Why average cholesterol values can be so bad

Jack had been told again and again that there was absolutely nothing wrong with his cholesterol panel. His numbers:

Total cholesterol 198 mg/dl

LDL cholesterol 119 mg/dl--actually below the national average (131 mg/dl).

HDL 48 mg/dl--actually above the average HDL for a male (42 mg/dl).

Triglycerides 153 ng/dl--right at the average.


So his primary care physician was totally stumped when Jack's heart scan revealed a score of 410.


Lipoprotein analysis (NMR) told an entirely different story:

LDL particle number 1880 nmol/l (take off the last digit to generate an approximate real LDL, i.e., 188 mg/dl).

Small LDL 95% of all LDL particles, a very severe pattern.

A severe excess of intermediate-density lipoprotein (218 nmol/l), suggesting that dietary fats are not cleared for 24 hours or so after a meal.

And those were just the major points. In other words, where conventional cholesterol values, or lipids, failed miserably, lipoprotein analysis can shine. The causes for Jack's high heart scan score become immediately apparent, even obvious. Jack's abnormalities are relatively easy to correct--but you have to know if they're present before they can be corrected. A shotgun statin drug approach could only hope to correct a portion of this pattern, but would unquestionably fail to fully correct the pattern.

As I've said before, standard cholesterol testing is a fool's game. You can squeeze a little bit of information out of them, but there's so much more information that can be easily obtained through lipoprotein testing like Jack had.

Comments (23) -

  • DietKing2

    8/29/2007 9:56:00 PM |

    Doctor,
    Have you ever heard of this?
    I hear you talking about Lp(a) quite alot and I'm not counting on my daily dose of Lipitor to straighten out whatever else might be going on backstage in my bloodstream, you know?
    Let me know what you think.
    Adam
    http://www.thecureforheartdisease.com/pauling/lpatent.html

  • Dr. Davis

    8/30/2007 12:36:00 AM |

    Hi, Adam--

    Yes, we've tried the Rath/Pauling formula informally but have never seen any substantial effect.

    Lipoprotein(a) is a very real phenomenon that clusters in high-risk families with heart disease. The treatment is specific, e.g., niacin, testosterone, and others. However, it must be measured specifically. Be sure to see the extensive conversations on our website, www.trackyourplaque.com.

  • Anonymous

    8/30/2007 2:53:00 AM |

    hello- I am new to your blog and just wondering your opinion on "The South Beach Diet" or what diet/book you recommend.
    I am a 50 year old male on a statin with a calcium score of 2. My lipid numbers are OK now but I really want to get off the statin and am totally confused by all the contradicting diet info out forthe public.Help!

  • Anonymous

    8/30/2007 3:21:00 AM |

    Hi Dr. Davis,

    I joined TrackYourPlaque today and appreciate your insight there.

    The story you relate in this post is incredible really and one I can relate to...

    10 years ago I had a mild heart attack at 43 which led to 3 stents.  5 years ago, just symptoms which got me to the hospital which led to a triple bypass.

    I've met with a lot of doctors, including cardiologists who appear often to know less about what they're doing than I have come to know through research and reading on the internet.

    I guess it's understandable that every adult patient wouldn't get sophisticated lipoprotein subfraction analysis as a matter of course.

    But you'd think that someone in my situation would get sophisticated input.

    My HMO was and is great for emergency conditions and has highly qualified surgeons and facilities.

    But after reading this post, I was struck again by how little informed and significant knowledge about best practice treatment methods one can really get in some HMO contexts.

    I know that I've spent a lot of time doing my own research to learn everything I could ('cause I don't want to die young) and I have to wonder sometimes what happens to folks with issues similar to mine who don't have a research and read orientation or the time to learn enough to protect themselves with preventative measures.

    Mid Life Male in CA
    aka "wccaguy"

  • Dr. Davis

    8/30/2007 11:45:00 AM |

    South Beach Diet is a wonderful program, at least phases 1 and II. Phase III, in my opinion, is too lax by including too much wheat. However, it is an overall solid and healthy diet. Also beware of its over-reliance on processed foods. The best foods for all of us are in the produce aisle, the ones with no labels.

    Our principal website, www.trackyourplaque.com, will also soon be releasing the NEW Track Your Plaque Diet that incorporates many of the concepts discussed here to help achieve control over heart scan scores.

  • Dr. Davis

    8/30/2007 11:50:00 AM |

    Mid Life Male--

    Yes. Lipoprotein testing, in my view, can make or break success in gaining control over your disease.

    Unfortunately, the lack of knowledge in this area is not confined to the HMO's. HMO's are, in fact, poorly represented in Wisconsin, yet ignorance among my colleagues regarding lipoprotein testing and other advanced measures of risk persists outside of the HMO setting. In short, it's everywhere. It's up to us to talk about it and spread the word.

  • Anonymous

    8/30/2007 3:02:00 PM |

    Hello- Greg here- I posted the South beach Diet question- thanks so much for the response. A couple questions:
    - Is your new book coming out actually a book to purchase or part of your membership web-site?
    - Can you tell me when it will be available?
    - I know you don't recommend wheat flour products but can you comment on sprouted grain bread line Eziekiel or similar brands, are these any better in moderation? Or should I just forget about bread entirely?
    - My calcium score was 2. That was about 3 years ago, now at 50 when should I have it done again?
    Thanks!
    Greg

  • Anonymous

    8/30/2007 3:19:00 PM |

    Greg - again- sorry, I might be confused here. My calcium score was 2 is that the same as a heart scan score?
    I am not sure I know the difference.
    Thanks!

  • Anonymous

    8/30/2007 4:11:00 PM |

    Hello- sorry for all  my comments but I just found your site and I am very impressed.
    I did a search for Splenda and didn't come up with much- can you comment on this product and the use of it in your program.I have dessert issues... I did enjoy the ricotta dessert on South Beach but what do you think of jello and the use of Splenda in desserts without wheat!There is so much on the web about the evils of Splenda- who to believe?
    Thanks!
    I really should just become a member I suppose.
    Greg

  • Anonymous

    8/30/2007 6:48:00 PM |

    Another question- do you have any thoughts on Dr. Gott's "No Sugar, No Flour Diet"? He is coming out with a cookbook this December to compliment this book.
    Thanks!
    Greg

  • Dr. Davis

    8/30/2007 8:20:00 PM |

    Sorry, no. I've heard of it but haven't yet read it. I like the title, however!

  • Dr. Davis

    8/30/2007 8:22:00 PM |

    In my experience, I've not witnessed any ill effects from Splenda or Stevia. I have seen plenty of mental cloudiness, however, with aspartame. I still think it's a good idea to keep your sweeteners, natural or synthetic, to a minimum.

  • Dr. Davis

    8/30/2007 8:23:00 PM |

    Yes, a heart scan score and a calcium score are the same thing.

  • Dr. Davis

    8/30/2007 8:26:00 PM |

    The New Track Your Plaque Diet will be a Special Report posted on the www.trackyourplaque.com website sometime in the next few months.

    With a starting score of 2, I would not recommend another scan for 3 to 5 years.

    I actually have a 18-month old loaf of Ezekiel bread in my freezer that I have not yet had a chance to play around with. So, no, sorry, no experience nor much knowledge of this specific product yet.

  • Anonymous

    8/30/2007 8:28:00 PM |

    Thanks for the responses.
    Can you tell me, in general, how often a person should have a heart scan done. As I said my last one was at 48 ( a score of 2)  I am now 50.
    Thanks!
    Sorry if I already asked this.
    Greg

  • Anonymous

    8/30/2007 8:56:00 PM |

    OK- I have been reading many of your posts today and thanks for your patience with my posting enthusiasm... I think I asked the same question twice!
    I have beed struggling for sometime with diet and my physician is no help.
    I did lose on South Beach but gained much of it back.
    I see that you recommend South Beach but as I read your postings it seems you lean toward a vegetarian diet too or am I reading into this.
    By joining the web-site would I get access to recipes and meal plans?
    Thanks for help and patience with the new guy.
    Greg

  • Dr. Davis

    8/30/2007 9:17:00 PM |

    Greg--

    South Beach is a wonderful program. Following a vegetarian diet is a choice, but not a necessary part of doing well on our program.

    Unfortunately, meal programs will not be found on the Track Your Plaque website, just discussion of principles and occasional recipes. We are working towards that, however.

  • Anonymous

    8/30/2007 9:45:00 PM |

    Thanks!
    I think I have been reading too much over the years as I have dealing with higher blood lipids and weight gain.
    The whole vegan/vegetarian crowd can make me nervous - The China Study, Ornish, McDougall, Fuhrman, Esselstyn, Pritikin, etc.... they all say theirs is THE way. I had the nutritionist write me back from the Pritkin Center and say South Beach (in the one study done) showed no decrease in LDL and that it is a horrible diet.
    Also there was an article between Ornish and Agatston in Ornish's column he writes for Newsweek where Dr. Agatston said Ornishes approach was aggressive but perhaps he should offer it to those that want to try it in the future ( I am not quoting correctly but you can google Ornish and Agatston and find the article) It kind of made me feel like he wasn't too proud of his program or maybe he was just trying to appease Ornish.... urrhhh... not sure.
    I know as the public we are really lead down different paths and the more I read the more confused I get.
    Best- Greg

  • Dr. Davis

    8/31/2007 11:33:00 AM |

    I always remind people not to  confuse diets meant to achieve WEIGHT LOSS and diets that correct causes of HEART DISEASE. There is a good deal of overlap but there can be crucial differences.

