Do you know much about the diet he recommends to decrease inflammation and heart disease?
Thanks!

He uses a low processed carbohydrate diet. I'm afraid I did not get too far into that aspect of things with him.

Thanks for the reply. I assume by "low-processed" you mean whole grains?
Greg

Although I read Dr. lundell's book, I remain unsure about how tightly he advises processed carbohydrate control. He is clear on minimizing sugars and sugar-equivalents like sodas and fruit drinks. However, on questions like some grains, I remain unclear.

I was under the impression that CLAs only exist in animal products and that beef is particularly rich in CLAs.  I also understood that CLAs are a form of transfat, although perhaps a beneficial form, if there is such a thing.  Do you think that adding CLA is helpful for regression of plaque?  Does TYP recommend doing so?  If so, should the CLA be via a supplement and what dosage is typical?

We are putting together a clinical trial to examine this issue. I don't have any preconceived notions over whether CLA will work or not. The animal data for reversal of atherosclerosis is fabulous, almost too good to believe.

The human data on weight loss is, in aggregate, modestly promising. But will it reverse atherosclerosis in humans? We're going to try and find out.

It is my understanding that CLAs are a derivative of Parent Omega 6. I have read that the correct proportions are two parts omega 6 to one part omega 3.  This is referred to as Essential Fatty Acids (EFAs).  Lack of EFAs impede the use of oxygen and oxygenation is crucial to the miochondria of a cell.  I'm interested to see what your comments are on EFAs.

Are you aware Dr. Lundell's medical license was revoked in 2008 by the Arizona Medical Board?  Go here to read about him: www.azmd.gov

It's true.
http://azmd.gov/GLSuiteWeb/Repository/0/0/1/4/97d47a09-71b9-4f30-8bfe-78428be876c4.pdf

@anon & David,

I didn't read the whole report of the deliberations, but from reading the first one, several observations can be made:
-Dr Lundell had retired from thoracic surgery at the time of the hearings.
-The hearings concerned complaints about certain high risk surgeries done by Dr Lundell, as they are done by all thoracic surgeons.
-None of this has anything to do with a nutritional approach to halting and reducing CVD.

Hi! How about fresh juiced carrots? It's hec of carbo thing but is it slow, fast, should I just eat vegetables and fruits and not juice them?

In my book, I recommend 3 g of fish oil daily. This would normally yield about 1000 mg of EPA and DHA depending on the concentration of the supplement. This is approximately the dose that reduced sudden cardiac death by 50%, and all cause death, by 25% in patients with previous heart attack.

Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

I've been taking fish oil since 2005.Went to a cardioligist who wrote me out a script for lipitor after my cholesterol test was a little high.Being skeptical i then went hom and researched this horrible medication and realized i could take a much healthier,cheaper and much better alternative.Well that alternative was fish oil and i'm so glad i did my research first before blindly accepting my fate.

Given the blood-thinning properties of fish oil, is it advisable to take it along with blood thinners such as Plavix or Coumadin?

Yep.Didn't have a lot of BF to begin with. But once I went 90% Paleo, I could see my libea alba within weeks.

I've been 80% paleo for a year, and while I lost oodles of BF, I'm still not there... :[

No yet, but I'm working on it

I've been wheat/sugar/flour etc free for about 4 months and although I didn't want to drop weight, it just happened; fast. About a month ago I dropped the rest of the grains from my diet and even though my weight stayed the same, the small love handles I had-or extra fat around the waist- disappeared. It wasn't much to begin with, but it's pretty much gone.

this raises an interesting question: what should your ideal weight be?  No doubtthere are benefits to Low Carb diet, but where or how low should your weight be.

I have lost 9 kg this year but my linea alba is still not visible, with the exception of between the two upper parts of the six-pack abdominal muscles.

Even though a fat-based diet is effective in removing fat tissue, it still takes time to remove the fat tissue.

Your "ideal" weight should be what you weighed when you were 25 yrs old....+/- 10lbs, at the most.
Women, post gravida, usually....usually...put on about 5-10 lbs after childbirth...that's reasonable...due to hormonal influences.
But men, you should be at your 25 yr old weight
Plus, that's when the human body fully matures in all neuromuscularoskeletal body areas.
Makes sense to be that weight...unless you are eating grains!

Combine the NO wheat with the plank, push-ups and pull-ups and your linea alba will jump forward. If you are not there yet; You also have a linea alba in your mouth ;)

Paleo has done me well - kept me slim. Lately, increased kettlebell workouts have tones me even more. Have to be honest though - just cant seem to get the full sixpack...upper four are there but those bottom two ba$tards....;)

Dropping the wheat made a huge improvement on my lipid profile. The only draw back is that I was already pretty thin with 18% body fat, now I'm probably down to 8%. People have commented that I look "too" thin and my cheeks have kind of a sunken look.

"Your "ideal" weight should be what you weighed when you were 25 yrs old....+/- 10lbs, at the most."

Don't get out much?  There are tons (pun intended) of massively fat, morbidly obese teenagers all over the country these days.  Go to your local Walmart and check it out. Truly sad. Starbucks muffins, HFCS, McDonald's, etc.

Re: whether you should weigh what you did at age 25, it depends on what kind of shape you were in at that age. Me, I weigh what I did in high school. Awhile back, I wasn't hungry for a few days and saw a number on the scale that I hadn't seen since junior high.

I wouldn't trade the white line for all the white food in the world.

"Your "ideal" weight should be what you weighed when you were 25 yrs old....+/- 10lbs, at the most."

I weighed 60kg at 183cm when I was 25. I now weigh 74kg which is far more appropriate.

It is also possible to be of "normal" weight and have very high body fat and very low muscle mass.

Also factor in relative muscle mass. I am a big believer of strength training, e.g., Fred Hahn's "slow-burn" techniques. Not only do you feel better, you enhance insulin responsiveness, increase HDL, reduce triglycerides, and increase bone density. However, this will increase the crude BMI measure, as well as body weight.

It also heightens the likelihood of seeing your linea alba.

Oh, I don't know... I dated a few women who had the linea alba readily visible, and their diet was mostly junky microwavable frozen food dinners and fast food (when I didn't take them out, that is
I think the Linea alba being visible is simply a benefit of fewer caloris, not the makeup of those calories.

Kent said:
"The only draw back is that I was already pretty thin with 18% body fat, now I'm probably down to 8%."

