"Placebos are frequently of value"

12. May 2009 William Davis (1)
The treatment of angina pectoris, generally speaking, is unsatisfactory.

Any procedure that relieves mental tension is valuable. Since patients suffer particularly during the winter, I encourage winter vacations in a southern climate.

I insist that obese patients lose weight, and have found small doses of benzedrine, 10 to 20 mg. daily, helpful in curbing the appetite.

I generally forbid smoking. This is a particularly disturbing task for many patients to carry out. In such cases, I suggest that 3 or 4 cigarettes be smoked daily, knowing full well that regardless of what I say or recommend, the patients is going to continue to smoke.

Innumerable drugs, most of which are of questionable value, have been used to prevent attacks of angina pectoris. In fact, placebos are frequently of value.

Testosterone--The male sex hormone has been effective in my experience. Whether it acts as a vasodilator or merely by promoting a sense of well-being is not known.

Alcohol--Alcohol (whiskey, brandy, rum) has been used for many years in the treatment of angina pectoris. I have prescribed it in moderate quantity--an ounce several times a day--and while I have not made alcoholics of any of my patients, I also have not cured any of them with it. Preparations, such as creme de menthe, are of value in relieving "gas" of which so many patients complain.


From Heart Disease Diagnosis and Treatment
Emanuel Goldberger, MD
1951
Tags :

Comments (1) -

  • Roger

    5/12/2009 8:04:00 PM |

    That guy was way ahead of his time.  Doctors were posing for cigarette ads in the '50s.  And who cared if you had "middle-age spread?"  We've just update his benzedrine Rx with Red Bull and triple lattés.  I'm surprised Nitroglycerine wasn't mentioned; my dad took it for his angina.  The winter vacation in the tropics suggestion could have been all about Vitamin D, without knowing it.

    The Atlantic Monthly had an essay on the placebo effect that I have never forgotten.  You can read it below.

    http://www.theatlantic.com/issues/2000/10/fisher.htm

Add comment

Loading
Thyroid: Be a perfectionist

Thyroid: Be a perfectionist

27. July 2009 William Davis (18)
If you'd like to reduce LDL cholesterol with nearly as much power as a statin drug, think thyroid.

When thyroid is corrected to ideal levels, LDL cholesterol drops 20, 30, 40 mg/dl or more, depending on how poor thyroid function and how high LDL are at the start. The poorer the thyroid function (the higher the TSH or the lower the T3 and T4) and the higher the LDL cholesterol, the more LDL drops with thyroid correction.

(For those of you minding LDL particle size, such as Track Your Plaque Members, the "dominant" LDL species will drop: If you are genetic small LDL, small LDL will drop. If you have mostly large LDL because of being wheat-free and sugar-free, then large LDL will drop.)

One of the problems is that many healthcare providers blindly follow what the laboratory says is "normal" or the "reference range," which is usually nothing more than a population average (actually the mean +/- 2 standard deviations, a common method of developing references ranges). In other words, a substantial degree of low thyroid function, or hypothyroidism, can be present when your doctor adheres to the reference range provided by the laboratory.

What does it mean to achieve ideal thyroid status? My list includes:

--Normal oral temperature of 97.3 F first upon arising. (The thyroid is the body's thermoregulatory organ.)
--TSH 1.0 mIU/L or less
--Free T3 upper half "normal" range
--Free T4 upper half "normal" range
--You feel good: mental clarity, energy, upbeat mood. You lose weight when you try.

Iodine replacement should be part of any thyroid health effort. Iodine is not an optional trace mineral, no more than vitamin C is optional (else your teeth fall out). The only dangers to iodine replacement are to those who have been starved of iodine for many years; increase iodine and the thyroid can over-respond. I've seen this happen in 2 of the last 300 people who have supplemented iodine.

In my view, neglecting T3 replacement is absurd. While it is not clear to me why many otherwise healthy people have low T3 at the low range of "normal" or even in the below-normal range, people feel better and have better health--faster weight loss, reduced LDL, reduced triglycerides, they are happier and enjoy more energy--when T3 is increased to the upper half of the reference range. (Crucial question: Why is the 5'-deiodinase enzyme that converts T4 to T3 inhibited, resulting in reduced free T3? What is in our diets or environment that is exerting this effect? I don't have answer, but we sorely need one.)