    The inclusion of abundant grains, for instance, from whole wheat or whole grain bread and breakfast cereals, magnifies undesirable small LDL particles and raises triglycerides, both powerfully related to increased coronary plaque growth.

    We use the heart scan score as our endpoint and guided along the way by lipoprotein patterns. I think this makes us worlds smarter about diet, what works and what doesn't.

  • Anonymous

    8/31/2007 1:32:00 PM |

    Thanks so much for all your help.
    I am wondering if your counsel patients at your clinic- either you or your staff.
    I am near LaCrosse, WI so not that far away. Or is it better just to join your site?
    I did have the LDL test and my particle size were a bit on the small side and as you know I have a calcium score of 2.
    Just wondering about next steps for myself- I know you cannot counsel via this blog, just looking for a general recommendation.
    Thanks!
    Greg

  • Dr. Davis

    8/31/2007 2:14:00 PM |

    Hi, Greg--
    I would suggest using our website.

    In all honesty, I do not do the website work to increase my practice. My practice is already bursting to overflowing. I am confident that the Track Your Plaque website can serve your purposes quite well.

  • Ask A Doctor

    8/13/2009 3:10:50 PM |

    I think that the lipoprotien tests should be included in the standard list for testing Cholesterol.

  • buy jeans

    11/3/2010 8:43:25 PM |

    As I've said before, standard cholesterol testing is a fool's game. You can squeeze a little bit of information out of them, but there's so much more information that can be easily obtained through lipoprotein testing like Jack had.

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Winning Through Intimidation

Winning Through Intimidation

Do you remember the book, Winning Through Intimidation by author Robert J. Ringer?



In his 1984 bestseller, author Ringer details how to succeed in business by overwhelming clients and competition by appearing hugely successful and powerful. Rather than a business card, he'd hand out an elegant book to represent himself. He'd show up in a limousine to a meeting, even when he could barely afford it. He used these tactics, even when he was a small-fry, in commercial real estate and built a successful business following such techniques.

This reminds me a lot of what happens in conventional medical practice: The large and successful hospitals, filled with trained staff and technology, exude legitimacy and success. How can they possibly be wrong? Such overwhelming know-how and multiple levels of expertise mustbe right!

Let's be grateful that we do have access to such high-tech, capable care. Unfortunately, just as Mr. Ringer used deceptive practices to appear something he wasn't, this is also true in hospitals. Not all physicians have your best interests in mind. Their principal concern is how profitable your care can be for them--can you be persuaded to have your stent, bypass, etc.. After all, look around you: Aren't all this equipment and personnel impressive? Aren't you intimidated?

The patient that most recently drove home this issue for me recently was a smart and capable executive who came in for consultation. He had been told by his internist that a surgery (to replace his aorta, a HUGE procedure) was probably necessary. In my view, it was not--his process was simply not that far progressed. The risks for danger over the next several years was virtually nil. Unfortunately, this man, now confused and worried, sought an opinion from the chief of thoracic surgery (in the usual white coat and with professorial demeanor, I'm sure) in a major metropolitan hospital (in Chicago), who promptly rushed him off to the operating room.

The pathology report, cleverly not mentioned in any other of the hospital documentation, showed what I had suspected: this man had mild disease that wasn't even close to requiring surgery. But, with all that technology, $100,000 or so of costs, chief of surgery who looked the part, etc.--they must be right!

Robert Ringer's concepts only ring too true for hospitals and some of the unscrupulous physicians in practice. Don't allow yourself to be intimidated.
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Unique vitamin D observations

Unique vitamin D observations

It seems not a single day passes that I don’t learn something new about this unique hormone (mis)named “vitamin D.”

From its humble beginnings recognized only as the factor responsible for bone maturation (with deficiency leading to childhood rickets), vitamin D now commands a recognized role in almost every conceivable aspect of health and disease.

Among the unique observations I’ve made over the past several years, having corrected vitamin D in well over 1000 people:

--Ankylosing spondylitis—This fairly rare genetic disease programs a peculiar solidification of the spinal column that leads to disabling restriction of spinal mobility, accompanied by incapacitating pain. A physician came to my office after reading my Life Extension summary of vitamin D’s cardiovascular benefits, After reading it, he put himself on vitamin D 10,000 units per day and verified “therapeutic” levels with a blood test. He came to my office (he requested a consultation) and proudly showed me his near-normal spine flexibility that, until approximately 2 months earlier, had left him rigid and unable to even tie his shoes. He also reported that the chronic pain that had left him completely dependent on anti-inflammatory agents and narcotics was nearly entirely gone.

--Aortic valve disease—The list of people with either aortic valve stenosis (stiffness) or insufficiency (leakiness) that develops later in life (not congenitally deformed or bicuspid aortic valves) continues to grow. Not everyone responds, but some of the cases I’ve seen have been nothing short of miraculous. One man had severe aortic valve insufficiency (severe leakiness). After one year of vitamin D, 8000 units per day that yielded a blood level of 67 ng/ml, the insufficiency was down to a minimal level. Before vitamin D, I had never witnessed “spontaneous” reversal of aortic valve disease before.

--Chest pain—Not the chest pain of heart disease, but a chronic gnawing, toothache-like pain in the sternum that is relieved within days of initiating vitamin D. I don’t know precisely why this happens, but I speculate that, with vitamin D deficiency, there is disordered calcium metabolism, and perhaps the sternal pain represents cellular (osteoclastic) activity that is eroding sternal calcium for the purpose of maintaining blood calcium, since intestinal absorption of calcium is poor. Replace vitamin D and the abnormal calcium uptake ceases. Just my guess.

--Relief from claustrophobia—This one has me stumped. But one man’s vivid description of his previously terrifying experiences in elevators and other enclosed spaces, now entirely gone raises some fascinating questions. For instance, how much psychological disease is nothing more than the expression of disordered metabolism from vitamin D deficiency?

--Immunity from viral infections--I first learned of this association from Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com). Dr. Cannell recounts his experience with the 2006 flu epidemic in the hospital in northern California, where he is a psychiatrist charged with the health of 200 inpatients held in closed wards. While the flu spread like wildfire to the patients in all the other wards, the 200 patients in Dr. Cannell’s ward failed to contract a single episode of flu while taking 2000 units of vitamin D per day.

I was a little skeptical at first, having been disappointed by the failure of several nutritional agents like zinc, vitamin C (perhaps, at best, a minimal effect). Now, three years into my vitamin D experience, I am absolutely convinced that Dr. Cannells’ early observation was correct: Vitamin D enhances immunity enormously. Not only have I personally not had a virus in several years, the majority of my staff and patients have been happily free of viral infections. There have been a few, to be sure. But the usual winters of hacking, coughing, and sneezing in the office have become largely a memory. It is a rare person who comes to the office with viral symptoms.


With new lessons being learned every day, it is inevitable that other fascinating new vitamin D observations have yet to be made.

Comments (47) -

  • Jenny

    2/21/2009 1:33:00 PM |

    Dr. Davis,

    Vitamin D appears to have a very strong antidepressant effect, which may be behind the response in agorophobia. People who have numbed their emotions with SSRIs may not notice it, but for someone who is not taking artificial mood drugs, Vitamin D has an effect on mood very similar to that burst of cheer one feels when going out into strong sunlight.

  • baldsue

    2/21/2009 1:44:00 PM |

    I wish it relieved constant headaches.  I do think the level of pain has dropped a notch or two since I started taking 4000 IUs a day.  And I can definitely tell the difference in my general feeling of wellness, aside from the headache, when I forget to take a dose.  In fact, that's the first question I ask myself when I feel dragged down, "Did I take my vitamin D?"

    Thanks!  I never would have ramped up my dose had I not read your words.

  • Elise P

    2/21/2009 1:51:00 PM |

    I increased my vitamin D supplementation to 3000 IU per day last fall bringing my level of D3 to 53 (I've since increased to 4000 per day).  Every year, about 3 times, I used to get a sore throat that turns to congestion that lasts for a week of misery.  I did catch the bug once this winter but it was two days of congestion and was gone.  I also got pregnant soon after adding the vitamin D, after trying for two years to conceive.  Also, my husband had allergy like symptoms, waking up sneezing and stuffy, which had gone on for 6+ months.  Two months after he upped his D to 6000 IU per day they're gone.  One question I have is for pregnancy - all the books say limit your D to 600 IU and I know they're still using the old information that looks at vitamin D as a dangerous fat soluble vitamin that can be toxic.  I'm planning to keep my supplementation at 4000 IU until the summer when I'll lower it a little, but can anyone speak to the safety of vitamin D during pregnancy?