This is extremely unlikely unless you are a world class endurance athlete. You are probably still 14-15% body fat. Even very thin people can have surprisingly high body fat levels.

I have a friend who is an Australian  national-level middle-distance runner. He has 15% body fat.

When you lose weight by caloric restriction (including LC diets) you will nearly always lose (a lot) of muscle as well as fat.

The only way to prevent muscle loss and bulk up is to undertake a resistance training program. Without this protein is just broken down and excreted in the urine.

Ballerinas and runway models often have appalling diets and still manage to stay thin.

It is even possible to get reasonably fat on a paleodiet by ignoring appetite signals.

Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

[...] defintions are a good starting point, but not complete. It is still possible to have an undefined linea albinea and handles with lower ab definition. Level 3 probably needs to be broken down into components.   [...]

you forgot one more benefit- effortless wieght loss! at least for many of us...

I've eliminated almost all sugar, and all refined grains, but I still  eat brown rice, oatmeal, and whole spelt bread. On my recent VAP test, my triglycerides were 78, HDL was 63, and my LDL was Pattern A (large, buoyant LDL). Also, my Cardiac C Reactive Protein was .84. I'm concluding that some whole grains are appropriate for me, and I use the blood glucose monitor to monitor postprandial glucose.

By the way, thank you for all the info.

Dr. Davis, following your advice as well as several other clarion voices in the nutritional wilderness, over the last 9 months I went from:
HbA1C 6.6, Fasting glucose 125mg/dl, BP135/85, LDL nearly 200, HDL below 30, body weight 245 (6ft tall, 40 in waist) on a mainly carb diet, to:

HbA1C 5.5, Fasting glucose 105mg/dl, BP115/70, LDL nearly in 1/2, HDL above 65, body weight 204 (still 6ft tall, but a 33 in waist) on a very low carb diet.

I've got 4 friends - all males in their 40s - who have also moved their personal numbers in these directions by greatly reducing carbs.  I'm trying to get my severely type II diabetic father to follow the same regimen, but his Medicare provided dietitian is fighting me every step of the way, with a diet based upon bread!  The struggle continues.

Thank you for being a consistent, well informed, voice of reason.  You've helped more people than you know.  (linked to you here).  Be well.

And I'm so unimpressed with the lack of any good hard endpoint data associated with the insulin sensitizers and such.  These dietary options really need to be explored further but, sadly, won't so long as physicians aren't reimbursed for it.

I agree regarding fructose.  

In people with impaired glucose tolerance, slashing starch too may indeed be beneficial.  But is there any evidence that slashing starch benefits people who have a healthy liver and pancreas?  In such people, I suspect slashing starch is just treating numbers and has nothing to do with health.  Otherwise, how do you explain Kitava, Peru, and Asia?

Sometimes I think that the results given with these studies are mostly due to the reduction of grains (lectins) and refined sugar and not carbohydrates themselves. I want to believe it is as simple as reducing carbohydrates but it doesn't explain how populations like Kuna and Kitava have good health markers even though they eat a high carb diet. Dr. WD, do you have any ideas related to this specific topic?

** I am not debating the results of low carb (I personally do paleo), and if your metabolism is already damaged low carb is the only way, but what if it is not? (you were never obese, diabetic, started healthy habits at a young age, etc).

Would these benefits also accrue to someone who does not get postprandial spikes in blood glucose on a low-carb diet - like the regular commentator "DrStrange"?

Actually, in the study reviewed in the post below, a 2-week replacement of refined carbs and sugars with dietary fat (mostly saturated) and cholesterol, led to a significant increase in HDL (14 percent increase in HDL from baseline for men).

http://healthcorrelator.blogspot.com/2010/02/want-to-improve-your-cholesterol.html

That was two weeks only.

In my own experience, higher consumption of saturated fat and dietary cholesterol has immediate effects on HDL, and those effects are especially strong with elimination of refined carbs and sugars.

Dr. Davis,

You mentioned Vitamin D.  I just got tested, level is 14.  However, I get episodes of calcium-based kidney stones (every 3-4 years or so).  How do you treat such patients?

One thing I don't understand is if all these benefits are independent or if they are all linked to glucose level.
If a particular carbohidrate causes little glucose spike will it still cause the other poblems?
Or if carbohidrate intake is followed by intense physic actvity which seems to take BG down does it still causes all the other problems?

Just letting you know, very nice post!

I totally agree.  I continued to struggle with my cholesterol the first year or so on a low carb diet.  After 3 years, my HDL has gone from 40 to 87 and my LDL has improved.  My blood pressure also improved over time.  My triglycerides were never high, but are usually in the 35 range now.  It's an awesome thing!

Welcome to Low Carb Dr. Davis!  From now on, your life will never be the the same

8-

In addition to what you have listed, which I can confirm in 100%, more beneficial effects will become apparent, such as:

- self-healing of teeth with no need for dental intervention, and roughly twice as fast healing of broken bones.

- healing of common cardiovascular diseases (arteriosclerosis, cardio myopathy and arrhythmia)

- rapid self-healing of hepatic diseases (i.e post hep-C cirrhosis healed in 6 months),

- improved kidney disease recovery (I heard of a patient  surviving on Optimal Diet without dialalysis with only 1/3 of 1 kidney left)

- normalization of one's body weight (obese loose, underweight gain),

- much stronger immune system (for instance, I never had a flu since yr 2000, before - twice a year)

- stronger more benign reaction to stress, no more paralyzing panic, no more total body vascular contraction and probably related better resistance to cold temperature.  

- no need to drink water frequently (fat metabolism releases water as an end product)

- never feel hungry again, no need to snack, eating once or twice a day becomes the norm.   For me no breakfast, no supper, only lunch and dinner, typically.  

- improved ability to hold breath longer when diving, generally we also naturally breath less frequently,

- different (improved) mood, subtle changes in the way one thinks, solves problems and react to life events, as no doubts, you will find out...  8-

Regards,
Stan (Heretic)

Daniel, I've tested my own blood glucose before and after meals and it's normal. However, I cut way back on all carbs a couple of months ago, and now eat around 47 grams of carbs per day. Results: I find that I don't need Sudafed or acid blockers at all now and I rarely take ibuprofin (an anti-inflammatory). The twinge in my shoulder and knee are gone. I've lost 10 pounds while working out *less.* I seldom get headaches, and when I do, they're mild. I also need a lot less sleep.

