Dr. Bill Blanchet: A ray of sunshine

26. June 2008 William Davis (4)
Another heated discussion is ongoing at The Heart.org, this one about Tim Russert's untimely death: Media mulls Russert's death as cardiologists weigh in

Although I posted a couple of brief comments there, I quickly lost patience with the tone of many of the other respondents. Should you choose to read the comments, you will see that many still cling to old notions like heart attack is inevitable, defibrillators should be more widely available, "vulnerable" plaques cannot be identified before heart attacks, etc.

I quickly lose patience with this sort of outdated rhetoric. However, our good friend, Dr. Bill Blanchet of Boulder, Colorado, has a far stronger stomach for this than I do.

Here, a sample of his wonderfully persuasive comments:


Heart disease cannot be stopped but we can certainly do better!

Goals we must achieve if we hope to solve the Rube Goldberg of coronary disease:

1. Find something more reliable than Framingham risk factors to determine who is at risk. Framingham risk factors are wrong more often than they are right. If you are comfortable treating 40% of the patients destined to have heart attacks, continue to rely on “traditional” risk factors only.

2. Treat to new standards beyond NCEP/ATP-III. These accepted standards prevent at best 40% of heart attacks in patients treated. This is unacceptable, and arguably why Tim is dead today! Why prevention protocols emphasize LDL and more or less ignore HDL, triglycerides and underemphasize blood pressure eludes me.

3. Motivate patients to participate in coronary prevention. Saying “you need to get exercise and lose weight” is not adequate motivation, it hasn't worked to date and probably won't work tomorrow. If you are satisfied saying it is "the patient's fault for not listening to me" so be it, that excuse doesn't work for me!

Currently “good results” consist of being able to convince 50% of patients at risk by traditional risk factors to participate in prevention and hopefully 30% will be treated to goal. Of those treated to goal, 60% of the heart attacks will still happen anyway. Mathematically we can hope to prevent <10% of heart attacks with this approach!

I have personally found a solution to this dilemma. It goes like this:

1. EBT-CAC [electron-beam tomography coronary artery calcium] is the most reliable predictor of coronary events period, the end! Anyone who disagrees has not objectively read the literature. The only test more predictive than the initial calcium score is the follow up score 12 to 36 months later. EBT predicted Tim Russert’s event 10 years before it happened; passing his stress test gave him inappropriate reassurance 2 months before he died. If only Tim had the benefit of a second EBT sometime over the last 10 years he and his doctor would have known that what they were doing was insufficient and improvements could have been made.

2. I treat to the standard of stable calcified plaque by EBT (<15% annualized progression, preferably <1% annualized progression). This correlates with a very low incidence of coronary events. Even the ACC/AHA 2007 position paper agrees with this. This is accomplished with aspirin, omega-3 fatty acids, diet, exercise, weight control, smoking cessation, treatment of sleep apnea, stress reduction, control of HDL, triglycerides and LDL cholesterol and excellent control of BP and insulin resistance plus the recent addition of vit D-3. Meeting an LDL goal of 70 is easy but prevents only a minority of events, treating to the goal of stable CAC by EBT is a challenge but when achieved, the reward is near elimination of heart attacks and ischemic strokes. This has indeed been my personal experience!

3. A picture of plaque in the coronary artery is a monumental motivator for patients to get on board to make things better. The demonstration of progression of that plaque despite our initial therapies gets all but a few suicidal patients interested in doing a better job. I think that similar motivational results can be had with carotid imaging; the difference is that CAC by EBT is clinically validated as being a much stronger predictor of events with progression and non-events with stability than any ultrasound test including IVUS.



Wow! I couldn't have said it better.

Sadly, I doubt even Dr. Blanchet's persuasive words will do much to convince my colleagues on this forum. And the cardiologists on this forum are likely among the more inquisitive and open-minded. The ones stuck in the cath lab day and night, or implanting defibrillators, are even less inclined to entertain such conversations.

While I admire Dr. Blanchet's energy for continuing to argue with my colleagues, the lesson I take is: Take charge of health yourself. If you wait for your doctor to do it for you, you could be in the same situation as poor Tim Russert. This is an age when your physician should facilitate your success, not prevent it or leave you wallowing in ignorance.
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Comments (4) -

  • Anne

    6/27/2008 7:40:00 AM |

    Being from over the pond I had never seen or heard Tim Russert, but over the past few weeks I seem to hear nothing but discussion and speculation about his death on the US forums I'm on. When I first saw a picture of Mr Russert in the first wave of reports after his death I thought to myself "That man is overweight, no wonder he died early. Why is everyone surprised ?"

    My mother died of an early heart attack because she smoked. At least five years before her death her cardiologist told her that her arteries were clogging because of her smoking. Yet she continued to smoke. She didn't even try to cut down.

