> Whether blood clotting and effects on IDL
>should be added to this list is uncertain.

Meaningless anecdote: I've noticed an increased tendency to bruise easily since I've been taking higher doses of vitamin D, and had been wondering whether it was the cause. I definitely have metabolic syndrome.

I wish Dr. Cannell would come talk the British media. We need a tank load of D talk to infiltrate here.

An irrational fear of skin cancer prevents most people from getting their vitamin D from sunshine. The doses that the medical establishment recommends are so small as to be almost worthless.

It would be helpful if you could tell us where the research on vitamin D you are referring to is published.  Some of us like to go to the original source.

See our special reports on the Track Your Plaque website with detailed references. Or, go to Dr. John Cannell's www.vitamindcouncil.com website.

Is cod liver oil the best way to get vitamin D or just vitamin D3 capsules?
Is there are connection with hypothyroidism and low vitamin D levels?

Either source for vitamin D works.

I do believe that correction of vitamin D has, in occasional instances, modestly increased thyroid function.

Cod liver oil has a lot of vitamin A, which in excess can lead to low bone density.  It is better just to take the vitamin D by itself.

I agree -- over 20yrs ago it was suggested that increased thyroid doses are required in the winter time for hypothyroid pts on replacement (see below). IT sure seems to suggest that Vitamin D deficiency exacerbates hypothyroidism (and I'd go as far to say it even CAUSES it)?  I've observed this as well. (it's corrected with D3)

In the second study, a corollary phenomenon occurred -- thyroid replacement in hypothyroid pts caused 25(OH)D to INCREASE (in the autumn when you'd normally expect it to decrease).  

Isn't it fascinating how thyroid hormone and D3 hormone are interrelated.
---When D3 hormone (sunlight) is lacking, thyroid function suffers
---When thyroid hormone is lacking, a high D3 dose fails to increase 25(OH)D much....
---When thyroid hormone is NOT lacking, high dose D3 causes a large increase in 25(OH)D (in normal euthryoid controls)

it all sounds very familiar to me...  

THANK YOU FOR ALL YOUR WORK AND INSIGHTS!! Keep up the strong work, g


Metabolism. 1984 Mar;33(3):215-8. Links
Is it necessary to adjust the replacement dose of thyroid hormone to the season in patients with hypothyroidism?Hamada N, Ohno M, Morii H, Jaeduk N, Yamakawa J, Inaba M, Ikeda S, Wada M.
Hypothalamo-pituitary-thyroid activity varies with the temperature of the environment; we therefore measured variables involved with thyroid function in summer and winter in normal controls and in patients with primary hypothyroidism. All seven patients had impalpable thyroid glands and had received a set replacement dose of thyroxine for over a year. In the patients, serum T3 and FT4 levels were slightly but significantly lower in winter, and TSH levels and delta TSH at 30 minutes in the TRH tests were significantly higher. In the controls, there were no significant differences between summer and winter in these values. These findings suggest that the dose required for replacement of thyroid hormone in patients with hypothyroidism may be higher in winter than in summer.

PMID: 6420646 [PubMed - indexed for MEDLINE]



Acta Endocrinol (Copenh). 1986 Nov;113(3):329-34.Links
Effect of vitamin D3 loading and thyroid hormone replacement therapy on the decreased serum 25-hydroxyvitamin D level in patients with hypothyroidism.Bársony J, Lakatos P, Földes J, Fehér T.
Twelve hypothyroid subjects, 13 healthy and 12 healthy women with a slight deficiency of vitamin D were studied to distinguish seasonal changes from the thyroxine-dependent ones. Serum 25-hydroxyvitamin D levels of hypothyroid patients were lower than those of healthy individuals when the sera were obtained in the autumn. In hypothyroid patients a single oral dose of 100,000 IU vitamin D3 resulted in a smaller increase in 25-hydroxyvitamin D concentration than in controls having subclinical exogenous vitamin D deficiency. Substitution therapy with thyroid hormone, started in our study always in autumn, increased the 25-hydroxyvitamin D concentration in hypothyroid patients, which was opposite to the autumn-to-spring variation of this hormone observed in healthy controls. The increase of 25-hydroxyvitamin D, dehydroepiandrosterone and its sulphate values following substitution therapy in the hypothyroid patients may indicate that thyroid hormone(s) is (are) involved in the regulation of steroid hormone synthesis.

