and antioxidant properties". Is this similar to the effects of Flavonoids?

  • Carl

    10/28/2007 6:09:00 PM |

    The Madiran I drink is imported by Bonny Doon and labeled 'Heart of Darkness'.  This one is easy to find locally, current prices run $12-$18 in my area.  
    I like it a lot, but it may take some getting used to. Tannat grapes as the name implies have Tannins galore, so I decant for half an hour or more and always drink it with food (grilled meats, roasted game).  

    They don't import this every year, but I still find plenty at my local store.  If this book becomes a big hit, expect the price of Tannat wines like Madiran to go up.  Judging from the wines he approves/disapproves you might find that reds with lots of tannins are worth trying.  

    I sometimes find other Madirans locally and I'll usually give them a try but HoD is my 'go to' Tannat.  By the way, the Tannat grape does very well in the South American country of Uruguay, so if you see one of those languishing on the rack give it a try.  



    South America has been kind to some varieties of wine and Tannat has done well in the country of Uruguay. Not easy to find

  • Carl

    10/28/2007 7:10:00 PM |

    Addendum: Esquire magazine ran a series of articles a few years ago about how to live to be 100.  They noted that Sardinian shepherds who ate the local diet of minestrone vegetable soup with local cheese and local red wine had esp. long lives.  The article attributed this to exercise, diet and the benefits of the local red wine.  They also pointed out that these red grapes -and others - grown at high altitudes had more of the beneficial flavonoids.  With that in mind, I started looking for good red wines from high altitude grapes. I found that traditional Argentinian Malbec from Medoza falls into this category.  I particularly recommend the Malbec made by/imported by Patrick Campbell (owner of Laurel Glen, maker of REDS and Za Zin zinfandels).  His Terra Rossa Malbec is everything we're looking for - and costs me $10 or so locally.  Highest recommendation.
    Note that Malbec is often blended with Tannat grapes, in france it's usually considered a 'blending' grape for Bordeaux...but in Mendoza (Argentina) it really shines on it's own.

  • Dr. Davis

    10/28/2007 8:15:00 PM |

    I am skeptical that resveratrol is the active substance in red wine that confers benefit, or at least substantial benefit.

    Corder also expresses skepticism based on the lack of an endothelial-normalizing effect. There is another study that suggests that resveratrol absorption in humans is poor and unlikely to achieve the levels that are required in experimental prepartions to achieve its purported benefits.

  • Dr. Davis

    10/28/2007 8:21:00 PM |

    Thanks, Carl.

    I'm heading to the wine store!

  • Anonymous

    10/29/2007 1:12:00 AM |

    hello- just wondering what you thought of the diet recommendations in Corder's book? I think he does offer up some bread recipes that inlcude wheat. I saw it very quickly at the bookstore- should I go back and buy it for the diet and wine advice?
    Thanks!

  • Alan

    10/29/2007 11:31:00 AM |

    Hi Dr Davis.

    More and more as I read your excellent blog I discover that, although I see it from a diabetic patient's viewpoint, we think alike on many aspects of diet.

    I've also written on wine, but directed more to diabetes health here: http://loraldiabetes.blogspot.com/2007/03/red-red-wine.html

    You might find some of the included references interesting. I practise as I preach; right now it's a very nice '03 Coonawarra Cabernet Sauvignon.

    Cheers, Alan, T2, Australia

  • Dr. Davis

    10/29/2007 12:11:00 PM |

    In all honesty, I simply glanced at the recipes, since I was skeptical that he had anything original to say in diet. He does, however, seem to provide some recipes with a focus on high flavonoid content. So I remain uncertain of how wise his diet is. I think his expertise is wine and flavonoids, not foods. I believe he is the sort of "doctor" that does research but does not take care of poeple. I am even more skeptical of health advice from people who do not actually take care of other people.

  • David

    10/29/2007 10:15:00 PM |

    Red wine is wonderful, to be sure, but apples and cocoa are the champs when it comes to procyanidins. One Red Delicious has over 200 mg. of procyanidins, or about 9 times the amount in a glass of red wine. (J Nutr. 2000 Aug;130(8S Suppl):2086S-92S).

    Procyanidins are amazing antioxidants, and the cardiovascular benefits are only the beginning of their healthy properties. They're also chemopreventative, and have exciting antiaging properties as well. One apple procyanidin (b2) has even been shown to promote hair growth in balding men in several clinical trials. Apple procyanidins are also water soluble and easy to absorb, and have advantages for people who don't drink alcohol (wine) or eat fat and sugar (chocolate).

    So I say, if you drink, switch to red wine. If you eat sweets, choose polyphenol-rich dark chocolate. Bitter is better. Just make sure you eat your apples too!

  • G

    10/31/2007 12:39:00 AM |

    Dr. D -- Salice Salentino (riserva 2003) is excellent! It's imported from the South of Italy and especially dark, bitter and delicious (even better, inexpensive and available at Trader joe's!!)
    Malbec from TJ's is good too (but not as nice as the above)...
    Thank you for the vote for Flavonoids!! congrats on you award from health.com (never heard of them but that's awesome) I wish Oprah would feature TYP on her program... I suspect she's 25-OHD deficient... (my sister mentioned Oprah was recently dx'd with hypothyroidism which of course is autoimmune and therefore related to Vit D deficiency)

  • shreela

    6/12/2008 4:26:00 AM |

    This looks very promising:

    Researchers studied 7,211 nondrinkers, and 3,598 people who drank a glass a day of wine, beer or liquor, testing them for elevated blood levels of alanine aminotransferase, or ALT, a finding that indicates liver damage.

    They found above-normal levels in 3.2 percent of nondrinkers, 3.5 percent of beer drinkers and 2.3 percent of daily hard-liquor drinkers.

    But among those who drank a glass of wine a day, the rate averaged only 0.4 percent.

    Wine May Help Keep Liver Healthy

    I searched alanine aminotransferase along with diabetes, heart disease, and alzheimer's, and each one had patients with eleveated ALTs.

    Another thing that interested me was that it also included white wines, which IIRC, don't have nearly as much resveratrol as red wines.

  • Rick

    1/21/2009 7:44:00 AM |

    For some reason, red wine upsets my stomach, while white wine and purple grape juice are fine. (I have to be careful with dark chocolate, too.) Anyone know why this might be?

    And as an aside, do you think vermouth has similar benefits to wine?

  • mongander

    8/16/2009 1:45:26 AM |

    My doctor has been bugging me to get on statins for years but I refused. I finally agreed to start taking niacin, which is what Dr William Davis recommends. When my doc told me my HDL had shot up to 80 (from under 40), I figured it was due to the niacin, but my doc asked, "Have you started drinking alcohol?"  I explained that while I don't usually drink alcohol, I do consume 1 oz of 190 proof Everclear which I use to help dissolve some fruit and berry powders (pomgranate ellagic acid powder and Muscadine Peel Powder). My doctor thinks the 1 oz of alcohol is what elevated the HDL. When I replied, "Well, that's good, isn't it?", she shrugged her shoulders.....she's Islamic, so she may not be able to admit that alcohol had a positive benefit.

    I also have a good diet, avoiding most processed foods, especially processed carbohydrates, avoid almost all wheat, but am not on a low carb diet.  I get quite a bit of exercise.

  • buy jeans

    11/2/2010 8:38:07 PM |

    Italy--Much red Italian wine is made from the Sangiovese grape and called variously Chianti, Valpolicella, and "super-Tuscan" when blended with other varietals. Corder rates the southern Italian wines from Sicily, Sardinia, and the mainland as high in procyanidins; most northern varieties are moderate.

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