    Why are people so surprised when smokers and overweight people die from heart attacks ?  I personally get very angry about it. My mother's untimely death had a terrible impact and caused a lot of problems for my family and it was her own stupid fault. Is there a Mrs Russert and Russert children/grandchildren ? Mr Russert's early death will have had a monumentally awful impact on them. I read he was a very intelligent interviewer....well he wasn't so intelligent because he must have known that his overweight was bad for him but he didn't lose it. Stupid. You don't need to be a cardiologist to know that overweight causes heart disease.

    Millions of pounds and dollars are spent on treating the symptoms these people have yet no one spells it out that they should just stop smoking, lose weight (stop taking drugs, stop drinking, whatever) FIRST ! It's pointless pouring medications into these people when they just carry on injuring themselves.

    I may still be very angry at my mother for killing herself with smoking and so may be 'over' ranting about this, but I make no apologies because these people know what they are doing. Their deaths are no mystery, require no endless discussions about causes. Their deaths are first and foremost their own faults and not their doctors. Sure they need help to stop smoking, to lose weight, stop drinking, stop taking drugs etc but they are responsible for carrying that through.

    Anne

  • Anonymous

    6/27/2008 4:01:00 PM |

    I found the most interesting part of the Dr."s comments were that while he would like less than 1% progression of calcium, he seems to be happy with "just" less than 15%. Although this is pretty close to what Dr. Agaston shoots for. He says in his South Beach heart Book than 10% or less means you've pretty much eliminated future risk and he STILL says there is no such thing as "regression".

  • Anonymous

    7/8/2008 6:06:00 PM |

    I volunteered for a study 10yrs ago and the heart ct gave me a calcium score that said 80% of my age group was better than I. It didnt change how I lived the next 10years. It took high blood sugar, reduced vision, wt loss, and frequest urination to prod me into action. By adding oatmeal and increasing fats yet drastically cutting carbs overall I inadvertently did amazing things to lower cholesterol without meds or exercise. I want another scan to see if fixing your floating cholesterol problem has a regression effect on your plaque or if it truly is too late once the plague is there.

  • buy jeans

    11/3/2010 10:04:59 PM |

    Sadly, I doubt even Dr. Blanchet's persuasive words will do much to convince my colleagues on this forum. And the cardiologists on this forum are likely among the more inquisitive and open-minded. The ones stuck in the cath lab day and night, or implanting defibrillators, are even less inclined to entertain such conversations.

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The Diabetes Gold Rush

The Diabetes Gold Rush

11. September 2008 William Davis (9)
Lou came into the office. Clearly, his program had gone sour.

Lou had initially obtained wonderful control over his heart scan score of 1114, having reversed modestly in his first three years of effort through correction of his multiple causes (including low HDL, severe small LDL, Lp(a), and a diabetic tendency).

But Lou now came into the office red-faced and sporting a big bulging abdomen. Blood sugar? Now in the overtly diabetic range. Lou said that his primary care doctor had suggested that he start on three new medications (glucophage, injectable Byetta, and Actos) to control his blood sugar. His doctor also told him to increase his intake of fibers by eating more "healthy" breakfast cereals like Cheerios.

Lou had apparently done just that (added "healthy" fiber-rich foods) even before his doctor had suggested it. (Lou failed to remember the several conversations we'd had about healthy eating.) Unfortunately, Lou also failed to connect his increased intake of "healthy fiber-rich foods" and his growing abdominal girth (his "wheat belly").

Here's the dirty little secret: Much of the world wants you to be diabetic. It is the health gold rush of this century. "Go West, young man!"




To find out what I mean, you need only ask: Who profits when people become diabetic? That's easy:

The pharmaceutical industry--Diabetes is a booming growth industry, a source of tens of billions of dollars of revenue, poised for enormous growth as the population ages and gets fatter. It is common for a newly-diagnosed diabetic to be given new prescriptions for two or three drugs with a monthly cost of $300. Of course, the chronic nature of the disease make this far more profitable than, say, a two week course of antibiotics. Presently, 70 new drugs are under development.

Diabetes drug maker Novo Nordisk reported a 25% increase in revenues in 2007 from diabetic agents in the North American market, along with near $2 billion increase in profit for the year. Merck's recently-released DPP-4 inhibitor, Januvia, has already sold $668 million in 2007 and is growing rapidly.

The medical device and supply industry. Take a look at the Medtronic quarterly earnings report, detailing the breakdown of their record-setting quarterly revenue of $3.7 billion:

Diabetes revenue of $269 million grew 12 percent driven by sales
of consumables, the accessories required by insulin pump users, and
continuous glucose monitoring products. Revenue from international
sales grew 31 percent over the same quarter last year.

That's what I call a growth industry.

The processed food industry. The food industry is as big or bigger than the drug industry. ADM, Kraft, General Mills all have annual revenues in the $12-50 billion range. There are plenty of others.

When we're told, for instance, that Cheerios reduces cholesterol, we're not told that it skyrockets blood sugar or triggers small LDL. When we're sold whole wheat crackers, Cocoa Puffs (which the American Heart Asscociation says is heart-healthy), or granola bars, hunger is stimulated, impulse to eat more grows, blood sugar escalates, we get fat, we get diabetic. It's a simple formula.