  • Shreela

    2/21/2009 1:57:00 PM |

    "Relief from claustrophobia"

    I fell asleep in the MRI, but if helps phobias in general, I get fairly freaked when bridges are skinny, steep, or curved (highway connectors).

    I've been taking the tablets since reading about the Vit D newsletter doctor (forget his name, sorry) recommending them, and the were 2 for 1, and I had 2 coupons also.

    I read your post about how taking tablets with oil might help -- I've been taking them with fish oil already, and now I'm using olive oil on my food before taking them.

    I'll get gelcaps when I run out of the tablets, and maybe handle bridges better 8^)

  • Joe E O

    2/21/2009 2:30:00 PM |

    I can personally vouch for the efficacy of Vitamin D in relieving a) chronic chest pain b) generalized anxiety.

    It seems like a bad dream at this point - but I was completely at the end of my rope for much of 2007 vis a vis the chest pain - which also nicely fed into the the anxiety. I was in bad shape....

    Another example of the the law of unintended consequences - i.e.  Avoid the Sun - leading to Vitamin D deficiency


    I wonder if the general "health advice" about avoiding salt is leading to iodine deficiency and the sub-clinical hypothyroidism.

    Peace

    Joe E O

  • steven

    2/21/2009 4:51:00 PM |

    can you explain the difference relationship and difference between D325(OH) and 1.25 measurement of D.  Thanks.

  • Anne

    2/21/2009 5:44:00 PM |

    Dear Dr Davis,

    Please can you tell the significance of the coconut at the top of your blog - is is because of coconut oil being such a good fat ?

    Anne

  • TedHutchinson

    2/21/2009 6:23:00 PM |

    Readers wanting to know more about the
    "Connection with Vitamin D and Cancer"
    will find this new Grassrootshealth 30 minute lecture from Donald Trump worth watching

    http://tinyurl.com/d3xeux

    and while short session of full body nonburning may a reasonable route for some to top up vitamin d in summer,  for many people, particularly those in Australia/NewZealand sun exposure at any time of day may not be worth the risk, but, neither is the use of sunscreen as safe as one might think or hope.
    You may be in for a shock when you listen to Edward Gorham. (and I'm not referring to the quality of his jokes)

    Skin Cancer/Sunscreen - the Dilemma

    http://tinyurl.com/buatue

  • Anonymous

    2/21/2009 7:51:00 PM |

    Another one to add to the unique list, I've noticed that vitamin D helps with improved demeanor.  I first noticed this after my brother-in-law began taking vitamin D along with fish oil.  The brother-in-law had always been a quite person with an unpleasant  demeanor to me.  After he began taking the two supplements he became sociable, and in general I and several others I know found him pleasant to be around.   At the time I didn't know if it was the supplements that helped but joked with other family members that for our sanity we MUST keep him supplied with D and fish oil.      

    After talking with my sister this morning, maybe I shouldn't joke.  My middle nephew is quite.  Talking with him for more than 5 minutes was rare.  He just wasn't a chatty person - much like his father used to be.  Well, my sister told me this morning that the middle nephew began taking vitamin D two weeks ago.  He will not drink milk and so my sister was worried he was not building strong bones - her quote.  

    It dawned on me that my parents had talked about receiving several surprising phone calls this week from the middle nephew - he never called anyone - and how pleasant it was to have long talks with him.  My parents thought their grandson was growing up.  I think it's the vitamin D.

  • Kismet

    2/21/2009 9:17:00 PM |

    Vitamin D supplementation seems almost too good to be true.
    Dr. Davis, although some data on zinc has been negative, zinc *acetate* and *gluconate* lozenges are backed up by some solid research(not for prevention, but to treat the common cold). Only recently there was a positive study published in the J Infect Dis, PMID: 18279051.

  • David Brown

    2/22/2009 12:10:00 AM |

    I've been taking 2,000 IU of vitamin D3 daily for a couple years and it seems to protect me from sunburn. It wasn't enough to protect me from a cold and bout with the flu last winter so I upped intake to 4,000 IU. No sickness so far this winter.

  • Anonymous

    2/22/2009 10:17:00 AM |

    I live in an extreme northern climate state and have been diligently taking 6,000 IU/d of NOW (brand) D3 (soft-gels) for the past seven months.

    I just had my 25(OH)D3 tested for the first time this past week.  It came in at 61 ng/ml.  YES!

    At work, I find my co-workers often coughing and sneezing all day long.  This, in a work place that requires continual contact with hundreds of retail customers.

    This is the first winter that I can remember I haven't had any viral/cold symptoms at all... not even a single runny nose.

    I learned of this hormone here first, and probably still would not have learned of it's importance if not for this blog.  I now continually stress to my family, friends, and co-workers this utmost importance of supplemental D3.

    Thank you Dr. Davis

  • mike V

    2/22/2009 6:14:00 PM |

    EliseP:
    Hope you will find this 2004 review helpful.

    Assessment of dietary vitamin D requirements during pregnancy and lactation.
    Bruce W Hollis and Carol L Wagner

    http://www.direct-ms.org/pdf/VitDGenScience/Hollis%20vit%20D%20pregnacy.pdf

    Note: Do not correct "pregnacy" in the URL. It only works as spelled.

    MikeV

  • hoosierville

    2/22/2009 10:31:00 PM |

    Doc,
    I again want to thank you for this blog. I've directed my siste here. She has 7 stents and had a quadruple about 10 years ago. She's 67 not and doing well but she still hasn't quit smoking. But she's on the D and you'd never know how bad her heart was (is).

    Anyway, I'd like to share this anectdotal little story. A friend at work contracted a bacterial repsiratory infection back in April of 08. I hadn't seen her in several months and then she stopped into my library on January 13, 2009 for a visit (we work for the school system) and she was still very, very sick. Every time she spoke she coughed, and you could tell it was a very dry and painful cough. I started telling her about Vit D and ended up telling her to take 50,000 IUs that day and then take 10,000 IUs for the next week and then do it again the next two weeks. Guess what? She's cured. She's been on every antibiotic under the sun and none of them worked. The vitamin D did it. She's almost norman again. She was sick for almost a year.

    I have had life changing effects from taking vitamin d and I've now joined the grassroots health D action program too.

    I posted sometime back about how it's helped my lungs and how much strength and stamina I've gained just in one short year. It's been an amazing experience.

    Debbie in Indiana

  • Anonymous

    2/23/2009 9:41:00 AM |

    To everyone who has left a comment on this blog, could you say if you were taking vitamin d3 tablets or oil-filled gelcaps?

  • Elise P

    2/23/2009 10:07:00 PM |

    To Mike V. - thank you for the link to that article about Vitamin D and pregnancy - I feel much more confident that I'm benefiting myself and my baby by taking a higher amount of Vitamin D.
    To the comment asking what form I'm taking - the oil gelcaps.

  • TedHutchinson

    2/24/2009 11:16:00 AM |

    I live latitude 52N
    Previously I used BIOTECH 5000iu dry powder filled capsules (not solid tablets) taken with food.

    They raised my status but even with full body sun exposure only to 40ng ~ 120nmol/l.

    I now take 5000iu oil based gel capsules (3 caps over 2 days 7500iu/d)but have also lost weight (stopped eating wheat)
    25(OH)D jumped from
    Sept 08 48ng ~ 120nmol/l
    to Jan 09 110ng/ml ~ 275nmol/l.
    I suspect Dr Davis is correct that oil based caps are more effective although some of that rise will be due to sunbed use and maybe weight loss.
    I have never used solid D3 tablets.

    There is no significant difference in daily cost, both 5000iu powder and 5000iu oil based caps can be bought in the USA and including p&p to UK cost around 5p daily.

  • Anonymous

    2/24/2009 6:39:00 PM |

    I have ank spondy as well - Its a tough disease that I have fixed almost completely with diet BUT the vitamin D has made my back feel more flexible anyway! Three weeks in - I will take a blood test soon to verify levels and see whether I need to modify the dosage.

  • mike V

    2/25/2009 2:38:00 PM |

    Re: Tablets versus Oil based. I started out with tablets (Sam's club) some years ago, and pretty much eliminated colds and infections. Based on Dr Davis's observations I switched about 2 years ago, with similar results. I should mention that I usually take oil soluble vitamins/ supplements together, often with a tablespoon of extra virgin olive oil.
    FWIW I am almost 73, and have no detectable plaque.

    PS To Dr D.
    I challenge all readers of The Heart Scan Blog to send $25 to Dr Cannell at the Vitamin D Council.