PMID: 3024434 [PubMed - indexed for MEDLINE]

This is very hopeful...Vitamin D3 stalls thyroid cancer, one case report:

Endocr J. 2005 Oct;52(5):613-6. Links
Vitamin D3 treatment for locally advanced thyroid cancer: a case report.Morishita M, Ohtsuru A, Kumagai A, Namba H, Sato N, Hayashi T, Yamashita S.
Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Japan.

There are many intricacies in the surgical treatment of locally advanced thyroid cancer, including the medical management of the remaining functional organ and any cosmetic impairments, which are sometimes very difficult to manage and eventually carry a relatively high morbidity and mortality. Here, we report on a case of a 65-year-old female with an extremely locally-advanced thyroid cancer involving both lobes of the thyroid, blood vessels, trachea and esophagus. Despite the severity of her condition, oral administration of vitamin D3 (alphacalcido) has stalled both the tumor growth and further increases of serum thyroglobulin (Tg) level, and has led to a good preservation of quality of life for the last two years. Several reports have previously demonstrated the efficacy of vitamin D3 to inhibit the proliferation of thyroid cancer cell lines in vitro, but clinical evidence has been limited so far. Therefore, this case report provides important evidence for the effectiveness of vitamin D3 therapy against advanced thyroid cancers.

PMID: 16284441 [PubMed - indexed for MEDLINE]

Another good story... 3mon old child with depressed thyroid function, CHF and profound Vitamin D deficiency in Oslo, Norway -- corrected with a Vit D analogue:

Acta Paediatr. 1995 Jan;84(1):106-8
Congestive heart failure caused by vitamin D deficiency?Brunvand L, Hågå P, Tangsrud SE, Haug E.
Department of Paediatrics, Ullevål Hospital, Oslo, Norway.

We describe a child, 3.5 months old, with severe vitamin D deficiency, profound hypocalcaemia, hyperphosphataemia, dilated left ventricle, severely reduced myocardial contractility and congestive heart failure. She also had depressed thyroid function with subnormal thyroxine and non-detectable serum thyrotropin (TSH) levels. The child promptly responded to calcium infusions, conventional anticongestive therapy and calcitriol. She is now 3 years old and received no medication. Myocardial function is normal but she has motor delay. We believe that her transitory congestive heart failure was caused by severe vitamin D deficiency with profound hypocalcaemia.

PMID: 7734890 [PubMed - indexed for MEDLINE]

Thanks, Marilyn. You're absolutely right.

In all honesty, I virtually never use cod liver oil, but for some reason some people gravitate towards it, perhaps since they took it as children.

I went to a local vitamin supplier yesterday to get some Vitamin D after reading your blog, which is most interesting I might add.  At this store they had Vitamin D2 and D3 but no D1.  Is there such a thing (D1) and which is the one I should be taking to benefit as suggested in the blog?

Hi, Jerome--

Vitamin D3 is the only form I recommend. In my view, vitamin D2 is a worthless scam, whether it's in milk, a multivitamin, or a prescription product. I've never heard of vit D1.

I liked the *idea* of cod liver oil, as it would replace both fish oil and vitamin D tablets - a total of 8 pills in my 26-pill regimen.

I bought what was supposed to be one of the best tasting ones and... it made me retch.  It also sort of tingles in your mouth.  And because it's oily, you can't rinse it out of your mouth.  It's just icky.

I gave some to the cats, figuring it would be a healthy snack for them... and all four of them refused it.

If someone can get it down, I think it's great stuff.  For me, I'll stick to the extra 8 pills...

Thanks for all the helpful comments.  I've got cod liver oil in the fridge so I think I will use it up and then get D3 capsules.
I take the cod liver oil with lemon juice.  I put the cod-liver oil in a little shot glass and squeeze some fresh lemon into the shot glass aswell and drink it in one swoop.  I then wash it down with some water with fresh lemon squeezed into it.  Gets rid of some of the icky fishy taste. The lemon also helps with digesting the fat.