Should anyone care for details, I've chronicled my experience in my blog.

jandro - it is a very good question.  I wonder too but the studies I am reading (see for example Lancet. 1996 ) seem to indicate that carbohydrate reduction is beneficial in all cases, including healthy rural young populations.  

I see it now in the same light as for example alcohol consumption: if you are healthy and young, a  harm may be minimal and some wine  (in moderation) may even provide you with some calories and micronutrients (i.e. resveratrol), but why bother consuming all that starchy and sugary plant food that we are not that well adapted for, that is useful only if we have nothing else to eat and that was probably meant for us only as a temporary food to get us over some rough periods of fauna decline.

  Since there is so little modern research done specifically on this subject we are still largely in the domain of hypotheses and theories. However not all that is speculative.  For example existing archaeological research does show us that paleolithic human diet consisted typically over 2/3 of meat!  We are talking about millions of years of human adaptation.

---

Dr. Davis,  I forgot to add to my above list of benefits the following point:

- reliable improvement (in almost every case) in treating the autoimmune diseases such as rheumatoid arthritis, asthma, eczema, psoriasis etc,

- intestinal disease (Crohns, IBS , very high fat only!).  

- Multiple sclerosis (not 100% especially if nerve damage is too advanced but improvement in most cases)

There is a lot of patient cases (hundreds) of the above disease reported by Dr. Jan Kwasniewski, from his medical practice in the 1980-ties, described in his books, especially "Homo Optimus" and "Optimal Nutrition".  

I think you will find those books extremely interesting, highly recommended.  

Stan

Um Heretic.. I think Dr. Davis has been low carb for quite a while now. No need to welcome him to something he's already quite familiar with

Stan, thanks for your response:

I read the abstract of the study you link and don't see how it is related to what I mentioned. It is comparing a vegetarian population with one that eats around a pound of fish a day. Seriously, is there a question there as to which is healthier? I also don't think they are healthier primarily because they consume less carbohydrates, but rather because they consume a pound of fish a day compared to no animal fat/flesh in the other group.

If you read my original post again you will notice I am not saying a vegetarian diet (in fact, I eat over a pound of meat a day), I am just questioning whether the true problem is carbohydrates or if it is lectins, assuming you have a generous amount of animal fat and protein. I personally eat around 20% carbs, mostly coming from tubers and squashes as I find fruits too sweet (I agree that fructose should be reduced). Generally eat one piece of fruit a day.

I also don't see any evidence to your claim that humans are not adapted to plant foods. We are omnivores, and that's how we have succeeded. We are adapted to a diet similar to what equatorial hunter gatherers have, since we evolved in a similar environment. People bring many archeological references of sites located outside of Africa not realizing that the environment outside of Africa is nearly as new to us as grains are. Most HGs living in Africa have plant food present on their diet. The information you tell yourself claims 2/3 of our diet was meat, what happened to the other 1/3?

And what if someone goes really lowcarb (mostly meat) and his LDL rises up to 500? No info on the the LDL size. The remaining bloodwork results are  really good. Is this something to be worried about?

Hmm, well I eliminated wheat and all glutens from my diet in January 2009. I eliminated sugar at the same time. I also eliminated high Omega-6 vegetable oils. I basically eat low carb. I love to use coconut oil. I've lost over 100 pounds.

But my cholesterol just goes UP and UP! At least total and LDL - HDL remains in the 58-62 range and triglycerides remain in the 60-70 range. But Total cholesterol went from 229 6 months ago to 279 3 months ago, to 280 today, and LDL went from 165 6 months ago, to 190 3 months ago, to 206 today.

And I can't understand why! Of course my doctor is rabid to put me on stations and crazy with me that I refuse, and looks at me cross-eyed when I request an NMR/VAP test for LDL particle size.

But it still bothers me that it continues to go up and up and up, as I feel like I'm doing all I can to lower it. I was also diagnosed with Hashimoto's 6 months ago and put on 50 mcg of Levoxyl. Then three months ago it was upped to 75 mcg. Today it was upped to 88 mcg.

Slashing carbs eliminating the bad stuff sure is not helping my total numbers, which means a huge argument with the doctor every visit, and I hate to argue. :-(

I'm so glad I found this post!. I've had a group of clients take on paleo eating as a 6 week trial, doing so has naturally decreased their carbs. I had each person do before and after blood tests and I was concerned that 80% had a reduction in HDL. They also had reductions in Triglycerides and LDL and blood pressure and significant weight loss - but couldn't figure this one out. Thanks so much for keeping us informed of what goes on for your clients, so I know what is happening with mine is normal.

Julianne
By the way here are some of the results in people's own words
http://paleozonenutrition.wordpress.com/2010/09/01/6-week-paleo-trial-results/

Aortic stenosis is +/- 2% once age 65 and +/-4% for those over
85; but that's still
+/-300,000 valve replacements done yearly for it. I'm not passing myself as the doctor here, so following is what I think is relevant science.

The cytokine TGF-B1 (transforming growth factor beta)is seen in the blood progressively more as the aortic stenosis pathology worsens. Other elevated indicators
are fibronectin, collagen I & II, plus sarcomeric protein myosin light-chain 2.

All of the preceeding seem to be driven by TGF-B1 kinase-1 (TAK1) pathway, &/or TGF/SMAD transcription factors. The obstructive build up involves TGF-B1 inducing a pheno-type alteration of the local fibroblasts into more of a matix.

It's altered the valvular cells' environment, so to speak, and so extra cellular matrix (ECM) components acrue. Calcium in circulation is capable of depositing in the aged valve matrix; which, scaffolding matrix, youth don't have to "trap" the calcium.

The treatment of very high
vitamin D would down-regulate the cytokine TGF-B1, high vitamin K2 encourage matrix solubility and restricted calcium mineral with it's ion dynamics take the load off valve.

Doc, this is a phenomenal result!!  Thanks should be given to your keen medical insight and willingness to try alternative medicine in helping your patients!  You have what I consider to be probably the best website of its kind on the internet.  
     I live in a Chicago S/W suburb, which is really not that far, from your Milwaukee Office.  I have gone to your city a few times on business over the past couple of years and I regret not making an appointment in getting an exam.  One of these days I will make the trip to see you with or without an accompanying business trip.  Maybe this will spur more folks from the Chicago area to make the trip up North.