    Dr D, if you are posting Cannell's latest newsletter, please edit from this comment.
    Thanks, MikeV



    The Vitamin D Newsletter

    February 24, 2009                                                
                            
    I know some of you want to unsubscribe but the system I used, like the formatting in this newsletter, is beyond my computer skills.  Thus, accept my apologies. If you want to unsubscribe, simply send a blank email
    to unsubscribe@vitamindcouncil.org.
    As readers from 3 years ago remember, this newsletter first published evidence vitamin D would prevent influenza and many varieties of the
    common cold in 2005:

    http://www.vitamindcouncil.org/newsletter/2005-nov.shtml

    I then published the theory in:                                                      
    Cannell JJ, et al. Epidemic influenza and vitamin D. Epidemiology and Infection. 2006 Dec;134(6):1129-40.

    As Science News reported, I realized this after observing an influenza epidemic at Atascadero State Hospital.

    The antibiotic vitamin: deficiency in vitamin D may predispose people to infection.  Science News, November 11, 2006
    Last year, we used vitamin D to explain virtually all of the many unsolved mysteries of influenza.

    Cannell JJ, et al.  On the epidemiology of influenza. Virology Journal. 2008 Feb 25;5:29.

    Our second influenza paper is by far the most accessed paper in the journal this year.

    Top 20 most accessed articles for last year in Virology Journal

    Today, researchers from Harvard and the University of Colorado, writing in the Archives of Internal Medicine, published convincing evidence my observations at Atascadero State Hospital were correct.

    Vitamin D deficiency linked to more colds and flu. Scientific American, Feb 23, 2009

    Adit A, et al.  Association Between Serum 25-Hydroxyvitamin D Level and Upper Respiratory Tract Infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-390.

    Influenza kill around 35,000 Americans every year and similar viruses cause additional mortality and untold morbidity. As I have said, It appears Linus Pauling was right about everything he said about vitamin C, but he was off by one letter. The Vitamin D Council, the nearly broke non-profit educational organization, now believes most influenza deaths and many other respiratory infections, like the common cold, could be prevented if Americans, and their doctors, understood some simple facts:

    ·         Vitamin D is not a vitamin, but a steroid hormone precursor, which has profound effects on innate immunity.
    ·         The amount of vitamin D in most food and nearly all multivitamins is literally inconsequential.
    ·         The correct daily dose of vitamin D for adults is approximately 5,000 IU/day, not the 200-600 IU recommended by the Institute of Medicine, the National Institutes of Medicine and the FDA.
    ·         The only blood test to determine vitamin D adequacy is a 25-hydroxy-vitamin D, not the 1,25-di-hydroxy-vitamin D test many physicians now order.
    ·         Healthy vitamin D blood levels are between 50-80 ng/ml, levels obtained by fewer than 5% of Americans.
    ·         Medicare’s new proposed rule change, which forbids Medicare carriers for paying for virtually all vitamin D blood tests (Draft LCD for Vitamin D Assay Testing (DL29510), will kill tens of thousands of Americans yearly.
    ·         The mechanism of action of vitamin D in infection, dramatically increasing the body’s production of broad-spectrum natural antibiotics (anti-microbial peptides or AMP) suggests pharmaceutical doses of vitamin D (1,000 IU per pound of body weight per day for several days) will effectively treat not only influenza and the common cold, but help treat a host of other seasonal infections, including meningitis, septicemia, and pneumonia, in both children and adults.
    ·         In 1997, when the Food and Nutrition Board (FNB) set the current guidelines for vitamin D intake, they forgot to correct for the widespread sun avoidance that began in the late 1980’s when the AMA’s Council of Scientific Affairs warned against sun-exposure, and recommended that all Americans should make every effort to never let a photon of sunlight strike their skin.  The failure of the 1997 FNB to compensate for sun-avoidance, has led to millions of deaths around the world.
    ·         Physicians who ignore vitamin D deficiency will eventually suffer medical-legal consequences.
    ·         While many think the influenza virus causes influenza, Cannell notes it was George Bernard Shaw who first understood: “The characteristic microbe of a disease might be a symptom instead of a cause.” George Bernard Shaw, (Preface on Doctors, The Doctor’s Dilemma, 1911).

    If you want professional newsletter services, you will need to help find a foundation that will fund us.

    John Cannell, MD
    http://www.vitamindcouncil.org/

    The Vitamin D Council
    9100 San Gregorio Road
    Atascadero, CA 93422

    (Posted by Mikev)

  • Dr. William Davis

    2/25/2009 10:56:00 PM |

    Thanks, Mike V.

    Dr. John Cannell is truly a visionary when it comes to vitamin D. He also has some of the best understanding of this issue of anyone around.

    We are overdue for a donation to his cause, also. Thanks for reminding me.

  • karl

    2/26/2009 3:18:00 PM |

    I would like your opinions of the resveratrol studies - they are now combining it with D3.

  • Anonymous

    2/26/2009 3:34:00 PM |

    "Chest pain—Not the chest pain of heart disease, but a chronic gnawing, toothache-like pain in the sternum that is relieved within days of initiating vitamin D. I don’t know precisely why this happens, but I speculate that, with vitamin D deficiency, there is disordered calcium metabolism, and perhaps the sternal pain represents cellular (osteoclastic) activity that is eroding sternal calcium for the purpose of maintaining blood calcium, since intestinal absorption of calcium is poor. Replace vitamin D and the abnormal calcium uptake ceases. Just my guess". interesting? I have hypothyroid and high blood calcium, made me confused as to taking vitamin D or not. i have chest pain on left side. changing my medication from synthroid to armour and starting on the Iodine drops brought body temperature, brain fog, moon face, gained weight, depression, and confusion to normal but chest pain is still there. i thought about vitamin D but avoided because of already high blood calcium. But what you just speculated above does makes sense. I am in winnipeg and should be taking vitamin D all the time. I will start on vitamin D and see if it will make any difference? The other problem here is going to see a doctor is like going to a principal's office in high school. They never Liston, treat you like numbers and most of them are sick themselves and never up to date or they never want to tell. you have to educate your self in order to save your health, relationships and jobs which are connected to one's well being.

  • Anna

    2/27/2009 4:51:00 AM |

    I made a donation to the Vitamin D Council in late 2007, but forgot to do so in 2008.  I rectified that the other day when I received the latest VDC newsletter - this time I made a $100 donation.  And the Grassroots Health office is in my town, so I have volunteered to help stuff test kit envelopes so they can save on envelope stuffing service fees.  

    I really feel the VDC is doing important work.  Except for the friends and family who "listen" to me and take enough D3, everyone I know who tests is either deficient or very low in the reference range.  

    Reading The Vitamin D Cure book now.  While I have some issue with the diet advice, the info about determining sun exposure and supplementation dose is very good.

  • TedHutchinson

    2/27/2009 1:09:00 PM |

    Vitamin D and Cardiovascular Disease Prevention
    http://www.youtube.com/watch?v=NJHfdUKSD2A
    another in the series of Vitamin D talks sponsored by Grassrootshealth.org and hosted by University of Califorian television.
    Allow 45minutes and it may be a good idea to download it if you are not familiar with the research. There is a lot of information (the conference it is taken from was aimed at doctors rather than the general public) and as it is complex you may need to listen to it twice.

    I think this particular video is worthy of Dr Davis's scrutiny. I am sure if Dr Davis devoted a specific blog to the highlight this video, he could make a better job of explaining some of the slides.

    Listen right to the end to the last question from the floor for the rather cynical audience response.

  • Anonymous

    2/27/2009 5:56:00 PM |

    Dr. Cannell knows quite a bit about vitamin D, but his understanding of vitamin A is abysmal.  He's telling people that they do not need any preformed vitamin A in their diets because it blocks vitamin D action.  This is a partial truth, but the message is all wrong.  If he spreads this message far emough, we'll be entering into an era of subclinical vitamin A deficiency and night blindness.  Until he changes, or at least clarifies, his stance on vitamin A, I cannot support him.

  • mike V

    2/28/2009 6:56:00 PM |

    To Anonymous on Vitamin A.

    Presuming your characterization is correct, it is my best guess that Dr Cannell is saving many more lives by popularizing the existence of wide Vitamin D deficiency.

    Can we get any info you may have on the relative hazards of existing Vitamin A deficiency?

    Why not pass it on? He may well appreciate your insight as much as a contribution!

    Thanks.

    Mike V

  • homertobias

    3/1/2009 12:03:00 AM |

    Ted, Dr. David Sane's presentation was fair, in my opinion.  We have alot of association data, plausability, potential for multiple mechanisms of action, but a paucity of studies showing that supplementing works to prevent cardiovascular disease.  They will come.  Alot of us are still disappointed and cautious after mistakenly recommending high dose folate for hyperhomosystienemia.  

    Interesting to me was the German data looking not only at 25-oh levels but 1-25-oh vitamin D levels being independently associated with CHD.  Can't figure it out.

    Also very interesting was the Italian data showing correlation between CIMT and Vit D levels in diabetics. I wonder if low Vitamin D levels correllate with MDCT?  OK Dr. Davis.  Does it?  From my reading, cholesterol levels, NMR lipoprofile, HSCRP, LPPLA2, do NOT correlate with coronary calcium scores.  (Dr. Hecht's data) Will D???