It pays to be a perfectionist when it comes to thyroid. Not only do you feel better, but LDL cholesterol can drop with a statin-like magnitude, but with none of the adverse effects.

If interested, Track Your Plaque offers fingerstick blood spot testing that you can perform in your own home. Each test kit will test for: TSH, free T3, free T4, along with a thyroid peroxidase antibody (a marker for Hashimoto's thyroiditis, an autoimmune inflammatory condition of the thyroid).
Tags :

Comments (18) -

  • Anonymous

    7/27/2009 1:24:46 PM |

    Interesting... my mother was put on a statin about a year and a half ago due to "hypercholesterolemia" (dx of course by a basic lipid panel).  Around the same time she was also put on thyroid medication.  Her LDL dropped and we all assumed it was the statin...

  • Nameless

    7/27/2009 6:35:06 PM |

    Low carb diets can influence T3 by lowering it. Certain beta blockers can inhibit 5'-deiodinase too.

    What do you think about studies like this one:
    http://www.reuters.com/article/healthNews/idUSTRE55B67D20090612

    Where they theorize that low thyroid function may be linked to longevity? I believe that has been found in certain species of rodents too and low metabolic rates for elephants (as the article researchers comment on).

    I'm not saying everyone should go around being hypothyroid, but am curious what your thoughts are. Perhaps lowered thyroid function is a part of aging?

  • sdkidsbooks

    7/28/2009 1:51:24 PM |

    I'm still wrestling with my pcp over my thyroid. I'm back on Armour 90mgs but my tsh is 5.6, which is needs to be lower, as you say 1.0.  My dr keeps telling me she doesn't want to increase the rx because she's afraid I will get atrial fibrillation. She doesn't test for anything else but tsh

    Currently, my morning temps are 96.3, I have trouble losing weight and my LDL is just at the upper range of normal and my LP(a)is 34. I'm not taking statins and am following all of the heartscan blog diet/supplement recommendations. I want to get my LDL down, lower my LPa and regulate my thyroid. Is it risky to take more Armour to lower my tsh?  I am taking 220mcgs of iodine should I increase that?

    Jan

  • Anonymous

    7/28/2009 4:01:32 PM |

    I'm a little confused about the iodine thing. I Googled around and found several studies implying that iodine supplementation can increase incidences of hypothyroidism.

    Here and here are two of the studies I saw. In the referenced-by section of the last one is an interesting study where excess iodine was found to be the root of goiter and thyroid troubles in some Peace Corps workers in West Africa.

    I started googling more specifically and found more sites that warned about iodine-induced hypothyroidism, but the majority stated the opposite (that iodine can help hypothyroidism).

    I'm not trying to contradict or anything, but I was wondering if you were aware, that's all. I mean, imagine the result if someone on the AAD (with all the prepackaged food) felt hypothyroid symptoms, and was told by a doctor to increase iodine intake, when they really had more than enough intake already...

    Perhaps you've already taken this into account. If you have the time I'd like to know your thoughts on it.

  • Dr. William Davis

    7/28/2009 4:19:18 PM |

    skids--

    Time for a new doctor, one who will listen to reason.

    Anon with question about iodine. Please put "iodine" into the Heart Scan Blog site specific search and you will find the several discussions we've had about this important issue.

    There is no question: We need iodine for health and many--not all--people are deficient.

  • Nameless

    7/28/2009 5:31:33 PM |

    I have read in a number of places that iodine can worsen Hashimoto's, although Dr. Davis feels it won't. Maybe he is right too, but he has never explained why high dose iodine is typically stated in various thyroid articles as something to avoid if you have an  autoimmune disease (besides potentially causing a hyper flare).

    The mechanism for worsening Hashimoto's would be:  iodine increases thyroid hormones, which in turns increases thyroid antibodies, which  then slowly kills off your thyroid quicker. Typically synthetic T4 or armour is used for hashimoto's, which can result in lowered antibodies (usually). I know of two studies where low-dose T4 decreased inflammation + antibodies in Hashi people too.

    I don't doubt that supplementing iodine if you are deficient is a good thing. But I am  not sure if large doses are a good idea if you have an autoimmune issue going on.

  • Kismet

    7/28/2009 7:35:55 PM |

    Anon read:
    Iodine: Deficiency and Therapeutic Considerations
    http://www.thorne.com/media/Iodine13-2.pdf

    The paper makes a compelling case that iodine is not necessarily the culprit. The hypothyroidism & life span data has me still worried, though. But that's nothing new.