I wouldn't necessarily be afraid of the A, as we can be deficient in the A as well.  Perhaps alternating between A-containing and A-less forms of D supplements would work.  That way you get a vacation from the A periodically.

As for surviving the fish taste...try following it up with a bite of something else that's strong tasting and contains fat, like cured olives or a tuna salad sandwich.

Hi Dr. Davis,

Have you seen literature making a connection to the plaque linked to Alzheimer's disease with the plaque responsible for heart disease?  I was asked this question by a distant cousin yesterday that wondered if the supplements recommended for TYP ,like vitamin D and K2, could help prevent those at risk for Alzheimer's (his grandmother, and mother both came down with Alzheimer's)

No, sorry, they are two completely unrelated phenomena, despite the use of the word "plaque" to describe both.

Fish oil benefits
Medical Research News
Published: Sunday, 30-Dec-2007  

It's good news that we are living longer, but bad news that the longer we live, the better our odds of developing late-onset Alzheimer's disease.
Many Alzheimer's researchers have long touted fish oil, by pill or diet, as an accessible and inexpensive "weapon" that may delay or prevent this debilitating disease. Now, UCLA scientists have confirmed that fish oil is indeed a deterrent against Alzheimer's, and they have identified the reasons why.

Reporting in the current issue of the Journal of Neuroscience, now online, Greg Cole, professor of medicine and neurology at the David Geffen School of Medicine at UCLA and associate director of UCLA's Alzheimer Disease Research Center, and his colleagues report that the omega-3 fatty acid docosahexaenoic acid (DHA) found in fish oil increases the production of LR11, a protein that is found at reduced levels in Alzheimer's patients and which is known to destroy the protein that forms the "plaques" associated with the disease.

The plaques are deposits of a protein called beta amyloid that is thought to be toxic to neurons in the brain, leading to Alzheimer's. Since having high levels of LR11 prevents the toxic plaques from being made, low levels in patients are believed to be a factor in causing the disease.

Alzheimer's is a debilitating neurodegenerative disease that causes memory loss, dementia, personality change and ultimately death. The national Alzheimer's Association estimates that 5.1 million Americans are currently afflicted with the disease and predicts that the number may increase to between 11 million and 16 million people by the year 2050.

The researchers examined the effects of fish oil, or its component DHA, in multiple biological systems and administered the oil or fatty acid by diet and by adding it directly to neurons grown in the laboratory.

"We found that even low doses of DHA increased the levels of LR11 in rat neurons, while dietary DHA increased LR11 in brains of rats or older mice that had been genetically altered to develop Alzheimer's disease," said Cole, who is also associate director of the Geriatric Research Center at the Veterans Affairs Medical Center.

To show that the benefits of DHA were not limited to nonhuman animal cells, the researchers also confirmed a direct impact of DHA on human neuronal cells in culture as well. Thus, high levels of DHA leading to abundant LR11 seem to protect against Alzheimer's, Cole said, while low LR11 levels lead to formation of the amyloid plaques.

Fish oil and its key ingredient, omega-3 fatty acids (found in fatty fish like salmon), have been a mainstay of alternative health practitioners for years and have been endorsed by the American Heart Association to reduce the risk of cardiovascular disease.

Fatty acids like DHA are considered "essential" fatty acids because the body cannot make them from other sources and must obtain them through diet. Years of research have shown that DHA is the most abundant essential fatty acid in the brain, Cole said, and that it is critical to fetal and infant brain development. Studies have also linked low levels of DHA in the brain to cognitive impairment and have shown that lower levels may increase oxidative stress in the brains of Alzheimer's patients.

Based on the positive results, the National Institutes of Health is currently conducting a large-scale clinical trial with DHA in patients with established Alzheimer's disease. For those patients, Cole said, it may be too late in the disease's progression for DHA to have much effect. But he is hopeful that the NIH will conduct a large-scale prevention clinical trial using fish oil at the earliest stages of the disease - particularly because it is unlikely that a pharmaceutical company will do so, since fish oil in pill form is readily available and inexpensive.