Excellent work Dr.Davis.Vitamin K2 ensures that calcium ends up where we want it.The combination of vitamins D3
and K2 has many benefits.

I am thrilled to read this thread. I am a 64 y/o woman diagnosed w/"mild to moderate" aortic stenosis with some regurgitation as well as some mitral valve regurg. As a child I had several severe strep throats, had a total hysterectomy at 42, and subsequently have been diagnosed with hypothyroidism, all of which I have read might be causative.  My MGH cardiologist says I'm not "bad enough" for surgery,and of course I don't want it, but I feel really awful--very tired, some chest pain at times, and occasional feelings that I can't get my breath.
I need a plan--and would appreciate any help.
Laura

Ever since I came across Dr Davis's heart scan blog four years ago I have been waiting for more more info on this. I have aortic valve stenosis - not due to degenerative changes but due to congenital aortic valve defect - a bicuspid aortic valve - and I have been supplementing with high dose vitamin D ever since.

Maybe for those who have severe calcification, they should avoid calcium. However, for the rest of the population, ensuring enough K2+D3+retinol(natural form)+magnesium and other nutrients is probably a better approach. Calcium itself protects against the heavy metal burden the body has been shown to accumulate with age. Calcium has also been proven to result in lessened inflammation (CRP), less genomic damage, longer telomeres, and lessened mortality. In the end, I would say, don't avoid calcium. Just make sure you don't get too much ***in relation*** to the other nutrients you are getting.

Echocardiograms can have substantial variability, certain assumptions are built into the mathematical formulas used to evaluate aortic valve stenosis. Was there any differences noted in the doppler velocity (Lvot, cw)or outflow tract dimension? Small differences in these measurements can yield large variability in aortic valve area. Just playing devils advocate here.......

I read some comments by a doctor on a website.He said,"Vitamin K2 decreased calcium deposits in aortic valves.Some of my patients' stenotic aortic valve systolic gradients decreased by about 20mm mercury."

Intestinal absorption of calcium can double or even quadruple when vitamin D levels approach desirable levels.Therefore, calcium supplements are not required.Hypercalcemia can lead to heart attacks, kidney stones , atherosclerosis and arthritis over long periods of time.There is plenty of calcium in food.

So you're saying my knees won't get better?!

1000 mcg per day!  Is that 1000 of MK-4 or MK-7.
For about 6 months a while backmI ws taking 1000 of MK-7
the-kid

I found out about K2 when my Dad was diagnosed with aortic stenosis. I tried to convince him to try Vitamin D and K2 but he went the conventional route and now has a cow's aortic valve.

I have been taking 200mcg K2 every day along with my ~4000 IU/day Vitamin D. I have never had a scan and always wonder how blocked my arteries are and whether the vitamin k2 is regressing any blockage.

A nice blog post from Nephropal on Vitamin K2

Thanks again Dr. Davis, your dedication to your job is incredible!
I have looked for K2 supplements containing both MK-4 and MK-7 but can't find them anywhere? They are not to be found in your own online shop at https://shop.trackyourplaque.com/ - where can I buy them in this proposed heavy duty dose (is's like 20 x 50mcg pills a day, quite a lot)? And what is the right balance between MK-4 and MK-7? Anyone?
Thanks - The Viking.

Viking,

I have searched long and hard for such a supplement with no success.  My guess is it doesn't exist because these two forms of K2 come from two completely different sources.

K2-MK4 (menatetrenone) is the animal form. The richest natural food source is found in green grass-fed cow's butter.  Supplements made from the natural source of menatetrenone are hard to find. The only one I'm aware of is a product called X-Factor Butter Oil made by Radiant Life.  There are less expensive synthetic forms of menatetrenone sold by Carlson Labs and Thorne Research.

K2-MK7 (menaquinone-7) is the plant form. Its richest food source is fermented soy beans, also called "natto".  Supplements made from a natural source of menaquinone-7 are widely available.

Life Extension's 'Super K' formula contains MK4 & MK7 and is available everywhere - try iherb.com

Natto is fermenting here at home; it's remarkably easy and cheap. Doc's posted data is for each 100 grams Natto (3.5 oz., +/- 2 shot glasses volume) Mk-7 = 1,000 mcg, plus Mk-8 = 84 mcg.

Home preparations won't exactly match commercial products analysis. Previously Doc stated that Natto raises serum Mk-4 & is active inside us for up to 4 hours; Mk-7 potent longer.

G.E.M. Cultures (now in Washington state) sell pure Japanese Natto spores by mail order. I've no financial interest here, just their long term customer. (Natto's poly-glutamic acid was a melting stabilizer in a tropical dairy development project's ice cream manufacturing.)

Buying the "commercial" size spore vial will let your learning curve be cheap. Online are plenty of variations on how to make Natto; G.E.M. ships with instructions in English and Japanese original.

To make 1 pound soy bean batch you just need to incubate a dish +/- 10 inches by 10 inches and less than 2 inches deep. It'll last a person weeks refrigerated.

I take one Life Extension Super K with Advanced K2 Complex softgel capsule per day.
Each capsule contains 1000 micrograms Vitamin K2 as menaquinone-4, 100 micrograms
Vitamin K2 as menaquinone-7 and 1000 micrograms of vitamin K1. I buy the capsules
at iHerb.com but other places sell them including Life Extension.
Invite K2 capsules contain 500mcg of MK-4,500mcg of MK7 and 1000mcg of vitamin K1.

Hi, Might'--

Thanks, as always, for your incredibly insightful comments. I, too, suspect that there are discrete, identifiable pathways that would provide a plausible basis for a D3/K2 effect on aortic valve pathology.


Anonymous with questions about the echo Doppler data--

The aortic valve areas were obtained with 3 views on the maximal aortic supravalvular velocity, using both the standard transducer as well as the Pedoff. On both studies, the LV outflow tract diameter was 2.1 cm. The second aortic valve diameter was also confirmed with planimetry.

Notably, peak aortic valve velocity dropped from 20 mmHg to 9 mmHg. I watched the echo tech (a very capable one, by the way) while he interrogated the valve. I am confident that we obtained the maximal peak velocity.

All in all, I believe it is a real effect.

Anonymous and Paul--

I have been advising the Life Extension "Super K."

Super K contains 900 mcg MK-4, 100 mcg MK-7, as well as 1000 mcg vitamin K1.