    From a purely CVD perspective T3 & T4 look like an interesting target...

  • Dr. William Davis

    7/29/2009 2:51:17 AM |

    Nameless--

    I said nothing about Hashimoto's. I am talking about people in general. Perhaps you noticed that I am not sitting in front of you providing personal information!

    You are correct: If you are in the throes of active Hashimoto's thyroiditis, you should not take iodine, no more than a raging fire requires more kindling.

    Let me restate: Iodine is--in the general population-- a necessary trace mineral. Humans cannot live without it.

  • Nameless

    7/29/2009 3:32:38 AM |

    Dr. Davis,

    I didn't mean to infer that you should provide detailed info here, or were even mentioning hashimoto's at the moment.

    I just know it came up in past iodine threads, and the autoimmune issues weren't really spoken about in detail then. Since someone here asked about it, I thought I'd make a comment. People sometimes don't get fully tested if they have a thyroid issue (actually based on how doctors treat thyroid people, I'd say most don't get proper testing). I just had a concern that if someone has an autoimmune thyroid issue, excess iodine could be a rather bad thing. So it's worth getting both your thyroid and iodine status fully checked out, before you supplement with large doses.

  • Anna

    7/29/2009 1:36:01 PM |

    "So it's worth getting both your thyroid and iodine status fully checked out, before you supplement with large doses."

    This is definitely true, but in reality, in conventionally practiced medicine,  it hardly ever happens.  I have been treated for hypothyroidism with T4 (and sometimes T3) for more than three years.  For almost 15 years my thyroid function has been tested, initially with just TSH, then with TSH and total T4, then finally the past few years with free T4 and free T3 tests.  Only my new doctor ever tested for thyroid antibodies.

    And autoimmune hypothyroidism usually presents quite differently from plain hypothyroidism - with stops and starts to the symptoms, or even periods of hyperthyroidism.

  • liverock

    7/29/2009 2:10:03 PM |

    Dr Davis
    Re your comment on what stops T4 to T3 conversion.

    Adequate selenium is required to form thyroid hormone and with the increasing amounts of heavy metals (which are selenium antagonists,)we all are absorbing, selenium levels are dropping.

    "Selenium is a cofactor for 5’-deiodinase, the enzyme required to convert T4 to T3. A low 24 hour urinary selenium level likely correlates with overall selenium deficiency and decreased tissue availability of T3 due to decreased conversion of T4 to T3."

    Rocky Mountain Analytical Lab Report.
    www.rmalab.com/index.php?id=16

  • trinkwasser

    7/29/2009 6:18:46 PM |

    "Crucial question: Why is the 5'-deiodinase enzyme that converts T4 to T3 inhibited, resulting in reduced free T3? What is in our diets or environment that is exerting this effect? I don't have answer, but we sorely need one."

    Statins? (grins)

    Agreed, if there's something we could avoid to prevent this it would majorly benefit all those poor folks whose doctors refuse to treat hypothyroid. Who are legion.

  • Dennis Mangan

    7/30/2009 12:58:09 PM |

    Anyone interested in the topic of iodine supplementation and who wants lots of detail ought to read Dr. Guy Abraham.

    http://www.optimox.com/pics/Iodine/opt_Research_I.shtml

    Will answer any conceivable question you thought you had.

  • Jessica

    8/4/2009 11:08:04 PM |

    I was going to post a response to your question:

    "(Crucial question: Why is the 5'-deiodinase enzyme that converts T4 to T3 inhibited, resulting in reduced free T3? What is in our diets or environment that is exerting this effect? I don't have answer, but we sorely need one.)"

    But it looks like LiveRock already posted 1/2 of what I was going to post and that is that selenium is needed to convert T4 to T3.

    The other 1/2 of the problem of T4 to T3 inhibition is Vitamin D. My dad (family physician) said that the 5'deiodinase enzyme is a D dependent enzyme. Crank up the D and add selenium and see if the conversion problem still exists.

    He almost always puts patients on iodine PLUS selenium (no more than 400 mg) as well as several of the B vitamins (riboflavin, etc) for thyroid management.

    Have you read Dr. Brownsteins book, "Iodine: Why you need it, why you can't live without it?" it's a fantastic read.

