Do stents prevent reversal?

27. January 2007 William Davis (3)
I've seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things--lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.

Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents--30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It's impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents.

Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don't know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent?

These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all.
Tags :

Comments (3) -

  • neil

    1/29/2007 4:38:00 AM |

    While I certainly enjoyed your book and am extremely grateful for your generous sharing in your daily blog, I am very troubled by this blog entry. Over the last day I have been thinking quite a lot about it off and on, and that would be because I have three stents implanted; two Cypher and one Taxus.

    Since my dates in the hospital cath lab in early 2004 I have been following along with TYP principles carefully with the hope of being additional plaque neutral or even a bit of regression, but I see from this entry my hopes might be dashed.

    Your statement in the blog entry "I've seen this phenomenon several times now", does this mean it happens most always, or sometimes, or occasionally? What is the game plan now for these patients? Do they (or did) have any similarities that might be contributing to their plaque growth (LPa, diabetes, vit. D, BMI, gender, etc), or are their lipoproteins and assays corrected to perfection?

    Thanks again for all that you do, your program and willingness to share is unique and very special to many of us. If you could follow up sometime on this situation with a future blog entry or observations, I would be most appreciative.

    With concern,

    Neil

  • Dr. Davis

    1/29/2007 1:29:00 PM |

    Neil--
    All this means is that the presence of a stent may modify the potential for reversal ONLY IN THE VICINITY OF THE STENT. Other areas, meaning the majority of your other arteries' lengths, are still subject to your control and the benefits of your prevention program.

    Keep in mind that this is an experience involving just a handful of patients. To my knowledge, there are no formal published experiences like this to compare to. All patients had their patterns corrected to perfection by Track Your Plaque standards and don't seem to be distinguished by any one single lipoprotein pattern.

    My "gut sense" is that the sort of plaque growth that we see around stents and tracked by heart scanning does not carry the same implications that non-stent associated plaque does.

  • Anonymous

    2/27/2008 12:43:00 AM |

    I just found your site recently and have been reading through the posts.  I find it very educational.  Thanks!  

    I'm curious.  Were the stents medicated stents (since it is my understanding that they prevent this kind of thing)?

Add comment

Loading
Even moore from Jimmy Moore

Even moore from Jimmy Moore

14. September 2011 William Davis (8)
The ubiquitous and irrepressible Jimmy Moore posted even more commentary about the Wheat Belly phenomenon here, what he calls "The Wheat Belly Bonanza."

Is low-carb really, at its core, little more than elimination of wheat? Sure, corn, rice, and sugar exert deleterious effects. But the dominant effect--by far--is the elimination of wheat. So is the low-carb movement really, at its core, a wheat-elimination movement?

Food (non-wheat-containing, of course) for thought.
Tags :

Comments (8) -

  • marilynb

    9/14/2011 12:12:20 PM |

    "So is the low-carb movement really, at its core, a wheat-elimination movement?"
    I think wheat would be the very close runner up to sugar.  Of course, if you eliminate wheat  you've also eliminated a major vehicle for sugar (cookies, cakes, donuts, muffins, hearthealthywholegrain bread...)

  • Dr. William Davis

    9/15/2011 11:51:43 AM |

    Hi, Marilyn--

    I would reverse it: wheat is far worse than sugar. Let me explain.

    Unlike sugar, wheat has other components, including gliadin, that stimulates appetite. Sucrose does not do this.

    Eliminating sucrose does not eliminate desire for wheat; eliminating wheat eliminates desire for sucrose.

  • Physician Nexus

    9/19/2011 7:19:31 AM |

    Dear Dr. William Davis:

    This letter is a request asking your permission to allow us to post your blog on our website, Physician Nexus, worldwide network exclusively for physicians.
    www.PhysicianNexus.com
    Physician Nexus is the fastest growing social network dedicated exclusively to physicians.  It is a global communications platform that was developed with a vision to transform the field of medicine, allowing physicians to connect with each other in ways that were not possible before.

    We would include your name as the author and include the link on your blog site.  However, even better would be if you joined and posted the blog.  
    Our community has more than 1300 physicians from 66 countries.  It's free, takes seconds, and is designed for physicians only.

    Sincerely,
    Omar Baig
    Physician Nexus Team
    2530 Berryessa Road
    San Jose, CA 95132
    (408) 802-5267

  • Jackie G

    9/24/2011 9:54:30 PM |

    In my low-carb house, being gluten-free and sugar-free go hand in hand. If someone were to "slip" I'd rather see a sucrose slip than gluten!

    (Side note, since I've eliminated gluten, I've been free from all headaches - now THAT is telling! I used to get migraines 3x/week!)

  • Dr. William Davis

    9/25/2011 12:04:55 AM |

    I agree, Jackie. Sucrose is not good for you, but it does not invite the appetite stimulation of wheat.

    I'm thrilled about your freedom from migraines.

  • John

    9/26/2011 10:07:14 PM |

    I am new to this site, but have seen numerous remarks about the importance of vitamin D.  I'm a kidney stone former and I'm afraid to take vitamin D supplements.  My wife was put on vitamin D and Calcium supplementation; never had a kidney stone and -- BAM -- got her first one at age 57.  Any wisdom about this?  I am seriously thinking about limited carbs and wheat as Dr. Davis suggests.  We'll see where that takes me.

