Heart scan book

20. April 2009 William Davis (0)


There are only two books on heart scans available.

One, of course, is Track Your Plaque.

The other is the basic book on heart scans, What Does My Heart Scan Show?

Lost in the navigation column to the left on this blog is the link to get the electronic version of the book. In case you didn't know, we make this available for free.

If you're interested, just go here. This book can provide many basic answers to the questions that often arise regarding heart scans, such as the expected rate of increase in score, how your score compares to other people, when should a stress test be considered. Many heart scan centers use this book for educational purposes to help patients understand the importance of their heart scan scores.

(The sign-up for the book requires that an e-mail address be entered.)

The hard copy of What Does My Heart Scan Show? is available from Amazon, also, for $12.99.
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Why do skinny people get heart disease?

Why do skinny people get heart disease?

13. June 2008 William Davis (9)
There's no doubt about it: The majority of people with heart disease are overweight. They may not be grotesquely overweight, just a few pounds over. But weight plays a crucial role in activating numerous factors that heighten risk for heart disease.

Excess weight reduces HDL cholesterol, raises triglycerides, increases small LDL (enormously), fans the fires of inflammatory responses (CRP, IL-6, TNF-alpha, etc.) raises blood pressure, increases resistance to insulin and raises blood sugar. Overweight people tend to be less physically active, may develop diseases of obesity like sleep apnea, and on and on. You've heard this all before.

But why do slender people develop heart disease? If we can't blame weight, what is to blame? By slender, I mean body mass index (BMI) of <25. (Yes, I know there are other ways, better ways, to gauge healthy weight. But, for simplicity, I'll use BMI.) Let's put aside the two obvious causes of heart disease, cigarette smoking and Type I diabetes. (I'd be shocked if any cigarette smokers read this blog.)

Slender people develop heart disease because:

1) They have lipoprotein(a)--The big, big neglected risk factor. In fact, the Lp(a) genotype is, in my casual observation, associated with a slender phenotype (genotypic expression). The prototypical example that makes headlines is the marathon runner--slender and superbly fit, but develops heart disease anyway. People wax on about the uncertainties of exercise and fitness when they hear about Jim Fixx and Alberto Salazar. But one factor would explain it all: Lp(a).

2) The murky category of the normal weight obesity. These people are generally recognizable by their flaccid tummies despite falling into a favorable BMI <25. Small LDL is the standout red flag in these people.

3) They were previously overweight but lost it.

4) They were former smokers.

5) Vitamin D deficiency--Deficiency of vitamin D is important for everyone's health. But there appears to be some people for whom it is the dominant risk. I believe that one of our great Track Your Plaque success stories, Neal, falls into this group. Some people who are vitamin D deficient develop colon cancer, others develop diabetes, others develop osteoporosis or multiple sclerosis, while others develop coronary heart disease and plaque. The likely reason for the varied expression is variation in vitamin D receptor genotypes (VDR genotypes).

6) The murkiest of all: Hypertension genotypic variants. This is a poorly sorted-out category, and one principally based on my observations along with scattered observations in such things as variations in the angiotensin converting enzyme genotypes. But I am convinced that there is a small percentage of slender people who show variation in some genetic type that predisposes to hypertension and heart disease. They also show a propensity towards enlargement of the thoracic aorta. This group is also among the most difficult to control in the Track Your Plaque approach, i.e., they have difficulty slowing or stopping the growth of heart scan scores. While blood pressure control in this group is important, it does not seem to remove the excess source of risk.

So, yes, being slender does put you into a lower risk for heart disease category. But it does not mean you are immune.

You can also be an overweight person who still harbors some of the features of the slender--you're an overweight slender person. The above list can still therefore apply.
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Comments (9) -

  • Anonymous

    6/14/2008 9:53:00 AM |

    Believe it or not, there is a guy I work with that smokes that reads your blog with interest.  He takes the supplements recommended, but can't seem to bring himself to do any more of the TYP program.  

    The good news is that his wife appears to have stopped smoking, and she also follows the low carb diet - not easy for her since she works in a bakery - plus takes supplements.