Still to be determined, he said, "is what the optimal dose should be. It could be that a smaller amount might be helpful, especially in a place like the south of France, where people are already on a Mediterranean diet."

Here in the United States, though, where fish consumption is not very high, the dose may need to be higher.

"There's a deficiency of DHA to begin with," Cole said, "and this may contribute to the low LR11 seen in many Alzheimer's patients."

http://www.ucla.edu/

This is for the person asking about Alzheimer's.

Marilyn
  




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Hi Marilyn,

Thanks for sharing the great information on fish oil/DHA!  I'm going to pass this on to my relative.

It is rather difficult to find good D3-sources in Europe. Swanson's seems to be available; gelatine capsules although with a white powder inside. Are they any good?

I do not advocate use of powder preparations of vit D. The absorption is simply too erratic. oil-based gelcaps are best.

I wonder what you think of this report? http://www.eurekalert.org/pub_releases/2008-01/bu-vdi010208.php I'm guessing that this is probably Hollick's idea of infiltration - get them to at least accept profitable D2 more before winning them over with D2.

Also, last year I was prescribed 400IU of D2 which raised my 10nmol/L to 21nmol/L; in realising this is inadequate what would you recommend is a good plan for me?

I don't know what to make of Holick's study. He is a source of reliable observations. However, his experience is dramatically different from my experience and that of many others. I have seen D2 have no effect whatsoever repeatedly. I had one woman who had been taking 50,000 units D2 per day have a blood level of D3 of 4 ng/ml.

Most of my patients take somwhere in the 4000-6000 units per day of vit D3 to generate a blood level of 50-60 ng/ml.

I saw the study about the vitamin D2 being just as good as D3 also.  Here is the link I read: http://www.nutraingredients.com/news/ng.asp?n=82331-vitamin-d-cholecalciferol-ergocalciferolI thought the article was interesting, until I read the part of the company that made the softgels.  I'd question  what where the Q/C of the content? Did an independent lab test the softgels?

Excellent point.

To me, there is absolutely no reason to take vit D2, given the uncertainty. It is not cheaper, more effective, nor more available. It may, however, be more profitable for a drug company. D3 is the human form; D2 is the plant form.

Is there any reason at all to take D2? I don't think there is.

Thanks for the information on Alzheimer's (AD) known now as 'Type 3 Diabetes.' It's conjectured that profound Insulin Resistance in the brain occurs prior to amyloid development in AD patients.  The brain can only use two types of fuel -- ketones (ie like during starvation) and glucose.  There appears to be a problem with excessive glucose.  Some neurobiologist experts believe a mildly ketotic diet may be beneficial for preventing this type of insulin resistance.

Many benefits in recent studies have shown that fish oil significantly decreases IR associated with Type 2 Diabetes, NAFLD (a precursor to diabetes and believed to be a new indicator for Metabolic Syndrome, non-alcoholic fatty liver dz) and even cancers -- including prostate (shown by Vieth) and glioblastoma -- a rare malignant brain cancer -- thought to be incurable but now being 'cured' with fish oil (and tamoxifen, etc cocktail).

Thanks ! !  g

sorry -- Vieth is in vitro data -- don't know if in vivo data exists yet

Seems word is leaking into the mainstream press about vitamin D.  Last night NBC Nightly News ran an article about the connection between low vitamin D levels and increased risk for heart disease.

Hi Dr. Davis,

I know that you recommend oil-based / gel caps for Vitamin D as opposed to tablets. Does the same hold true for daily multi-vitamins? Is a capsule and a gelcap the same thing?

Wow another sickness that not enough Vitamin D is contributed to.  I just read an article at Here Comes The Sun talking about ways you can intake more Vitamin D.  Check it out.

Paul--
Vit D gelcaps contain oil. Gelcaps are capsules. However, not all capsules are gelcaps; some contain powder.

Oil-based vitamins like A, D, and E are best taken as an oil. The D, for instance, in your multivitamin probably doesn't work at all, or absorption is erratic.

Gelcaps are no more expensive, so why bother with tablet or powder forms?