Have you seen any results like this on any of the other heart valves?
My Dad has severe mitral valve stenosis. I am taking D and K2 and trying to convince him to do the same.

Thank you, Dr. Davis.

Looks like I'm in need of sharpening my search skills.

Super K looks like a good deal.  I'll have to check it out when my supply of K2 runs low.

In the Life Extension Super K, is the 1000 mcg of K1 a problem as far as causing clotting?

I always understood that K2 (both MK-4 & MK-7) do not cause clotting like K1 does.

Would love to see some calcium scoring results (and/or angiogram) before and after K2 administration, as well as carotid ultrasound results.

Thanks for this blog, I visit it often.

I'm curious if the addition of large doses of fish oil to the formula would also help decrease stenosis.

FWIW, another source of K2: http://www.vitacost.com/NSI-Ultra-Vitamin-K-with-Advanced-K2-Complex/?ntt=844197013470

I don't have the links at hand, but I remember reading second-hand a study that showed excess K1 does NOT up-regulate clotting. Unless you are on Warfarin, K1 is completely safe, even for stroke patients.

Good luck.

Off topic but amusing considering...

http://www.sciencedaily.com/releases/2011/02/110223122425.htm

High Vitamin-D Bread Could Help Solve Widespread Insufficiency Problem

ScienceDaily (Feb. 24, 2011) — With most people unable to get enough vitamin D from sunlight or foods, scientists are suggesting that a new vitamin D-fortified food -- bread made with high-vitamin D yeast -- could fill that gap. Their study, confirming that the approach works in laboratory tests, appears in ACS' Journal of Agricultural and Food Chemistry.

Wow, to any regular reader of this (wonderful) blog that (i.e., the vitamin D bread) is hilarious!!!

Measured my just finished Natto yield from 1 pound dry soy beans. Digital scale here is down, so spring scale reading is ~ 875 grams Natto made.

Spores cost $14 (plus shipping) and are enough to make +/- 86 pounds of finished Natto. That's 39,000 grams of Natto.

If 100 grams Natto offering 1,000mcg Mk-7 is fine, then that's 390days worth. Dry soybean substrate for 390 days Natto is 45 pounds of soy (using my spring scale yield data).

Elsewhere in this blog, Doc I think, stated 32.7 mcg K2 decreased aorta calcification. Maybe the decimal got misplaced in my notes. Or reversal, verses prevention, demands mega-dose vitamin K.

I fork mash +/- 50 gr. Natto and blend it in with  +/- 50 gr. Hummus. That amount of Natto will fit on 2 rice cakes as well.

Dr. Davis, my greatest respect for your work. Two questions to your groundbreaking observations on D3/K2:
1) Did the patient in question have a biscupid or triscupid valve?
2) Was the patient exposed to any other lifestyle changes apart from D3/K2 that could explain the remarkable change?
3) I have seen some sites selling K2 warning against taking them together with high fibre meals. Why is that, and what is the best time/frequency to take D3/K2?
Regards, Louis

I'm curious if Dr. Davis has seen any improvements in his patients using vit D3 alone.

I expect K2 (MK-7 to be exact) helped, but was just wondering how he knows what helps or doesn't, when his patients are doing several protocols at one time (D3, fish oil, no-wheat/low carbs, perhaps niacin)...

Might-o'chondri-AL,

Your notes are correct.  The 32.7 mcg K2 data point comes from the Rotterdam Heart Study.  It was the minimum dose in participants showing a lower risk of both heart attack and aortic calcification.

I use Life Extension Super K with Advanced K2 Complex that I buy from iherb. You can also get K-2 (MK-4)from High vitamin butter oil from green pastures. (You can buy it alone or with Fermented Cod Liver Oil)
Use this code to save $5.00 off your 1st order with iherb: ROV990

Hi, Louis--

The fundamental problem with retrospective observations is that you never know with absolute certainty what was done to achieve the observed effect.

However, everybody in the Track Your Plaque program and coming through my office do nearly the same thing, i.e., fish oil, vit D, diet, etc. I NEVER witnessed regression of aortic stenosis until we added vitamin D. I am speculating whether K2 adds yet another level of control over aortic valve disease.

This is still in the world of anecdotal observation. This is, of course, nothing even close to a clinical trial. But this can be how new ideas get their start.

Hi Doctor Davis,

I am new to your HS blog and, after reading a few, I'm glad I signed on. Great info. Quick question regarding this idea of "cleaning" or adding flexibility to the arteries: Do you put any value in Chelation therapy? I took oral chelation supplements for a time and it seemed to lower my triglyceride and cholesterol levels. Any thoughts on this, especially as it pertains to the oral version versus the IV method?

Thanks,  Chris

This is been amazing. I am take it seriously. Thanks for this information.

Chances are the calcium supplement you are taking now is a rock source of calcium. The label will say "calcium carbonate", which is nothing more than limestone. AlgaeCal Plus contains an organic, plant-sourced calcium form derived from a unique South American marine algae called Algas Calcareasâ„¢.

Dear Dr. Davis,

Thank you for your website.  I am a 68-yr female with AS.  My aortic valve area is 0.69.  I weigh 118, and fast-walk/jog for an hour 4 days/wk.  I am asymptomatic, and my cardiologist advises watchful waiting.  

How much Vit.D would you advise.  Is the amount weight related?

Thanks again.  

Karen

Intestinal absorption of calcium can double or even quadruple, when vitamin D levels levels.Therefore desirable approach, calcium can not required.Hypercalcemia to heart attacks, kidney stones, atherosclerosis and arthritis over a long period have lead tours is a lot of calcium in food.

Dr. Davis's heart scan blog ever since I met four years ago, I have been waiting for more information on this. I have aortic stenosis - not because of degenerative changes, but because of congenital aortic valve defect - bicuspid aortic valve - I have been using high doses of vitamin D supplements since.

Dr. Davis,

Do you mean to say that you put him on 1,000mcg of K2 MK-7 per day? (or was the 1,000mcg a combined total of all forms?)

Dear Dr. Davis, a Final Guidance question.....

I know Life extensions Super K is a good supplement, but the question that seems to have been asked a few times on this blog is..."what is a good & ideal target daily does combination of both MK-4 and MK-7" ?

We have heard you say that 1000 mg a day of mk4 & mk7 is a good target...but in what ratio?  Just like Omega3 has good target ratio of EPA/DHA....can you suggest some guidance as to what a good target ratio
of mk4 & mk7 would be ?