  • Donna

    9/29/2011 3:23:19 PM |

    Dr. Davis, I was diagnosed with primary biliary cyrrhosis of the liver about 5 years ago, stage 2.  I'm a third generation liver disease patient, with a twin sister and a 1st cousin having the same disease also.  At that time, the doc I was seeing was honest enough to tell me he was not very educated about the disease, but did research it and found that low Vit D was a problem associated with PBC.  My level was almost not existent.  After years of taking the wrong vit D and taking it wrong altogether and getting only as high as a 16, I started researching it myself and put myself on the correct VitD and dosage of my choice and now have a level of 99.  Whoops!  I feel better, but I did stop the Vit D about 3 months ago to try to drop it a bit.  My doc did not order a repeat test.  I didn't ask for one as I was being scolded for prescribing my own treatment at the time.  lol  So, being the good Doc, what should I do at this point.  Retest the vit D level and go from there, or just begin a maintenence dose and retest the next time they draw labs, which could be 6-12 months from now?  And what would a maintenence dose be, in your opinion?  I have no reason to believe my level would stay up with nothing bc it was so low and bc of the PBC.

    Thank you, Donna

  • Philip

    10/16/2011 12:32:26 PM |

    My 93 year old Granny who is still going strong lived on a staple diet all her life of toast for breakfast (wheat) granary brown bread sandwiches every day with cheese or ham usually and in the evening the staple is usually potatos with a meat dish.... My theory is that the situation is highly conditional on how many calories you are burning, if it's being burnt off it makes no difference to a person of normal weight, no?

    How do you explain that?

Add comment

Loading
The Russert Protocol at work

The Russert Protocol at work

25. June 2008 William Davis (6)
Without a concerted effort at prevention, heart scan scores (coronary calcium scores) grow like weeds. The average rate of growth is 30% per year.

Keith is an illustrative case. At age 39, Keith's heart scan score was 29, in the 99th percentile due to his young age. (In other words, young people before age 40 have no business having plaque. If they do, it's bad.)

True to conventional practice, Keith's doctor prescribed a cholesterol drug (Zocor), asked him to take a baby aspirin, and prescribed a blood pressure medicine. He asked Keith to cut the fat in his diet. His doctor even exceeded conventional (ATP-III) LDL cholesterol treatment targets.

Keith, an intelligent and motivated businessman, happily complied with his doctor's instructions. Eighteen months later, a 2nd heart scan showed a score of 68, representing an increase of 135%, or 76% per year.

This is the very same approach that the late Mr. Tim Russert's doctors employed: treat (calculated) LDL cholesterol with a statin drug, treat high blood pressure, reduce saturated fat, take aspirin. It was a miserable failure in Keith, whose plaque continued to grow at a frightening rate of 76% per year. It was also an obvious failure in poor Tim Russert.

Further investigation in Keith uncovered:

--Severe small LDL--80% of all LDL was small (despite a favorable HDL of 58 mg/dl)
--Measured LDL particle number (NMR) showed that "true" LDL was actually about 60 mg/dl higher than suggested by the crude calculated LDL
--An after-eating (postprandial) disorder (IDL)
--A pre-diabetic blood sugar and insulin
--Severe vitamin D deficiency
--Very low testosterone

All these patterns were present despite the steps Keith and his doctor had instituted. It's no wonder his plaque was undergoing explosive growth.

The conventional approach to coronary disease prevention is inadequate, more often than not a mindless adherence to one-size-fits-all template crafted to a great degree by drug industry interests and "experts" who often stand at arm's length from real live patients.

Keith's "residual" abnormalities are all readily correctable. He has since made dramatic improvements in all parameters. Among the strategies used is a wheat- and cornstarch-free diet that resulted in 12 lbs lost within the first few weeks of effort.

If you are on the "Russert Protocol," have a serious conversation with your doctor about the continued advisability of remaining on this half-assed approach to heart disease. Or, consider finding another doctor.
Tags :

Comments (6) -

  • Anonymous

    6/25/2008 10:23:00 AM |

    Testosterone deficiency is indeed another important factor, perhaps before vitamin D for some men.

    I guess it's no co-incidence that men's sperm rates are declining due to the range of chemicals in our environment which have an adverse affect on testosterone levels.

  • Stargazey

    6/25/2008 1:24:00 PM |

    I don't normally leave comments at your blog, but I wanted you to know that I read it regularly. Thanks for the all work you put into your posts and for the inspiration you provide!

  • Anonymous

    6/25/2008 3:01:00 PM |

    Except that for people with low testosterone (and I am one of those)when you try to correct the low testosterone with testosterone it lowers HDL. Its almost a "choose your poison" proposition.

  • Anonymous

    6/26/2008 9:44:00 AM |

    "However, only testosterone pills have been shown to lower blood levels of the good HDL cholesterol and cause heart attacks. Testosterone injections and skin patches do not (5,6,9)."
    http://www.drmirkin.com/men/M169.htm

  • Anonymous

    6/27/2008 3:09:00 PM |

    You don't mention testosterone cream, I'm on that and my testosterone went from 66 to 50,with no other changes in eating, weight, medicine . . . not a good trend.

  • Anonymous

    6/29/2008 10:37:00 AM |

    You should try Nebido (if available in the US), it's an injection that lasts up to 12 weeks - give or take a few weeks according to how you feel. It seems to be the most popular treatment in Europe due to being something you only think about 4x a year and achieves steady state levels.

    "The observed changes in the lipid profile under treatment with Nebido® were assessed as beneficial. Serum concentrations of total cholesterol, LDL cholesterol and apolipoproteins A1 and B were lowered, while HDL cholesterol, triglycerides and lipoprotein A remained unchanged.1,2,3"
    http://www.nebido.com/scripts/en/professionals/productinfo/lipid.php

    Where trigylcerides and HDL remain unchanged I guess this is where vit D and fish oil steps in.

Add comment

Loading