Just wondered what your opinion on this anti-D report is? http://www.prweb.com/releases/2008/1/prweb639651.htm

For what it's worth, I think this guy is going too far. His Marshall Protocol might be entertainable for those with certain autoimmune diseases, but saying D is bad for everyone based on his *personal* model seems nuts. Furthermore, his basic assumption is that everyone with low D 'is' ill, rather than has the potential to. And yet we know treating D in associated illness restores health.

Would this guy withhold blood because a bullet causes bleeding? No wonder he's not an MD.

Is this guy from the same planet?

I've witnessed such extraordinary effects of vitamin D replacement that, for me, there is no turning back. Thus far, the effects of vitamin D replacement have paralleled the effects of sun exposure (except for the tan, of course).

For every new idea, there will always be those who protest. Some have validity, some are plain kooks.

Dear Dr. Davis,

Thank you for your support of Vitamin D. I recently was tested and found to have a level of 37. I do have a question or two, though. I was on the mega-dose (50000IU twice a week for four weeks).

I am now on 2000IU per day (just started this past Sunday). I have all of the Metabolic Syndrome symptoms except the high glucose (my last fasting was 81).

How long do you think I should continue on this does before I have my level checked again? And how long before I would start to see results?

My doctor seems very concerned about my CRP (3.1), and I'm really hoping that this vit d. regime helps.
Thank you.

Unfortunately, the "mega-dose" you refer to probably yielding nothing--it was probably vitamin D2 (ergocalciferol). In my experience, this synthetic form fails to be converted to the active form in humans, D3.

We wait at least 4 weeks before checking a blood level, ideally 8 weeks.

Just found out that I have
vitamin D deficiency.  I have
neuropathy, muscle weakness
and arthritis.
I hope taking the 50,000 units
three times a week helps.
We must certainly need our D,
I'm proof.

I have been detected with high TSH levels - 6 (the thyroid hormones are within range)and low Vit D - 25.
Additionally, my cholesterol is 223 (good one is 81).
I also seem to be getting ovarian cysts.
Is all this related?

quite interesting post. I would love to follow you on twitter.

Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

In short, metabolic syndrome creates a metabolic mess that leads to dramatic increases in heart disease, vascular disease and stroke, and cancer. The medical community has been paying increasingly greater attention to this condition because of its booming prevalence and because of the big bucks invested in "education" by the manufacturers of the diabetes and pre-diabetes drugs, particularly makers of Actos and Avandia.

Vitamin D is proving to be a very important and powerful influence on many of the facets of the metabolic syndrome. Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases.

I was wondering can you have a genetic compenont against making enough vit d by the sun? I bask in the sun for hours (since I love it so much and I am drawn to it like postive charge does to negative charge) yet I am d deficient, I suffer terrible metabolic syndrome, the whole nine yards just short of type 2. my doctor calls me prediabetic.

I have even improved my diet big time over the last 3 years. lower gi, lower sat fat, more veggies etc. omega 3 fish oil

I never use sunscreen and I never burn. just a nice light brown tan.I keep this tan by the way almost the whole winter. I started to take a cal vita d mag supplement chewables and I drink whole milk with it to make sure I absorb them being fat soluable and all. I can't expose my belly for more than a few minutes that will burn. ouch!

being obese I am sure whatever cal vita d I take is going to end up in storage hoarding it an all. what can I do? I now drink more whole milk, eat organic bacon per suggestion from article the obesity epidemic is metabolic syndrome a nutritional deficiency. by stephanic seneff. real nice lady by the way.

anyway slowly after implementing her suggestions my fasting hypoglycemic especially at night has improved, i don't run to the bathroom like i used to, I am more relaxed too. I have more energy, all this is a slow process not overnight. over many months.

I don't have to eat at 3 in the morning anymore because of getting super hungry, nervous sweaty etc.

but I still suffer some of the symptoms just not as severe. is there anything else I can do to speed up the improvments in mets?

reduced cal diets do not work I get to hungry can't sleep and lose all energy. even a slight reduction which I have done makes me to hungry to sleep at night. or forces me up to eat after a couple of hours of sleep.

forcing my body to get by on less caloires is not an option. (losing weight is always touted by my doctor to cure mets but mets was caused by my dieting history) I have lost hundreds of pounds over my 35 dieting history.