Thank you!

Adam

HI, Adam--

I wish I knew! This is the difficulty with K2: too little known.

Sure, there are plenty of opinions, but little fact. You and I can only continue to follow the emerging evidence and make our decisions as the evidence unfolds. Right now, it is simply not clear what the ideal regimen is.

Dear Dr,

I just came across your blog. Mind-blowing stuff. Especially because I have mild-moderate stenosis. Moderately calcified and bi-cusped. I wanted to know if any of your patients had bicusped aortic stenosis and your treatment with D3 and K2 might have seen reversals?

also, do you suggest K2 with Mk-4 and Mk-7 or is just MK-7 sufficient?
I am taking just about 2000 IU D3 and 100 MK-7 K2, fish oil and veggies, fruits, walking.

Hope you can respond.

As always, thank you for all the good work you do.

Tom.

life extention vitmin k2 is from GMO soy.  Shame on them for trying to poison us.

Can you tell me how you found out that Super K contain GMO soy?

My father was just diagnosed with aortic stenosis and I had to go to a friend who is a biochemist to discuss some nutritional options for an 83 year old man.  I have used Isotonix supplements or the Nutrametrix line of same product since 1995.  Personally I wanted to go in that direction with a scientific mind to talk with. My Dad''s doctor told me he personally uses supplements but was not allowed to direct my father on them.  He is basically following a check list.  My Dad is a player and I have him on a great regimen.  After finding your blog, I am looking to add d with k2 in Isotonix.  I have him on an Isotonix Calcium supplement that has d3 in it.   Not junk calcium or tums.  
http://dwithk2.blogspot.com/
this is my blog and you can go to the bottom of it to see label on the product.
Our next stop is the cardio doc who we were advised would want to replace his aortic valve.  I really think that should be a very last resort.  
Really, I believe some lifestyle changes and bumping some Isotonix supplements to heavy dosing is a better option.

The key, in my view, for control over aortic stenosis (thought I have not YET published the observations) is:

1) Supplement vitamin D to achieve a 25-hydroxy vitamin D level of 60-70 ng/ml, and
2) Vitamin K2 supplementation to provide 1000 mcg MK-4 or at least 100 mcg MK-7, and
3) Take NO supplemental calcium, as calcium is passive "mortar" that will calcify the aortic valve.

Pertaining to myself (aortic valve stenosis and stenosis of the spine) and my wine (parathyroid adenoma (non malignant) on Sinsipar to control without surgery.

If we eliminate calcium  supplements (which this  makes me consider), can I forget about getting too much in food (I also take buffered Vitamin C, which will be a problem, since I have gastritis).

Also wonder if magnesium, boron & strontium are good or bad to take??????

Last, can you give me a link for natural treatment of parathyroid adenoma. My wife also refuses to take Boniva and her bone density is bad.

Thanks in advance.

Dr. Edwards--

Unfortunately, no data.

You are venturing further into the world of "normalizing" calcium metabolism. I'd like to believe that all this makes sense, as they tend to benefit osteoporosis/osteopenia, and removal of calcium as a supplement is likely a good thing, given its contribution to cardiovascular risk.

But we lack real data on the effects. I will tell you that the vitamin D, however, is very real, having now done this in around 60+ patients.

Dr. Davis,
     I'm 67, female with CAVD.  Heart murmur, dizziness, exhaustion since holidays led to apt with cardiologist resulting in mild aortic stenosis diagnosis in early April.
     I have taken Vitamin D3 over last two years after Welcome to Medicare physical showed low levels.  I have now added CoQ10.  After stumbling upon your blog, I'm now adding 135 mcg K-2 Mk7.  
     Despite the fact that I'm symptomatic, I'm hoping to avoid heart surgery until the new trans-vascular technique is approved for a wider range of patients.  I return to my cardiologist in early August and I will be most interested in comparing new test results against my April numbers--call it a personal clinical trial of one.
     A few years ago I observed open heart surgery at a major surgical center in Houston.  I vowed I would never have it myself, but here I am now, staring it squarely in the face.  I can't thank you enough for your website. It's given me a small measure of hope.

Dr Davis:
I am a 70 year old slim athletic male with a bicuspid aortic valve that has been stable for about 6 years with echo area measurements showing 1.2 to 1.3 sq cm.  When I got my first echo 6 yrs ago I searched published literature and decided to start 200mg MK-7 daily and I take quite a few supplements, including vit D, niacin, and about 3 gms fish oil (EPA+DHA).  My cardiologist is surprised to not see a reduction in area, and valve replacement seems to have been put off successfully.  This year, however, my ascending aorta was measured at  48 mm by echo, up from 44 (MRI measurement) a year ago.  Surgery was recommended, based on the aneurysm, not the valve, but of course both would be done at the same time.  A cardiac CT scan was ordered by the potential surgeon and the radiologist report indicated a maximum ascending aortic diameter of 45mm, but the surgeon said he looked at the 3-D CT images and it looked more like 47-48 mm to him.  Search for coronary artery plaque indicated all arteries "normal" except for the "1st Obtuse marginal: Tiny focal calcified plaque causing no luminal narrowing" .Beginning January, 2012, I have eliminated wheat and calcium supplements and have actually gone low-carb, high fat, adequate protein to the extent to be in "nutritional ketosis".  Ketones range from 0.5 to 1.9, depending on time of day and whether it is before or after exercize, etc.  I feel great!  Given that I am "on the boarder line" where surgery is recommended, I have thought about giving this more stringent diet a year to see if the aneurysm shrinks.

My question is this:  Some time ago you posted your experience of seeing patients ("Jake") where diet/supplements contributed to reducing the size of an aneurysm, but I cannot find any follow-up information in your excellent blog (or publications).  What is the best diet/supplement regime that would optimize reduction of an aneurysm?  If the mechanism for the aortic wall degredation is the same as for artery plaque, then I know your answer because of your writings on this subject.  My interest in writing is to determine if there are other dietary or supplement changes I should make that would optimize my chances of improvement in my one-year trial, should I decide to do it.  Also, do you agree that nutritional ketosis (which I have no problem staying on) should be advantageous?

Dr. Davis,
I chanced upon your blog while searching for content of MK7 in natto! What a fortuitous discovery for me.