  • Trinkwasser

    3/2/2009 1:41:00 PM |

    Anecdotal, but I suffer chronic atypical depression with symptoms related to SAD. Venlafaxine 225mg has been my best treatment to date (tricyclics work better but with more side effects, SSRIs don't work well at all and then stop, the connection seems to be to dopamine and norepinephrine)

    Getting my BG in line (I used to mostly do not-diabetic-yet highs dropping to not-quite-hypo lows several times a day) and I have dropped this to 37.5mg

    Taking D3 over a prolonged period and despite the appallingly dull winter I have had singificantly fewer SAD symptoms (while a lot of non-sufferers have been worse!)

    I've been taking tabs BUT with flax oil, EPO and actual complete fish so maybe the oil is helping the disposition, I'll replace them with gelcaps when I run out.

    Now the sun has finally started to come out and my energy levels have improved as they often do around this time of year (waking up from hibernation) I have dropped the venlafaxine to 17.75 mg and doing if anything even better.

    Meanwhile in Scotland a GP is finding clinical cases of Rickets for the first time in her career.

    One wonders whether apart from the too low RDA there are other factors interfering in D metabolism which have become commoner than in the past. Maybe the low fat diet prevents absorbtion? Maybe statins break one of the pathways? Otherwise surely someone would have noticed all these recent findings long ago?

  • mbarnes

    3/23/2009 4:20:00 PM |

    It is amazing how much concern folk raise about the potential toxicity of vitamin D when the literature clearly shows you can take as much as 10,000units per day without problems and there was a phase I study in MS patients that used 40,000IU per day without side effects. here is another good site on vitamin D with lots of reviews of the anti cancer data:
    www.vitaminD3world.com

  • Anonymous

    12/2/2009 5:50:47 PM |

    How interesting. I have been taking oral gelcap vitamin D for some years now and I never seem to get ill when other people all around me are stuck down with terrible symptoms. Or, if my husband has flown-blown flu, I might have a sore throat for a day and feel a bit more tired than usual for a day and then I'm fine.

    I was wondering whether my apparently amazing ability not to get sick might be because I have MGUS (monoclonal gammopathy of unknown significance) -- I was wondering if it might be that my immune system is so 'good' it is also attacking me too -- whether there might be some link, that at some point in the future will be my undoing. ? But I much prefer the more optimistic vitamin D theory of my lack of colds and flu etc.

  • Anonymous

    12/2/2009 6:05:01 PM |

    To the person who asked about vitamin D and pregnancy, and to the other person who asked about tablets vs oil gel caps, I was taking tablets for years without it raising my serum D levels, It was when I switched to D3 oil gel caps as a result of reading this blog, that my levels started to climb. When I finally went up to 6000IUs that seemed to help a lot.

    When I became pregnant, I asked my (high risk) maternal foetal medicine doctor about it, and he said that is that was the level of supplementation it was taking to keep my vitamin D levels up to normal, I should keep taking it. He also said that I should continue to try to get some sun every day (I am not in a hot sunny place) that would be important too. He seemed to be saying that just taking the supplements is not enough. You need both.

  • Anonymous

    12/30/2009 3:45:58 PM |

    Hello!!! heartscanblog.blogspot.com is one of the most outstanding innovative websites of its kind. I take advantage of reading it every day. I will be back.

  • DougCuk

    1/9/2010 10:05:34 PM |

    I do not as a rule take any supplements - but I am now recommending all my family and friends to take high dose Vitamin D. I have been researching this topic for the last two months - I have a degree in Zoology and worked in Bio-Physics - and the more I read the more convinced I have become. I have created my own webpage with links to the best Vitamin D websites, charts and videos. Anything I find gets posted here: http://www.stargateuk.info/vitamind

  • Anonymous

    2/9/2010 5:16:44 PM |

    On Vitamin D and pregnancy, here's a quote about recent studies:

    "In two U.S. government-funded studies, Hollis is studying vitamin D supplementation of up to 6,000 IU daily in nursing women, and 4,000 units per day in pregnant women. So far "not one single adverse event" has been observed in women on the highest doses, he said in an interview."

  • Anonymous

    2/19/2010 8:06:00 PM |

    Dr Davis,
    I eliminated cereals from my diet 6 month ago and since then I haven't have an herpes outbreak that used to plague me if I didn't take VALACICLOVIR 500 mg every day I would get an outbreak 7 days after I did't take the pill, now I'm supplementing 6000 iu of vitamin D a day I hope that I will stay outbreak free for longer!!!! I have to tell you that I stopped eating cereals specially wheat after reading this blog   and have felt better than ever!!!

  • Anonymous

    3/7/2010 9:08:28 PM |

    Vitamin D controls T cell antigen receptor signaling and activation of human T cells. WOW

    http://www.nature.com/ni/journal/vaop/ncurrent/full/ni.1851.html

    Regards
    Niels

  • vitamin D

    5/17/2010 5:23:29 AM |

    According to me after read this post I think that vitamin D is more good to take for better health because it helps blood to stay in normal level.

  • Anonymous

    8/24/2010 8:15:39 AM |

    I've suffered from depression for many years, along with joint pain that flares up from time to time, but have never tested positive for any antibodies, so have no idea what it is that causes the problem. I've just learned to deal with the pain and stiffness myself and only use over the counter anti-inflamatories when the pain gets too bad to handle without using anything because they've always upset my stomach.

    These last couple of years fatigue has plagued me as well. Last year my dr detected low levels of vitamin D and suggested I took 1,000 units a day. A couple of weeks ago, he retested my levels only to find that they had dropped significantly, from 36 to 20 (normal range 50-75). I am now on 2,000 units a day. Within 24 hours I began to feel more energy than I'd felt in years and my mood had lifted. I've always been aware that in winter I had less energy and was more morose, but never connected the dots. My daughter also suffers from depression and a couple of weeks was going through a really bad patch. I insisted the dr measured her D3 levels and sure enough she was low on D3.She started on 2,000 units of D3 and improved within 36 hours from being a crying mess to being full of energy.

    For someone like me who's always been a vitamin skeptic, I'm amazed at the difference in such a short time. I'm 3 weeks into taking 2,000 units a day and can't see any effect on my joints yet but have my fingers well and truely crossed on this one.

    Does anyone know if low D3 levels are also connected with chronic gastritis? I has diagnosed last year and have developed gastric intestinal metaplasia (which explains why I get stomach pain if I take NSAIDS or aspirin). However, there has been no cause established for me developing this condition and since I rarely take the NSAIDS that's not the cause either. I tested negative for HP infection and have never smoked and rarely drink alcohol. I'm now wondering if this condition is also due to low D3 levels.

  • Rhett

    9/29/2010 12:18:36 PM |

    I was recently diagnosed as severely vitamin D deficient and was unable to find a decent place dedicated to vitamin D discussion, so I decided to start my own forum http://www.vitamindforum.com . I would love to hear everyones experiences!

  • Philip Gower

    10/4/2010 3:27:38 AM |

    I have upped my daily dosage of D3to 15,000U,and feel great ! My lifelong psoriasis has largely melted away, and occasional angina has stopped. At age 73 I am able to walk our dogs in hills for hours daily, and I take no prescription medications.I also supplement with SSKI drops, and follow a low carb diet.In 6 months I have dropped 50 lbs, and seem to be levelled off at about 150 lbs.I am about to test for the "25" D3 blood level, mostly out of curiosity. I have stopped getting colds or flu !

  • buy jeans

    11/3/2010 2:53:06 PM |

    --Relief from claustrophobia—This one has me stumped. But one man’s vivid description of his previously terrifying experiences in elevators and other enclosed spaces, now entirely gone raises some fascinating questions. For instance, how much psychological disease is nothing more than the expression of disordered metabolism from vitamin D deficiency?

  • aashvi

    11/9/2010 10:31:42 AM |

    There can be several kinds of chest pen but when it is related to heart disease, it becomes dangerous.  It’s very important that we should keep this in mind. Dilse India provides information about  chest pain. The information can be helpful for those who have chest pain and there is danger of heart disease.
    Website : Risk of chest pain

  • online pharmacy

    3/7/2011 8:49:40 AM |

    Previous research has suggested that vitamin D levels were inherited, in part, but a new study of 33,996 people has found three specific genetic variants that seem to correlate with a person's levels of vitamin D.

  • Shashin Patel

    6/7/2011 1:04:18 PM |

    This is a great post. It contains a lot of important information about Vitamin D and how much should its requirement be. I came across one nice article about Vitamin D and wonder if you like it. To know more click on the link  below:
    Boca Wellness and Nutrition

  • Rohan

    6/9/2011 5:51:38 PM |

    Fruits and vegetables are excellent sources of potassium which helps to regulate fluids and maintain normal blood pressure. That includes bananas, sweet potatoes, avocados and cantaloupes in your diet.
    You may find more information on Boca Wellness and Nutrition

  • Shashin Patel

    6/15/2011 3:42:48 PM |

    Nice video about Vitamin D and its facts. You can find it at
    http://www.youtube.com/watch?v=mhWK6ktRI1Y

  • [...] around 50ng/ml. I've read others experiencing similar.   "Unique vitamin D observations"  Unique vitamin D observations | Track Your Plaque Blog  snippet:    ...–Immunity from viral infections–I first learned of this association [...]