I would like to hear any suggestions you may have. my doctor keeps pushing weight loss but that is what got me like this in the first place.

From the two lists you've provided (and the critical caveat about dietary cholesterol and saturated fat), it seems so simple to reduce my risk of heart problems.  Lose weight on a carb-restricted diet (I've lost 25 pounds towards a 35 pound goal so far) and:

1) blood pressure falls
2) blood glucose, insulin, and diabetes risk falls
3) triglycerides fall
4) HDL rises
5) LDL composition improves
6) Lp(a) falls
7) Athletics are easier and more enjoyable.
8) I feel better about my appearance (anti-pessimism).

How in the world can anyone still say that low-carb (high-fat) diets are bad for you or increase your risk of heart disease, heart attack, or stroke?

And yet, this is what I keep hearing over and over and over again.  

I'm learning to not talk about my diet (cooking eggs in butter, drinking whole milk, etc.) because almost everyone who hears me describe how I'm losing weight gets very defensive about the established advice to cut fat in order to lose weight.  All of my assurances that the science doesn't actually back up the US Government's (or the AHA, ADA, etc.) position fall on deaf ears.  The fact that I'm losing weight and getting regular blood tests to verify progress on cholesterol and some inflammatory markers seems to have no effect on anyone.

Shutting up and just improving my own health seem to be the best way to keep the peace.  Sigh.

Dr D what are your thoughts on the chol ratios ?It used to be thought that it was more significant.
You're right on with those thoughts mentioned about AHA and ADA.

Hi, Chickadee-
I find that the standard numbers like total cholesterol and LDL very limited in predictive value. Ratios like total cholesterol to HDL are simply manipulations of these basic numbers. They improve predictive confidence for heart disease and heart events, but they are simply statistical manipulations. If you are using lipoproteins (e.g., NMR), you've already far surpassed the limited value of these ratios.

Wonder if you have ever seen this study where rye turned on certain genes that prevent diabetes, control blood sugar, and wheat and oats and potato had the opposite effect and turned them off?
http://www.ajcn.org/cgi/content/abstract/85/5/1417?maxtoshow=&HITS=80&hits=80&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=85&resourcetype=HWCIT

American Journal of Clinical Nutrition, Vol. 85, No. 5, 1417-1427, May 2007

I don't know if you can infer from this that oats and potatoes may be just as bad as wheat but it was interesting.

Also, I know you have blogged about some HDL subfractions having issues as well. Is that a consideration as well? Article: Sizing up your HDL. http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=heart.disease&conitem=c31a99edbbbd201099edbbbd2010cfe793cd____

Hi Dr. Davis,

What a fantastic post to start off the New Year.

I see that Vitamin K2 has now made the short list.  I'd noticed that you were talking about it more recently.

Do you think this has the potential to become another "D3-like" sleeper for risk control?

Thanks for all you do.

Can't the rest of the world catch up to your progressive pace Dr. Davis?

Obviously you enjoy figuring out and solving puzzles. Have you seen National Treasure yet?
Dr. Davis, y-o-u are our National Treasure.

As Heart Hawk says it... 'Jack, Smack and WHACK that Plaque!'

I like that... kinda Tony Soprano-style *ha ha*

Happy New Year to you and your family and all the TYP-ers and Early Adopters!  
g

Hi, MAC--

Interesting. I wonder if rye deserves a reconsideration. I have to admit that I've dismissed rye since it nearly always occurs as part of wheat-containing products. Perhaps this was throwing out the "baby with the bath water" sort of issue.

HDL sub-fractions are indeed something we pay attention to, though the therapeutic efforts to correct them are virtually the same as those that correct small LDL.

Wcaguy--

The more I use vitamin K2, review what data exists, and observe its effects, the more I am convinced there is a real effect here.

However, K2 does not appear to exert the broad array of benefits that D3 does, such as resolution of winter blues, metabolic syndrome, increased HDL, drops in blood sugar, decreased inflammatory responses, etc. K2's effects are more confined and narrow.

I'm hoping this preliminary experience holds. I think it may have been responsible for heart scan score reduction in a couple of people, but it's often hard to know when people are doing multiple things all at once.