I started taking a Vitamin D3 supplement last year when my level was diagnosed at 20 ng/ml. I took about 3000 IU per day for 9 months and my level rose to 27 ng/ml. I did so using a D3 spray in coconut oil sprayed under my tongue.

Recently, I came across research that D3 supplementation, even in the 2000-3000 IUs a day dosage, without K2 supplementation will cause calcification of arteries and soft-tissues.

Wanted to ask for your input on this:
- How much K2 should I take, especially to reverse calcification? Seems like 100 mcg of MK7 and 1000 mcg of MK4 are common doses.
- Can I take K2 just 2-3 times a week, just to be conservative. How about if I just eat Natto for MK7 and stay away from the supplements?
- Would you still recommend D3 along with K2? If so, what is a safe D3 dose to go with 100 mcg of MK7?
- Is calcification observed in those who were taking Calcium with D3 or it can be seen even without Calcium supplementation? I eat a pretty low-carb, high-fat, decent amount of proteins, less red meat diet. Also, I take no dairy, calcium supplement or calcium fortified foods.

Thanks so much for your time.

Update to my first comment after six months.  

After six months of K2/D3, CoQ10, and Niacin supplements, I had my first nuclear stress test at my cardiologist's office.  Photos were picture perfect--strong, well functioning heart.  Efficiency percentage was mid 60s in March, but went to 87% in late August.  Primary Care physician had difficulty locating murmur that was pronounced in March.  I'm now scheduled for a second echocardiogram in early February.  That will be the acid test.  

Despite excellent test results, I'm still experiencing some fatigue and dizziness, but not nearly so much as when first diagnosed.  I remain hopeful that with continued supplement therapy and good eating habits, I'll be one of the lucky ten percent who experience remission from AS with K2/D3 therapy.

Hi Rita I thought to mention that I've been going through the comments here and really appreciate that you are giving us updates of your progress. Hoping for good results for you next round!

Dear Dr.Davis,
I came across your blog by chance and very interested in your opinion regarding valve problems. I would be most grateful if you can advice me on my situation:
I always believed that I have a strong heart as I excercised a lot--swimming and hiking, never expected that the first thing knocked me down is my heart. Starting this year from January, I went to Hospital Emergency 8 times, 4 in Jan, 2 in Feb and 1 in April and anthor 1 in Nov, all because of very fast heartbeat. The first 4 made me hard to breath and thought I was dying. All the blood tests at the hopsital came out normal. However, the ecogram showed that I had moderate aortic valve regurgitation. As meantime I was suffering from gastric problems of not being able to eat much, my heart condition gave me scaring experience of being extreme fatigue, dizzy, chest pain, neck and should pain.  Doctors said I do not need to do anything.
Even the fast beat of my heart is getting better recently, constant fatigue and dizziness and neck pain prevents from living a normal life.

I am also scared to see my 4 year ecogram with only "traces of aortic valve regurgitation," now changed to moderate.

I would likfe to know why my valve degenerate so fast? what can I do to stop the process. After seeing your blog, I bought vitamin D (my level is 43) and K2 (both mk4 and 7), how much dose should I take, will these vitamins alone help stop the degeneration process?

I also considering coming down to see you if you give appointments for consultation.

Thanks for your help!

Holly

by the way, I am 50 years old and have a stressful job.
HOlly

Dr Davis,

Any research on a wheat less diet and lipoproteins and their affects on Aeortic stenosis? If elemenating them will prevent or reverse this condition?

Thank you,

Karen

There are several different causes of aortic stenosis. Congenital (ie bicuspid aortic valve) and rheumatic fever start at younger ages. ASc or sclerosis is a disease of older people, same age risk as ASHD or coronary disease (atherosclerosis) and is nothing more than a variant manisfectation of the same risk factors that causes myocardial infractions., high blood pressure, smoking, obesity, diabetes and lipid disorders from high carb diets or a combination commonly called Metabolic syndrome. All of these risk factors cause coronary artery disease and/or ASc, it is just a crap shoot as to which one may show up first...but, treat both the same. Does that mean Vit D doesn't work? Of course not, newer studies beginning to show high Vit D levels are Importent in atherosclerosis Ann cancer prevention.

My husband has a coronary calcium score of over 900. His cholesterol levels were: total:217, HDL:44, LDL:147, trigyclerides:167. His cardiologist wanted to put him on Provastatin and scheduled him for an echo-cardiogram stress test. He has chosen to put off taking the statins and has started taking K2 and magnesium supplements. Is this ok? Should statins be recommended for his score?

Is there a cardiologist in or near Santa Fe, NM, who has an understanding of nutrient issues similar to yours?

I stumbled upon your blog a year ago when researching how to reverse aortic valve calcification.  At the time I was 49 and had just gotten my echo results.  I was told that I had abnormal relaxation of my left ventricle consistent with diastolic dysfunction, a trileaflet aortic valve with a trace of regurgitation and mild calcification.  My aortic root is borderline in size.  Well that was a heck of a blow because my echo the previous year was normal.  (I have echos done because I had chest pain several years ago that turned out to be esophageal spasm.  However, everyone in my family died from heart disease and my father had his major MI at age 47.  My grandmother died from aortic stenosis... so they do yearly echos on me.  I also have hypothyroidism, polycystic ovary syndrome and my ApoE genotype is 3/4)

After I read your blog, I went out and bought Life Extension Super K.  I have been taking it for over one year--since last July.  I found in my research that people with the ApoE4 allele don't hold on to vitamin K2 as well as those who do not have this genotype, so I didn't know if one pill a day was enough.  After a gigantic hassle trying to find a lab that runs the undercarboxylated osteocalcin test, I finally had my level drawn.  It came back at 3.8.  (Normal was anything below 12.1).  The results provided a graph which showed I am in the low normal end of the spectrum.  It showed that 80% of the population is lower than me--which surprises me because I bet most of the population doesn't take vitamin K2.  Maybe the only people having this test done are those who do supplement with vitamin K...   In any case, that lab was drawn in mid May, and since that time I doubled my dose to 2 capsules per day.  What should my undercarboxylated osteocalcin level be?  I can't find any data about what level is acceptable to reverse calcification.  I have also been taking vitamin D for several years--my level was originally 9.  I take 50,000 units once a week.  My last D level was 87.4, so I'm pretty close to the 70 that you suggest.  I also throw in about 8,000 u of vitamin A twice a month because I read that it's necessary to downregulate the D.  My D had gotten as high as 115 last year but has been in the mid 60s-80s since.  I also take CoQ10 200mg per day and fish oil. (I was taking it daily, but what do you think about the new study out saying it increases the incidence of prostate cancer?  I didn't want to increase my possibility of any kind of cancer, so I'm only taking it twice a week now... thoughts?)