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Prophylactic bypass surgery?

Prophylactic bypass surgery?

This question comes up around once a week:

My CT heart scan score is ____. Wouldn't I be better off just getting a bypass (or stent, etc.) and getting it over with? If I know that heart attack is in my future, why not just get it over with?

The most recent source of this question was the wife of a patient. Jack had a heart scan score of 92 in 2005. He made very little effort to correct his causes, permitting pre-diabetic patterns to persist, failed to correct vitamin D, etc. and a repeat heart scan score showed a dramatic rise to 264.

Jack's wife asked whether he should just have a bypass.

There are several problems with this line of reasoning:

1) Bypass surgery does not reduce the long term risk for heart attack.

2) The risk of bypass surgery often outweighs the risk of an asymptomatic heart scan score.

3) Bypass surgery is a temporary "fix," a fancy Band Aid for a disease that progresses after the procedure. One bypass typically prompts another, and another...

4) Bypassing arteries that have vigorous blood flow often causes the bypass graft to not "take" and close within the first few days.


Thankfully, nobody in his right mind has proposed that we perform prophylactic bypass operations.

Of course, hospitals and surgeons would jump at the chance to perform procedures in anybody with some threshhold heart scan score. It would double or triple their business overnight. At $70,000 or more per procedure, they would dance in glee. Of course, you and I would pay for their new burst of wealth by a sharp increase in our health insurance premiums. Not only that, the people who underwent the procedure would not benefit.
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Apo E4 and sterols: Lethal combination?

Apo E4 and sterols: Lethal combination?

Phytosterols, or just "sterols" to its friends and neighbors, are a group of cholesterol-like compounds that are abundant in the plant world. Lately, however, sterols have proliferated in the processed food supply, thanks to the observation that sterols reduce LDL cholesterol when ingested by humans.

This must mean that sterols are good for you.

Uh oh. Wait a minute: There is a rare disease called sitosterolemia in which there is unimpeded intestinal absorption of all sterols ingested through diet. They must have really low LDL cholesterols! Nope. They develop coronary disease--heart attacks, angina, etc.--in their late teens and 20s. In other words, if sterols gain access to your bloodstream, they are bad. Very bad.

Conventional thinking is that only a modest quantity of dietary sterols gain access to the bloodstream. But there are two potentially fatal flaws in this overly simplistic line of thinking:

1) What happens when you load up your diet with "heart healthy" sterols, such as those in "heart healthy" margarines, mayonnaise, and yogurt, effectively increasing sterol intake 10-fold?

2) What happens in people with the genetic pattern, apo E4, that is carried by 25% of the general population that permits much greater intestinal absorption of sterols?

My prediction: Despite the fact that sterols reduce LDL, they may, in certain genetically-susceptible people, such as those with apo E4, increase risk for heart disease: heart unhealthy.

Here are two studies that suggest that greater sterol absorption in people without sitosterolemia are at higher risk for heart disease:

Alterations in cholesterol absorption/synthesis markers characterize Framingham offspring study participants with CHD

Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study

Comments (24) -

  • Kathy Hall

    2/11/2011 12:04:41 AM |

    Does this include the beta sitosterol that is in most prostate supplements?

  • Lucy

    2/11/2011 12:32:16 AM |

    How can I get tested for sitosterolemia?

  • Anonymous

    2/11/2011 1:08:44 AM |

    I know for a fact that Costco sells 5000+ bottles of CholestOff every WEEK! The stuff is a blend of sterols.

  • preserve

    2/11/2011 1:43:45 AM |

    Yeah costco also has "sterol" oatmeal bars.

    I try to stick to the freezer and wine section.

  • Anonymous

    2/11/2011 2:46:10 AM |

    I like how you state plainly it's "rare," and now your followers are going to start to believe themselves to have this ailment. I like your blog, but as of late, you're war on heart disease is imitating the ad baculum aspects of America's war on terror.

  • Davide

    2/11/2011 3:04:46 AM |

    Excellent article. I've had the same exact thoughts and that's why I don't take supplementary plant sterols.

    It's pretty comical. When people supplement with sterols, all they are doing is swapping some of their cholesterol in LDL particles with sterols. The sterols essentially take the place of the cholesterol in the blood. But both have the proclivity to cause atherosclerosis.

    So, the cholesterol lowering effect is just an illusion.

  • Anonymous

    2/11/2011 4:16:23 AM |

    I'm not so sure Apo E4 would even be considered 'rare' amongst those who have heart disease problems... or who are considered high risk.

    E4/E4 is quite rare, but E3/E4 isn't really. I think it's around 25% of the population, if I recall correctly. And I'd expect amongst those with heart issues, it'd be higher than that.

  • Anonymous

    2/11/2011 7:56:33 AM |

    So what do you eat if you are disp. to Apo E4. If I eat sat. fat my LDP
    rocket up. If I eat more veg. and fruit and lean mead it rocket dovn.
    Am I on the track??

  • Dr. William Davis

    2/11/2011 12:40:05 PM |

    Hi, Kathy--

    Yes, it does.


    Lucy--

    In general, testing for sitosterolemia is not something I would recommend except in specific situations, in which case the various sterols in the blood can be measured.

    That was not the point of the discussion, but the far more common Apo E4 that affects 25% of the population, who thereby potentially hyperabsorb sterols.

  • Daniel A. Clinton, RN, BSN

    2/11/2011 3:46:49 PM |

    Ted,
    I can do you one better. This prospective cohort study (n=1137) found "Higher levels of HDL-C (>55 mg/dL) were associated with a decreased risk of both probable and possible AD and probable AD compared with lower HDL-C levels (hazard ratio, 0.4; 95% confidence interval, 0.2-0.9; P = .03 and hazard ratio, 0.4; 95% confidence interval, 0.2-0.9; P = .03). In addition, higher levels of total and non–HDL-C were associated with a decreased risk of AD in analyses adjusting for age, sex, education, ethnic group, and APOE e4 genotype." Here's the link to the abstract:  http://archneur.ama-assn.org/cgi/content/abstract/67/12/1491.
    Makes you wonder the REAL reason behind statin drugs.

  • Kevin

    2/11/2011 6:43:41 PM |

    I used beta-sitosterol for over a year.  I used it because I didn't want to take a 5-alpha reductase inhibitor such as Proscar.  But I developed the same side effects that Procar is known to cause:  Poor libido, gynecomastia and generalized muscle weakness.  I don't track cholesterol so I don't know what the beta-sit might have done to it.  Six months off the beta-sit and I'm just now starting to feel like a normal man again:  morning wood, etc.

  • Lucy

    2/11/2011 9:15:49 PM |

    That was my reason for asking... because I'm a 3/4

  • Anonymous

    2/12/2011 4:54:58 AM |

    Fructose Alters Brain Metabolism
    One of the competing theories to explain the obesity epidemic is a rise in fructose consumption causing alterations in hormone levels that increase appetite. UCSF med school prof Robert Lustig has a pretty good rant-lecture on the evils of fructose. Well, here's another study on part of the mechanism in the brain of how fructose might be causing increased obesity.

    PORTLAND, Ore. – The dietary concerns of too much fructose is well documented. High-fructose corn syrup has become the sweetener most commonly added to processed foods. Many dietary experts believe this increase directly correlates to the nation's growing obesity epidemic. Now, new research at Oregon Health & Science University demonstrates that the brain – which serves as a master control for body weight – reacts differently to fructose compared with another common sweetener, glucose. The research is published in the online edition of the journal Diabetes, Obesity and Metabolism and will appear in the March print edition.

    In humans the cortical brain control areas of the brain were inhibited by the influx of fructose.

    Functional MRI allows researchers to watch brain activity in real time. To conduct the research, nine normal-weight human study subjects were imaged as they received an infusion of fructose, glucose or a saline solution. When the resulting brain scans from these three groups were compared, the scientists observed distinct differences.

    Brain activity in the hypothalamus, one brain area involved in regulating food intake, was not affected by either fructose or glucose. However, activity in the cortical brain control areas showed the opposite response during infusions of the sugars. Activity in these areas was inhibited when fructose was given but activated during glucose infusion.

    This is an important finding because these control brain areas included sites that are thought to be important in determining how we respond to food taste, smells, and pictures, which the American public is bombarded with daily.

    The result increases the plausibility of fructose as a causal agent.

    "This study provides evidence in humans that fructose and glucose elicits opposite responses in the brain. It supports the animal research that shows similar findings and links fructose with obesity," added Purnell.

    If you want to reduce your weight also consider other theories for the cause of obesity including grains as a possible major cause.