So be aware that there is little incentive among corporate giants in the food, medical device, or drug industries to encourage behaviors that decrease the incidence of diabetes. In fact, there is enormous financial incentive to make sure that diabetes continues to grow at the startling rate it has over the last decade.

To be sure, the drug and medical device industry will also develop better tools to deal with diabetes and its complications. But the very best way to deal with diabetes is to not develop it in the first place.
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Comments (9) -

  • Anonymous

    9/11/2008 11:53:00 PM |

    while you mention a low fat diet in your book, you now seem to speak of a higher sat fat diet, but how high?  also, it appears that oatmeal and oat bran are recommended by you to be good.  Is this correct?  I thought grains should not be consumed

    It would be helpful to those of us who have read your book to have a current picture on your diet recommendations as they currently stand.  thank you for the fine blog you produce.

  • Dr. William Davis

    9/12/2008 1:03:00 AM |

    Hi, Anon--

    The new Track Your Plaque Diet will be coming out in both the www.trackyourplaque.com website, as well as the revised version of the book, likely out in 2009. This will include all the new strategies we've been employing.

  • Anna

    9/12/2008 3:53:00 AM |

    Have you thought about an e-book?  Would make updates much easier.  I'd get it and recommend it (I do have the TYP book).

  • Ricardo Carvalho

    9/12/2008 3:53:00 AM |

    Dear Dr. Davis, I believe your post demonstrates a lot of courage and personality by recognising that the pharmaceutical, medical and food industries are more worried about their profits than about promoting health among our society. We already knew this, of course, but it is different when it’s said by a doctor. In Portugal, in 2006 an estimated 6.5% of the population was diabetic. In the last 7 years, the number of diabetics increased an amazing 40%! Also, it is estimated that there are thousands more undiagnosed cases, so the total number today can be around 1 million (10% of the population). This is the 4th cause of death in Portugal and cardiovascular disease is 1st. Some of these cardiovascular deaths might be related to diabetes, isn’t it? In my opinion, this is a total catastrophe requiring urgent mobilization from all sectors of our society! But, unfortunately, most authorities don’t seem worried at all about preventing this. After all, their profit is proportionally higher to people’s ignorance. I also notice that some, or most(?), doctor simply don’t have a clue about what is healthy food, glycemic control, low-carb or paleolithic diets, etc. Also, total cholesterol is still considered the number one problem, when perhaps glycaemia is much more relevant to public health. The spouse of a friend of mine, who is a nephrologist, says that “doctors are just mechanics”, so I assume they really don’t care about avoiding the engine’s damage, but only about repairing it. I think this shouldn’t be like this. We want preventive medicine! I once made a rough estimate of diabetic related deaths in Portugal - and this can be far from reality -, and it was about 5.000 people/year. Too many deaths and human suffering that could be avoided! How many people will die in our country because of terrorism, carjacking, assaults, and so on, the major concerns in the media? I don’t have the statistics but certainly very few. Metabolic disorder induced diseases, like cardiovascular disease and diabetes, will kill many thousands and should be world’s priority number one. People perhaps think this is inevitable, something decided by the external forces of destiny. But it’s not, proper lifestyle changes can make a tremendous difference. I personally believe in emulating the traditional and ancestral ways of living: something like a paleodiet, caloric restriction, unprocessed foods, no refined sugars, minimal amount of cereals & dairy, being active, walking & running, etc., the so called Primal Blueprint (www.marksdailyapple.com). I don’t want to make this comment be larger so I’m stopping here. I finish this comment with a few book suggestions from my Amazon Listmania: http://www.amazon.com/lm/R3HD91CU3D7QOO/

  • Anne

    9/12/2008 10:49:00 AM |

    And don't forget all the gold in taking care of diabetic complications from inadequately controlled blood glucose. What would happen to that industry if people followed guidelines of Dr. Bernstein or read Blood Sugar 101?

  • steve

    9/12/2008 7:26:00 PM |

    glad to hear there will be a revised edition of the track your plaque book updated for current knowledge.  Will that be early '09 and in the meantime other than elimination of grains where in the low carb universe is best for fighting heart disease; sat fat matters, and should be low, or don't worry about it.  Thank you.

  • Anonymous

    9/13/2008 1:00:00 PM |

    I'll wait for your new book but I am perplexed that a vegetarian diet, by implication, would be unhealthy.

  • Peter Silverman

    9/17/2008 3:19:00 PM |

    I can't understand why people who ate the traditional Asian diet, mostly rice, had such low rates of diabetes and heart disease.

  • Steve Cooksey

    2/7/2010 8:40:14 PM |

    Dr.  Davis,

    This post means SO MUCH to me.

    I am a paleo diabetic... no meds, no insulin (lost 75 lbs) .

    I have been saying the same thing ... and now I know I am on the right track.

    Steve

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