I had an echo and a Lexiscan (because I couldn't walk on the treadmill due to foot problems and foot surgery 1.5 yrs ago) done last week.  I get my results tomorrow and am hoping that the calcification is gone... When I had my echo done last year I was overweight (BMI 38.8) with some sleep apnea.  After that appointment, I walked out of that office and changed my life.  I have been on basically a "no white" diet--no sugar, flour, pasta, rice, bread, sweets, etc.  Because of my PCOS, I can't even eat complex carbs without gaining weight.  (I have done strict Atkins before but couldn't sustain it because it was so strict.  This is working for me.  My carbs come from low glycemic fruits and vegetables primarily.  I do eat meat, dairy and nuts).  I went back to the gym and go every other day.  I lift weights (my son is a personal trainer), climb the stair master for 20 minutes and then go home to ride my exercise bike for 45 minutes every day.  I ride my exercise bike every day for at least 45 minutes and sometimes do double cardio days on weekends.  I have lost 63 pounds in the last year.  I would like to lose another 20 pounds.  I have an oral appliance for the sleep apnea and will have another sleep study done after I lose the last 20 lbs.  I know that I didn't used to snore when I was thin (pre-pregnancy).  I'm only 11 lbs above my pre-pregnant weight now.  I know that the sleep apnea can lead to diastolic dysfunction.  I'm hoping I'm reversing that!

Any other suggestions for me?  I'm especially interested to know how much vitamin K2 I need to take to potentially reverse this darn calcification.  I've mentioned the K2 to my other doctors and so far they're all in the dark and don't even seem to care about it... I'm shocked, because there are big studies out there that back it up.  I don't know about my cardiologist because I don't see him until tomorrow.  I'm shocked that my endocrinologist didn't seem to care because he does bone density scans in his office.  I'm getting one done in a couple months.  In my past 2 scans, I was dropping towards osteopenia.  I'm hoping with the vitamin K2 that I show dramatic improvement so that I can show him I was right about the K.

Thank you for any help,
Lisa D. RN

Oh come on Jim, try google every once in awhile.  This isn't Dr. Davis' discovery...it's been studied and written about for at least 8 years now.

Isn't that the brand that everyone over on the Inspire.com site is having problems with?  Seriously, there's been quite a discussion about it.  Many found that once they switched to Carlson's K2 only, that their palpitations, etc., went away.

Add wheat and carbs to that interaction.  I used to think I got anxious and/or depressed in response to challenges I was facing in my life.  My experience with low (and zero) carbing has shown me that I get anxious or depressed in response to eating carbohydrate the day before.

No carbohydrate, life is wonderful, full of promise, joy and excitement.

I never would have believed it.  (Would have saved me a TON on therapy.)

"Does it represent the indirect effect of adrenaline, cortisol, or other “stress hormones”? Do factors that relate to low HDL, such as unhealthy diet full of carbohydrates and physical inactivity, also tend to cultivate depression?"

Answer to these questions is YES. Lowered HDL is a result of lipoprotein metabolism in plasma and it is related to increased VLDL secretion from liver.

I suppose there's always going to be exceptions to the rule and I'm one of those. My HDL is high at 89 mg/dl, but I'm under a considerable amount of stress, not only because of ongoing health problems but also because my son has an autistic spectrum disorder and is *hugely* stressful to live with.

Anne

wow, over half a bar of chocolate and wine drank daily - I switch to that from my unbranded low-carb style
(and I'm being serious in that "low-carb" logo is pretty worn out today, but if you write a book titled "Choco diet" with a subtitle that can be similar to that of Agatston's "SBD: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss" then you will reach far greater an audience than those getting interested in just a coronary plaque (not that I personally think the heart is "just" a peculiar detail.)

Just a quick question:  If stress can affect lipid levels, what about thyroid levels?  (Related to my kitty with hyperthyroidism that seemed to be brought on by great stress.)

You hit the nail on the head, Dr. Davis!

I was recently hospitalized during a "vacation" to California with "takotsubo syndrome", or stress induced cardiomyopathy.  I had chest pain after 5 intense days of dealing with a particularly difficult and nutty relative.

The hospital did the usual testing, including a cholesterol panel, which showed HDL of only 46, which puzzled me greatly.  Utilizing the Track Your Plaque principles, I have succeeded in raising my HDL to consistently around or over 60, so was quite puzzled by such a big drop to pre-treatment levels.  Now it all makes sense!  

BTW, I have fully recovered and an echocardiogram shows ejection fraction and heart wall motion have returned to normal.  I was very lucky, and the interventional cardiologist probably was a little disappointed he didn't get to place any stents. Oh well, he'll live, and I've still got plenty of medical bills to show for the experience!

My advice?  Nix the stressful situations and the nutty, negative people... it's a lot better for YOU and much cheaper in the long run, too.

As always, thanks for the great and informative blogs!

Terri
madcook
Houston, TX

I've been on Atkins for almost a year, so I've already done all this. I had a hdl level of 105 for almost a year, but the last panel showed a hdl level of 84 ! Yikes! WHat happened? So I was very happy to find your blog ( thanks Jimmy Moore) as I read that emotional stress can cause a drop of 20 points or more. Since I've been out of work since mid August I'd say yes, I've been under some stress. Looking forward to my next blood work! Thanks for the info, great reliever of my pain!
Hugs,
Gracie

I'm severely intolerant to red wine - not just the flushed face a lot of people get but knockout rhinitis, asthma, rheumatic joint pain, diarrhoea, and so on. Are there any other foods or beverages that I can substitute? I'm not terribly worried, but it'd be nice if there was something.

Dear Dr. Davis, what about synthetic HDL? Does it works? And does it makes any sense? Would you please write us an article about this subject? - http://www.healthcentral.com/cholesterol/news-280802-66.html

Why? Does it represent the indirect effect of adrenaline, cortisol, or other “stress hormones”? Do factors that relate to low HDL, such as unhealthy diet full of carbohydrates and physical inactivity, also tend to cultivate depression?