    By Randall Parker 2011 February 09 05:42 PM  Brain Appetite

  • Dr. William Davis

    2/12/2011 4:57:38 PM |

    Hi, Peter--

    Thanks for catching that.

    Now fixed.

  • Might-o'chondri-AL

    2/12/2011 9:40:08 PM |

    Foods with naturaly occuring levels of Beta-sisterol: fruits like avocado, nuts like pecan & cashew, seeds like flax & pumpkin,
    legumes like soya & peanut, grains like wheat germ & rice bran, oils like corn & soy, plus herbs like Saw Palmetto & Pygeum. Once again it is good to recall that if something is good for you that doesn't automaticly mean more is better for you.

  • Gene K

    2/13/2011 7:29:32 PM |

    @Anon about naturally occurring sitosterol levels -

    As an APO E4 person, should I be concerned about my intake of avocado, flax seed, and tofu?

  • reikime

    2/13/2011 11:07:34 PM |

    couldn't leaky gut syndrome cause increased sterols in the bloodstream?

  • Anonymous

    2/14/2011 4:03:27 AM |

    So... how much sterols?
    For example almonds and other nuts are high in sterols. Lot of vegetables are high in sterols. In this blog nuts have been recommended often as well as a plant based diet. So does this change that?
    What should apoe4 people eat? They can't eat fat, now they can't eat vegetables? Is starving to death the only way to avoid heart disease?

  • Anonymous

    2/15/2011 7:12:55 AM |

    Also tofu and soy has been promoted which have esterols...

  • Kurt G. Harris MD

    2/16/2011 4:06:56 AM |

    Another benefit to total avoidance of plant oils!

    Miniscule n-6 means miniscule fat soluble sitosterols.

    Are you ready to advocate an animal-fat based diet for ApoE4 and the 45 total reported cases of sitosterolemia?

    If you worry about LDL, ApoE4 needs to be "low fat", but if you worry about early death and AD, I think high animal fat is the way to go for these folks.

  • Might-o'chondri-AL

    2/16/2011 5:42:19 PM |

    Isn't the problem for APOE4 the way the molecule degrades? Quite recently fish oil Omega 3 has been cited for allaying APOE4's side effects. The Omega 3 balances out the metabolite (an APOE4 protein fragment) that otherwise messes with the lipid structure of the mitochondria(s) membrane(s); it (fish oil) prevents dysfunction.

  • Janknitz

    8/24/2011 2:27:51 PM |

    http://m.npr.org/news/front/139889533

    I heard a report on this study on NPR yesterday.  It's important to note who sponsored the study in the first place.

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Study review: yet another Lipitor study

Study review: yet another Lipitor study

This continues a series I've begun recently that discusses studies that have emerged over the past 10 years relevant to heart scan scoring and reversal of coronary atherosclerotic plaque.

The St. Francis Heart Study from St. Francis Hospital, Roslyn, New York, was released in 2005. This was yet another study that set out to determine whether Lipitor exerted a slowing effect on coronary calcium scores. This time, Lipitor (atorvastatin), 20 mg per day, was combined with vitamin C 1 g daily, and vitamin E (alpha-tocopherol) 1,000 U daily, vs. placebo. A total of 1,005 asymptomatic men and women, age 50 to 70 years, with coronary calcium scores 80th percentile or higher for age and gender
participated in the study.

After four years, heart scan scores in the placebo group increased 73%, compared to 81% in the treatment group. Statistically, the cocktail of drug, vitamins C and E had no effect on heart scan scores.

Other findings included:

--Participants experiencing heart attack and other events during the study showed greater progression of scores than those not experiencing heart attack: score increase of 256 vs. increase of 120.

--While treatment did not reduce the number of heart attacks and events overall, participants with starting heart scan scores >400 did show a benefit: 8.7% with events on treatment (20 of 229) vs. 15.0% with placebo (36 of 240).

(Note what is missing from the treatment regimen: efforts to raise HDL (starting average HDL 51 mg/dl); reduce triglycerides (starting average 140 mg/dl); identify those whose LDL was false elevated by lipoprotein(a); omega-3 fatty acids from fish oil; correction of other factors like vitamin D deficiency.)


Are we pretty in agreement that just taking Lipitor and following an American Heart Association low-fat diet is an unsatisfactory answer to gain control over coronary plaque growth? No slowing of heart scan score growth seen in the St. Francis Heart Study and similar studies is consistent with the 25-30% reductions in heart attack witnessed in large clinical trials. Yes, heart attack and related events are reduced, but not eliminated--not even close.

And when you think about it, it should come as no surprise that the simple strategy studied in the St. Francis Heart Study failed to completely control plaque growth. Lipitor and statin drugs exert no effect on small LDL particles, barely raise HDL cholesterol at all, and have no effect on Lp(a), factors that increase heart scan scores substantially.

Though these discussions have frightened some people because of the suggestion that increasing heart scan scores are inevitable and unavoidable, they shouldn't. It really should not be at all shocking to learn that taking one drug all by itself should cure coronary heart disease.

Instead, findings like those of the St. Francis study should cause us to ask: What could be done better? How can we better impact on heart scan scores and how can we further reduce heart attack, particularly in people with higher heart scan scores?

My answer has been the Track Your Plaque program, a comprehensive effort to 1) address all causes of coronary plaque, and then 2) correct all the causes.

Comments (6) -

  • Anonymous

    12/3/2007 10:59:00 PM |

    Dr Davis, What would be your reaction to another Dr's blog site quoting the latest NCEP report of 9/07 that lowering LP(a) is not necessary unless it is in the 80-90th percentile? He also states that the report says raising HDL is only an "option" but not a proven deterrent. I don't have the credentials to argue this point but.... I certainly want to disagree with him.   Over&Out

  • Dr. Davis

    12/4/2007 2:53:00 AM |

    If the question is whether this physician is properly reiterating NCEP guidelines, he is right.

    I regard NCEP as being as least 10 years behind the times and a consensus opinion driven as much by big science as big pharma.

    It is also based on outcome studies, what I would call "body count" studies, rather than studies based on surrogate measures like heart scans. If we wish to wait for people to die in order to understand whether a treatment works or not, then his comments hold water. If our desire is to not gamble our lives away waiting for consensus opinions, then taking reasonable action based on available data is, in my view, a more rationale approach.

  • Anonymous

    12/4/2007 3:12:00 AM |

    The problem with following surrogate markers is they are just that.  The danger is illustrated well with the Torcetrapib story:  the drug did raise HDL the surrogate marker but the trial had to be halted because adverse events were so high.  It made "sense" to raise HDL and it is not clear what the exact mechanism of the excess deaths are (elevation in BP which the drug caused or ?).  Random controlled trials are still the best way to move forward no matter how long or messy they may be.

    On the subject of people having to decide in real time what treatment strategy they want to follow I believe one can make informed guesses but ultimately people should realize they are only guesses and may or may not prove to be correct.

  • Dr. Davis

    12/4/2007 3:29:00 AM |

    Yes, I agree with your second statement.

    However, I think we're talking apples and oranges here.

    With torcetrapib, we're not talking surrogate markers, but introducing a foreign substance with generally unknown extent of effects. With heart scanning, we're talking about a surrogate measure of the disease, and one certainly far closer to the disease than the rather "distant" HDL-to-event relationship.

  • Lipitor Prescription Information

    11/10/2008 8:45:00 PM |

    My name is Giulia White and i would like to show you my personal experience with Lipitor.

    I have taken for 9 years. I am 60 years old. I took 20 mg for 9 years and I told numerous physicians about my pain and stiffness and was told that I had arthritis and to keep taking it. I left it at home by accident when we went on vacation and within 3 days, the pain in my legs began to go away. After 2 weeks I knew it was a very dangerous medication. I went to my new physician and he wanted me to try Pravachol. Afer 4 days on it, I was in a fog and thought I had the flu. I have been off it for just 36 hours and feel better. I am an RN and should have known that I was experiencing side effects with Lipitor, but you listen to your Doctor because you trust him. I now tell my patients to trust what their bodies are telling them. Statins can't be good for anyone but the drug companies!!!!!!!!!! They keep lowering the recommended levels so that almost everyone is considered to have "high" cholesterol. If someone is 30 and on this for 30 or 40 years there is not telling what the long term effects will be.

    I have experienced some of these side effects-
    Joint and Muscle Pain / Stiffness.

    I hope this information will be useful to others,
    Giulia White

  • buy jeans

    11/3/2010 8:47:11 PM |

    (Note what is missing from the treatment regimen: efforts to raise HDL (starting average HDL 51 mg/dl); reduce triglycerides (starting average 140 mg/dl); identify those whose LDL was false elevated by lipoprotein(a); omega-3 fatty acids from fish oil; correction of other factors like vitamin D deficiency.)

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Triglycerides divided by five

Triglycerides divided by five

Here's a bit of lipid tedium that might nonetheless help you one day decipher the meaning of shifts in your cholesterol panel.