I know you were reading "Good calories, bad calories" and wonder after reading that if you still feel saturated fat is bad?

I loved Mr. Taubes' book.

However, I am not prepared to endorse the full embrace of saturated fat. I am going to go back to the original literature before I (re-)make up my mind on this issue. I'm well aware of the arguments on both sides of the issue, but there's nothing like the real sources.

How is it that the focus is still on total LDL and not the size of the LDL particles? The inverse relationship between HDL and triglycerides per Taubes book was presented in 1961.

I was a test subject in the early 80s for Quaker Oats research to claim that eating oats would lower your cholesterol and even then my blood work came back with sub fractions. So over 25 years ago they were interested in these subfractions.

Second question. If you have bad subfractions of HDL do you always have bad subfractions of VLDL and vice versa? As you have indicated the therapeutic efforts to correct  both are the same. Just curious.

In my view, lipoprotein testing is an absolutely crucial part of determination of risk for heart disease. The reasons for its lack of use by practicing physicians are several, but principally 1) complexity, 2) no big bucks for promoting any specific treatment from a drug company.

Lipoproteins do tend to travel in "packs". HDL subclasses do follow LDL subclasses which follow VLDL--they do tend to track together, though they can also diverge.

Hi Dr. Davis,

I don't take issue with you often, if ever, but I must object to your point that lipoprotein testing and analysis is "complex" and that's a reason why practicing physicians don't do it more often and/or effectively.

You've made this point before and it struck me that this point was wrong and I figured out how to show that it was wrong but then forgot about it.  Your making the point again jogged my memory.

I'll bet you that I could explain generally how lipoprotein subfraction distributions impact risk of CAD to my 10 year old daughter and a few of her friends (all 5th graders) and they could understand it and explain it's importance.  

Admittedly, the explanations wouldn't be on a par with what one would expect from an adult with a scientific bent.  I'm hoping that you wouldn't insist that their explanations would need to be on a par with a practicing physician for me to demonstrate the point.

The point is that it's NOT difficult to grasp the concept that lipoprotein subfraction distributions have an extremely significant impact on CAD risk.

I must insist that you cease and desist making this point or you will force me to make a video that I post on the web showing some young teens explaining the importance of lipoprotein subfraction testing and analysis.

You know, it took over 20 years for the cholesterol concept to be incorporated into daily clinical practice of the average primary care physician, despite enormous marketing budgets from the drug companies.

Lipoprotein testing, I agree, is really not that complicated. Just a few months of education and someone could diagnose and treat quite confidently. It is, however, a significant hurdle to a primary care physician dispensing flu vaccine, prescriptions for arthritis, doing pap smears, treating colitis, etc., just one more new thing to learn among many.

I believe that the new generation of "lipidologists" will be a practical solution, since my colleagues, the cardiologists, are too focused on the next exciting procedure and the primary care physician is spread too thin. It's also the reason why I've gone straight to the person most interested in lipoproteins--you and other readers--to provide this information.

Dr.D,
In your list of risk factors, what do you mean by "high blood pressure with exercise"?  Do you mean that blood pressure is high only during exercise or that blood pressure is high even though you exercise?  
Thanks for a great blog.
Kate

Dr. D.

I think your last response really begins to get to the heart of the problem.

Wikipedia says that "cardiology is the branch of medicine pertaining to the heart and the vascular system of the human body."

I didn't read the whole Wikipedia entry on the subject, but I'm pretty certain that "next exciting procedure" is not descriptive of any limitation of the subject matter that it might be assumed cardiologists should be expected to know something about.

Seems to me you're right in pointing out that Primary Care Physicians are spread thin and can't be faulted too much for not knowing detailed treatment nuances of every disease.  Even for them, however, one would think there would be greater interest in treatment of the single most significant cause of death in the US and most of the industrialized world.

But it's also understandable that Primary Care Physicians have expected to be able to look to their cardiologist colleagues for leadership in promotion of the best treatment regimes for CAD.

In my view, the problem is that cardiologists, in general, have utterly failed to provide the kind of knowledge leadership the current state of the science of lipoproteins ought to require.