  • Mike Turco

    6/14/2008 7:01:00 PM |

    Another smoker here... not bragging about it. As I've been reading your blog for some time I don't believe your comment was meant to exclude those who smoke. Maybe there are fat people reading too?

    Which kills more people: stress, smoking or obesity? If you could pick two out of three to eliminate, which and why?

    Just curious. Love your blog, by the way.

    Mike

  • Anonymous

    6/18/2008 8:32:00 PM |

    Very informative Doc.-- Thanks for writing this blog-- On "Vitamin D deficiency" that could lead to such thing as heart attack or diabetes; since i'm lactose intolerance and a sugar hater so i drink soy milk & mix 1-2 tbsp of honey into orange juice daily. Do you think it's enough to get some Ds for a woman in 30s? I don't like pills if i don't have to take it, including supplements. Any thoughts/ideas would be fine. Thanks for this blog again!

  • Anonymous

    6/21/2008 1:54:00 AM |

    I smoked years ago until one day I visited a friend in the hospital. In the next room was a hideously hacking and choking man -- obviously suffering severely. His sobbing young wife explained to me that he had lung cancer. It was a glimpse into hell.

    I never smoked another cigarette.

  • Dana Seilhan

    6/22/2008 6:25:00 PM |

    There was a study that came out in 2006 which debunked the "fat kills you" idea.  From what I can tell, it goes like this:  Fat by itself is just energy storage.  But fat is also a symptom of health problems that lead to diabetes.  This explains the correlation in SOME people between overweight and diabetes, and overweight and heart disease.  But excess fat in itself is not what kills you.  This is how you can be slender and still get diabetes or heart disease--it just happened that you didn't have the extra weight as a warning signal.

    If one is going to criticize a fat person or call them unhealthy it is important to do a health workup on that person first to see what's going on.  Your heart scan is a good idea;  so is a five-hour GTT with insulin levels.  The latter in particular is going to pick up glucose metabolism problems early.  Glucose metabolism problems seem to be what lead to everything else you mentioned.

    As for vitamin D I have to laugh every time I see someone fretting over where to get it.  Go out in the sun for fifteen minutes a couple times a week!  Bonus:  You can overdose on food and supplement sources of D, but you can't overdose on the kind you make from UV exposure.

  • Mike Turco

    6/25/2008 3:56:00 AM |

    Hi Dana,

    I am overweight too, actually, but I've lost a lot of weight and I'm getting towards where I want to be (low-carb, no wheat, etc.) I've struggled with my weight all my adult life. I didn't mean to say fat in a derogatory way, that is just the word that came out while I was typing. I sure didn't mean to hurt yours or anyone's feelings. Sorry.

    Mike

  • Anonymous

    3/2/2010 4:22:23 PM |

    Hi I'm a very slender person with a history of heart disease, colon issues ms and diabetes in my family (who are also slender).  I'm now entering middle age and trying to start getting a better lifestyle and cut out some of the bad foods I've been eating.

    I find this difficult because I have difficulty maintaining my body weight even with my bad diet.  It sounds like I should be really popping the vitamin D from my family history.  However do you have advice on how to eat a healthy HIGH calorie diet so that I do not lose weight?

  • Anonymous

    7/27/2010 5:04:30 PM |

    I am overweight and it isn't easy to lose the weight.  It's obvious that overweight people have a problem - addiction to food as with any other addiction such as drugs or alcohol, etc. Why isn't there more help for us overweight people?  My doctor keeps telling me to lose weight - and join weight watchers - I have but it's not helpful.  It's like telling a drug addict to stop taking drugs and letting them walk out the door and you're on your own.

  • Anonymous

    7/27/2010 5:04:53 PM |

    I am overweight and it isn't easy to lose the weight.  It's obvious that overweight people have a problem - addiction to food as with any other addiction such as drugs or alcohol, etc. Why isn't there more help for us overweight people?  My doctor keeps telling me to lose weight - and join weight watchers - I have but it's not helpful.  It's like telling a drug addict to stop taking drugs and letting them walk out the door and you're on your own.

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