Recall from prior discussions that conventional LDL cholesterol is a calculated value. Contrary to popular opinion, LDL is usually not measured, but calculated from the Friedewald equation:

LDL cholesterol = Total cholesterol - HDL cholesterol - triglycerides/5

For the sake of simplicity, let's call total cholesterol TC; HDL cholesterol HDL, and triglycerides TG.

We've also talked in past how a low HDL makes calculated LDL inaccurate, sometimes wildly so. (See Low HDL makes Dr. Friedewald a liar.)

Here's yet another source of inaccuracy of the Friedewald-calculated LDL: any increase in triglycerides.

Let's say, for instance, that starting lipid panel shows:

TC 170 mg/dl
LDL 100 mg/dl
HDL 50 mg/dl
TG 100 mg/dl



You're advised to follow a standard low-fat, whole grain-rich diet advocated by "official" agencies (the diet I bash as knuckleheaded). Another panel a few months later shows:

TC 230 mg/dl
LDL 140 mg/dl
HDL 50 mg/dl
TG 200 mg/dl



(Obviously, I've oversimplified the response for the sake of argument. HDL would likely go down, LDL would change more depending on body weight, small LDL tendencies, and other factors. You'd also likely get fat.)

Now your doctor declares that your LDL has gone up and you "need" a statin agent.

Nonsense, absolute nonsense.

What has really happened is that the increased dietary intake of wheat and other "healthy whole-grain foods" has caused triglycerides to skyrocket. LDL increases, in turn, by a factor of TG/5, or 40 mg/dl. Thus, LDL has been inflated by the triglyceride-raising effect of whole grains.

This is yet another reason why the standard lipid panel, full of hazards and landmines, needs to be abandoned. But calculated LDL in particular is an exercise in frustration.

Though the example used is hypothetical, I've witnessed this effect thousands of times. I've also seen many people placed on statin drugs unnecessarily, due to the appearance of a high LDL cholesterol that really represented increased TG/5, usually induced by an excessive carbohydrate intake, including those commonly misrepresented as healthy such as whole grains.

Comments (8) -

  • Anonymous

    9/2/2008 9:44:00 PM |

    very interesting.  What recommendations would you have with someone with low HDL of 40, Triglycerides of only 37, and LDL of 90 most of which are small particles?

  • Paul Anderson

    9/3/2008 6:12:00 AM |

    Surely the rise in LDL attributed to the increase in triglycerides would only be 20, as the increase in triglycerides was only 100 (The other 100 already being counted first time around) or am I missing something here.

    I have read elesewhere that there may actually be a rise in triglcerides during a period of active weight loss, which can result in a temporary rise in cholesterol.  If this is the case this would also, on the Friedewald formula, show an apparnet rise in LDL, when in fact all that was happening was that the body was utilising stored fat for energy.

    Does anyone have any views on how long after weight loss before cholesterol levels settle down?

    Do you need to get to an optimal weight before the lipid panel is returned to a normal/optimal level, whatever that is?

    Dr Davis - do you still hold to the 60:60:60 target, and have you revised your view on saturated fat.

    As an aside, where do you stand on protein consumption?  and its effect on blood sugar and circulating insulin levels?

  • Anonymous

    9/3/2008 9:55:00 PM |

    generally you see a low hdl with high triglycerides.  what if the hdl is low,say 40, and the triglycerides are low, say 37, all measured by NMR which shows lots of small particles.  Isn't this just a genetic problem, and maybe diet cannot address?

  • parky

    9/4/2008 1:04:00 AM |

    The math here seems backwards compared to your statement.  If TC  and HDL stay constant (a big IF), and TG goes up, then calculated LDL goes down, not up like you state.

    LDL=TC-HDL-TG/5

    or LDL + HDL + TG/5= TC

    I suppose what really happens is like your example, where TC AND TG both go up and TC goes up more than TG/5, giving a net increase in calculated LDL.

    Anyway, thank you for a great blog, and a great website.  Its great to see someone who actually measures what works and what doesnt!

  • Anonymous

    9/4/2008 6:19:00 PM |

    Dr Davis,
    This is somewhat off your topic.
    In your experience, have you noticed any blunting of the effect of niacin on HDL by antoxidants?
    Also, have you seen PMID 17662090,
    17214603, and 16230278?
    Your thoughts?
    I greatly appreciate the diligent
    work you have put forth in heart
    disase prevention!

  • Lizzi

    9/6/2008 2:58:00 PM |

    I think another way to look at this phenonema is to look at someone's total non-HDL cholesterol as the indicator of risk, not just LDLC.  Total non-HDL cholesterol approximates measuring Apo B. BTW, Dr. Davis, I have thoroughly enjoyed your blogspot.

  • Alvin Wong

    11/4/2008 9:53:00 AM |

    Whatever the case maybe, I thought that our liver is intelligent enough to balance to production and recycling of the cholesterol particles; irrespective whether they are being carried by LDL or HDL.

    Wouldn't by this theory, the total cholesterol level is constant until ingestion of saturated fats and red meat or conversely reduction by exercise etc.

    http://www.4life-stay-healthy.com
    http://www.4life2u.com/r/alvinwong

  • buy jeans

    11/3/2010 2:39:57 PM |

    What has really happened is that the increased dietary intake of wheat and other "healthy whole-grain foods" has caused triglycerides to skyrocket. LDL increases, in turn, by a factor of TG/5, or 40 mg/dl. Thus, LDL has been inflated by the triglyceride-raising effect of whole grains.

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Planned obsolence

Planned obsolence

In the 1960s, you’d purchase a new car. If you changed the oil, adhered to the maintenance schedule—and were lucky—you might expect to get 100,000 miles out of your automobile. Only an occasional car made it beyond that odometer hurdle. Even if the engine made it past the 100,000 mile milestone, the automobile body would inevitably start to develop rusting decay at the edges of the fenders, signaling body rot that threatened to open gaping holes of metal.



Then along came Toyota and Honda, whose cars easily reached 100,000 miles and well beyond, reliably and with bodies intact. As this realization sunk into the American consciousness, many asked, “Why can’t American automakers accomplish the same sort of trouble-free longevity?” “Buy American” emerged as a mantra to preserve American jobs and prop up an economy vulnerable to the superior automotive products from Detroit’s competitors.

Of course, American automakers have since responded to the challenge posed by the Japanese auto industry and produced automobiles that essentially matched the reliability and longevity of Japanese cars. But, the great unanswered question remains: For years before the onslaught of Japanese competition, did Detroit quietly plot to maintain a policy of planned obsolescence that ensured Americans would have to scrap the old and buy a new car every few years whenever the odometer tipped over 100,000 miles?

We will never know. At worst, it may represent the behind-closed-doors, back-slapping sort of plotting that, for many years, maximized revenues, ensured shareholder returns, and secured executive paychecks. Or, perhaps it wasn’t some evil conspiracy but just complacency, a profitable position of comfort at that. There’s little incentive for industry insiders to reveal such self-incriminating information.

But the example set by the American auto industry presents an unusual learning opportunity for us, a chance to make some useful comparisons to the heart healthcare industry.

Is the American healthcare industry also guilty of practicing a policy of “planned obsolescence,” just like Detroit? The product that helplessly crumbles is, of course, not your rust-riddled automobile, but you.

When someone sees a primary care physician year after year, yet appears one morning in the emergency room, clutching his or her chest in agony from the closed coronary artery responsible for a life-threatening heart attack—prompting the flurry of activity that results in $100,000 in hospital procedures . . .

Perhaps “planned obsolescence” is not the perfect phrase to describe the situation, but the principle still applies: A failure to inform the patient that such an outcome was possible—no, probable—makes you wonder whether such an outcome was predictable and thereby preventable in the first place.

What should we do when planned obsolescence leads us down a path engineered by someone who has something, often substantial, to gain? Even if it's just complacency, or adhering to a beaten, ineffective status quo (can you say "low-fat diet?), it all points in the same direction.

You have a choice: Refuse to buy a 1962 Impala of health care, otherwise known as conventional heart disease management.

Comments (1) -

  • Anonymous

    5/12/2008 9:04:00 PM |

    My father was working in Detroit in 1980 and 81, arguably the center of America's anti Japanese car hatred at the time.  I can remember when he came home he would tell stories of the destruction of Japanese cars that auto workers did.  If you drove a Japanese car in Detroit at that time, I got the impression  that there was an excellent chance the auto would be crashed into on purpose while sitting at a stop light or someone at night possibly might take a sledge hammer to the hood or windshield.

    Many people have a hard time handling change. What happened with Americas auto employee's rage over competition from Japanese car isn't much different than you see in the stock market, I believe.  People have a tendency to believe something will last forever.  They don't want to believe that events tend to occur in cycles.  Even when all evidence seems to point toward an event happening, they  find reasons to ignore it, and later act in disbelief when it occurs.        

    Times have been good for many health care professionals.  But the writing seems to be on the wall that change is coming.  Hopefully, I am guessing it will, inexpensive heart disease prevention will play a larger role in the future.  The results prevention bring are too good to ignore.

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