I'm not certain about what kind of doctors run the AHA and the ADA but if they are run primarily by cardiologists then I'd be hard pressed not to come to the conclusion that the general failure of this profession is even more massive for all the reasons you find fault with those organizations.

I think THAT is what is so hard for all of us to fathom:  How could it be that such a large and seemingly smart and educated group of people fail to "get it", about diet at the ADA and the AHA, about lipoprotein education leadership for the colleagues, etc.

Given the tragic consequences of that general failure, is it possible even to argue that there is another group of white collar professionals who have failed more than the cardiologists?

Hi, Kate--

I'm referring to blood pressure measured during a stress test. It's too difficult to assess your own BP while exercising. It has to be done by someone else in the midst of exercise, meaning a stress test. However, this effect can be an important "coronary risk."

WC--

It is dismaying, I agree.

I do feel that my colleagues have been sidetracked by the promise of financial gain, probably no different than the mortgage lenders making unwise sub-prime loans, stockbrokers churning accounts for commissions, pharmaceutical manufacturers inflating drug prices in the U.S. while charging far less in more cost-conscious countries.  

It's the profit motive, alive and well. It is through conversations like this that help all of us break out of the profit-driven bounds of the conventional approach.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2075568

Someone posted an article with a similar finding in one of your earlier posts.
If this is true, it's absolutely astounding that statins could simply be pricey analogues of cheap-ass (pardon my French) vitamin D.

I also believe calcium channel blockers used for epilepsy, which clearly simply block calcium from entering the desired part of the body, could be replaced by D. Instead of blocking calcium, it's probably best to ensure proper metabolism.

We know that wheat intake is not good for people with lots of small ldl, what about psyllium ? Is it good bad or indifferent as far as small ldl partcles ?

Indifferent: psyllium reduces all LDL particles, regardless of size.

Dr. you mention high blood pressure with excercise as a risk factor and then go on to say that this is something that would be found out during a stress test. My question is surely everybodies blood pressure raises during excercise what level would be "high" for someone during this stess test ?

"High" depends on the level of exercise on a formal exercise "protocol". However, we use a crude cut-off of any BP >170/80 as clearly high.

Dr Davis,

Good list.  But I was wondering about some other factors that others list that don't appear either in your list or the conventional one:
* Inflammation - as measured especially by C-reactive protein, or other measures.
* Advance glycation endproducts (AGE) as measured by pentosidine, skin autofluorescence, etc.  Sure it correlates with blood sugar, but other factors (antioxidant status, fructose in the diet, dietary intakes of oxidized oils) throw the correlation off.

Yes, good point.

We do address inflammation, but only occasionally does it emerge as something that requires specific action, e.g., suppression of matrix metalloproteinase. Otherwise, all the steps we take to correct the other factors also correct inflammatory responses.

AGE's are a fascinating issue, but not one we've specifically addressed for purposes of plaque reversal.

Dr. Davis,

Wanted to make a friendly suggestion.  I have been printing pages from your blog to hand out to others.  
I was thinking if possible to do, it would be helpful if there was a "print button" for blog posts.  Also it would be good for the printed  page to have your web sight highlighted somewhere on the print.

Dr D,

First time reader and I am excited to see a cardiologist that is actually standing up for correct Western Medicine. I have a question about this post ( a year late I know), but wanted to discuss. You state "* High blood pressure with exercise" as being another problem. In one of the comments you stated that this can be under 170/80. I have been treated with beta blockers and thiazidines to reduce my BP. It's been "working" for 10 years now, yet I was severly overweight. Recently I started to eat a grain free diet under the Primal Blueprint method and amped up real totally body fitness. I lost about 40 lbs since and feel amazing.

Recently I went back to my cardiologist and began discussion about lowering my dosages since I get winded and shortness of breath during my workouts.

Anyways, I asked the Dr. to lower the meds and then told me that I was going to die if I stopped taking them. Told me to eliminate caffeine, and sodium to lower it. Said I needed to eat more vegetables.

Can you explain why BP would not lower with proper diet and 6 days of exercise a week for almost a year?

Thanks!
dan