  • dearthyroid

    8/14/2009 2:42:16 PM |

    Thanks so much for this post.  It's always so interesting to me to read up on iodine in relation to thyroid health.  I have Hashimoto's myself and know that there's so much controversy surrounding iodine... I don't know quite what to believe just yet.  Either way, thank you for your explanations about thyroid levels and cholesterol and treatment. The thyroid and liver are connected in a very powerful way that often gets overlooked.

    Thank you!

    Liz Smile

  • grace

    8/28/2009 12:16:47 AM |

    Great post!thanks for sharing.now i know that low carb diets can influence T3 by lowering it,try to put some thyroid medication by thyroid kits.

  • lightcan

    10/16/2009 10:55:45 AM |

    What about fluoride? I've read that it affects the thyroid. Is there a mechanism by which it might affect the conversion of T4 to T3?

Add comment

Loading
Lipids are snapshots in time; heart scans are cumulative

Lipids are snapshots in time; heart scans are cumulative

12. August 2006 William Davis (0)
Let me paint a picture. It's fictional, though a very real portrait of how things truly happen in life.

Michael is an unsuspecting 40-year old man. He hasn't undergone any testing: no heart scan, no lipids or lipoproteins. But we have x-ray vision, and we can see what's going on inside of him. (We can't, of course, but we're just pretending.) Average build, average lifestyle habits, nothing extraordinary about him. His lipids/lipoproteins at age 40:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

At age 40, with this panel, his heart scan score is 100. That's high for a 40-year old male.

Fast forward 10 years. Michael is now 50 years old. Michael prides himself on the fact that, over the past 10 years, he's felt fine, hasn't gained a single pound, and remains as active at 50 as he did in 40. In other words, nothing has changed except that he's 10 years older. His lipids and lipoproteins:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

Some of you might correctly point out that just simple aging can cause some deterioration in lipids and lipoproteins, but we're going to ignore these relatively modest issues for now.)

Lipids and lipoproteins are, therefore, unchanged. Michael's heart scan score: 1380, or an approximate 30% annual increase in score. (Since Michael didn't know about his score, he took no corrective/preventive action.)

My point: If we were to make our judgment about Michael's heart disease risk by looking at lipids or lipoproteins, they would'nt tell us where he stood with regards to heart disease risk. His lipids and lipoproteins were, in fact, the same at age 50 as they were at age 40. That's because measures of risk like this are snapshots in time.

In contrast, the heart scan score reflects the cumulative effects of life and lipids/lipoproteins up until the day you got your scan.

Which measure do you think is a better gauge of heart attack risk? I think the answer's obvious.
Tags :

Add comment

Loading
Heart scans know no race

Heart scans know no race

27. March 2008 William Davis (0)
The New England Journal of Medicine just published a new analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) database authored by Dr. Robert Detrano of University of California-Irvine.

As we would expect, the study confirmed the ability of heart scans and coronary calcium scoring to predict heart attack. This study is unique, hovever, in including Hispanics, Chinese Americans, and African Americans in its 6722 participants.

The analysis confirmed that coronary calcium scores yielded similar information, regardless of race. It confirmed that people with a zero heart scan score had a nearly zero risk of cardiovascular events; it also confirmed that higher scores (e.g., >300) yielded much greater risk over the 4 years of observation: 7.73-fold greater risk for people with scores 101-300; 9.67-fold greater for scores >300.

One of the media reports on the study can be viewed on HeartWire

Bill Sardi's Knowledge of Health website and blog also has an insightful commentary.

To those of us who have used heart scans in thousands of people, the MESA results come as no surprise, having seen these phenomena played out every day in real life. Although similar results have been previously shown in a number of other smaller studies, Detrano's analysis of MESA does serve to further validate these concepts. It also serves to deliver the message more broadly into the mainstream media message.

No surprise whatsoever: Coronary calcium scores obtained through heart scans represent a measure of the disease--coronary atherosclerosis--itself. It is not a risk factor that may or may not be associated with development of coronary atherosclerosis. Thus, when heart scan scores are held up in comparison the cholesterol, LDL cholesterol, c-reactive protein, or any other risk measure, heart scan scores outshine all these measures by enormous margins as predictors of your future.

Want to know what your uncorrected heart disease future could be? Consult your heart scan score. Not your cholesterol panel.


Copyright 2008 William Davis, MD
Tags :

Add comment

Loading