Dr. Davis, would you please specify the millisievert values you are assuming for chest x-ray, EBCT Ca score, MSCT Ca score, and CT angiogram? I just got a 64-slice Ca score and they told me I received an effective dose of 2 mSv. Would a CT angiography typically result in 20 mSv?

Hi,

Please see my Blog post, CT scans and radiation exposure at http://heartscanblog.blogspot.com/2007/06/ct-scans-and-radiation-exposure.html

You may notice some differences. There's enormous variation in exposure, depending on how it's measured, how the scan is performed, type and manufacturer of scanner. However, you can get a good idea of ballpark figures from the table in the blog post.

Let me try that URL again:

http://heartscanblog.blogspot.com/
search/label/CT%20scans%20and%
20radiation%20exposure

Or, go to the left sidebar of Blog contents and see "CT scans and radiation"

I watch Fox news.  And with that statement I'm sure some are rolling their eyes.  Never before in the history of America has declaring what news channel one watches apparently pigeonholed one on their political views.  

Like many I get my news from different locations: internet blogs, TV, radio, magazines, newspapers, etc, but in the morning I often watch Fox and Friends.  I do so for two reasons I suppose, the first being that I enjoy the joking around / humor on the set.  The second reason why I watch Fox is because it goes out of its way to present two sides of a debate.  It seems revolutionary what Fox has done to TV news - present two sides of a story.  Some people become terribly wound up over this.  On a personal note, I have an "ultra liberal" uncle, by his own definition, that in all honesty is so upset over Fox news and me watching it that he no longer communicates with me.  Uncle Gordon probably has never watched Fox News.  He only knows what he has heard.  And knowing him if he did watch he would only see the conservatives and not notice the liberal view point.  I hope one of these days he calms down and we can find ourselves on friendly terms again.  Change is hard for some to come to terms with.          

When reading this blog, it disturbed me.  I wish that all news reporters tried harder to present two sides to a story. These high radiation reports would be easy to demonstrate as being only half true.  But instead, because of poorly researched, unprofessional reporting, there undoubtedly will be Americans that will decide to not have a life saving CT heart scan for fear of radiation poisoning.  And that is sad.

Hi, JT--

I couldn't agree more.

If there's one theme that presents itself over and over lately, it is the struggle to discern the truth in the sea of information we're all presented with every day. I can only hope that we all zig-zag towards a real truth over time.

Re the CTCA - new study out concerning radiation exposure for young women.

don't rush to the doctor for every sniffle, sneeze, bump or bruise.  too many see their doctors way too often.  also, don't rush to the ER everytime your kid cries for more than 60 seconds.

get a plan that has a health savings account.  these typically have a very high deductible ($250 per individual) and cover one check up per year.  a lot of health care costs end up being out of pocket.  makes you think twice about frivolous health care expenditures.  also causes you to want to be a healthier person.

Our premium for our the highest deductible option we could get health insurance, for 2 adults, went up $500. And neither of us have had any medical procedures, we take no prescriptions, and never even entered a doctor's office last year.  At some point, it's no longer insurance...it's highway robbery.  

And we eliminated all grains from our diet earlier this year, so hopefully we will go another year without needing a doctor.  Really makes it hard to keeping paying that premium...

You are so right... it's crazy.  Our insurance premiums got so high we couldn't pay our other bills.. our deductible was $9800.  Add to that our regular Dr. bills and it was insane.  

The clincher was when the naturalist lady down the street was dying of malignant melanoma. It had reached her lymph nodes.  Her family told me the drs insisted on operating to take them out, plus chemo.  But what does this crazy lady do?  She says "no way, I'm gonna go the natural route".  I mean, this lady is DYING.  She even smells like death.  Three weeks later I see her at the grocery store, and she looks like she just came from the gym.  "My goodness, you look so much better! What have you been doing?" She says "Oh, eating a lot of greens, I am so sick of greens! But it's keeping my PH between 7.2 & 7.4.  My naturopath said hardly no one dies of cancer, they just die of acidosis." It's now 3 months later, and the woman is running around like a teenager.  

Well this was always my great fear. Cancer - w/o insurance. So now, I ask myself, why the heck am I going broke trying to pay for this insurance?  Stick a fork in me, I'm done. Feed me some greens.

Come you guys, Saint Obama FIXED the American Health Care System. Didn't he... He really did, didn't he - he SAID he would...

Dr. Davis, you forgot to mention that another big saver is never to buy prescription Niaspan, but instead buy over the counter Slo-Niacin or Endur-acin.

One other big money saver is to invest in a pill cutter as most drugs cost the same for all dosage options. Have your Doc double your dosage and then just cut the pills in half and save 50% right off the bat.

I would say, start living a low-carb paleo lifestyle and you won't need supplementation and medical care (except from healing that wrist ) at all. How do you do this? http://www.cutthecarb.com/getting-started/

I really enjoy this blog and have got a lot of useful information from it over the years. But goodness, I know for sure that America is a dreadful place to live for health care ! I feel much safer in the United Kingdom where I know I get an excellent service from the National Health Service.

Also, vitamin D3, oil based cholecalciferol, has recently become available here on prescription. It's a German manufacture called Dekristol and is good value - 50 capsules of 20,000 IU each costs about £20 to the NHS (l£7.20 directly to the patient). That's cheaper than any health food shop over here !

Yes, no Niaspan! That one completely slipped my mind.

I used to be the largest prescriber of Niaspan in Wisconsin. Now I use Sloniacin or Enduracin exclusively. Compared to about $150-$170 per month for two tablets of Niaspan, the equivalent quantity of Sloniacin or Enduracin costs around $8.

Thanks for reminding me, Anon.

Hi, Chuck-- Yes, indeed. In fact, that is probably what I am going to do personally.


Hi, Patty--I've had that same impulse. Unfortunately, one hospitalization is enough to bankrupt most people, or at least strip you of all your savings and retirement money. That's yet another part of the story.

I won't go to doctors that overcharge the insurance company. I changed plans and needed a refill of Flonase, which my previous doctor prescribed for hay fever. My new doctor wouldn't write the prescription unless I came in for an office visit, for which he billed the insursance company $500. He used the time to pitch his surgery services, saying if I was ever in the hospital and needed surgery, I could request him. I signed up for a different doctor.

i apologize if i mislead anyone.  our deductible is $2500 per indvidual not $250.  our family of 4 max is $3500.  once we reach that for the year for everyone, we have no more out of pocket.  the most we have spent out of pocket in a year (3 years on the plan) is about $500.  we have been fortunate.

Unfortunately, I train a client whose doc insists he take niaspan and not an over the counter prep, even regular niacin, which I personally take. Even with insurance it still costs him $60.00 a month.

My husband and I try to avoid doctors except when it's absolutely necessary! We have found that eating low-carb and supplementing with D3, kelp, etc. that we are rarely ill.

Dr. Davis
Great advice! I am a midwestern hospital CEO, we employ about 2000 people. I had meetings recently to discuss next year's health plan changes and told everyone this stunning fact: 1% of our staff account for 35% of our plan expenses!
I see little evidence of motivation to change behaviors. Like most Americans they are going to come to a doctor like you and want a pill to fix it.
Keep up the good work

In our company's employee benefits meeting last week, after they announced premium increases one of my buddies blurted out, "Hey, I'm on Obama-care.  Aren't you supposed to be paying me now?"  Pretty funny.

exercise - even walking a few miles a day makes you healthier (1000 steps equals one mile) - eliminate the gym membership and do your own housework, gardening to stretch and strain a little for free

Don't know if this is helpful, but just ran across it:

http://www.amazon.com/Prescription-Alternatives-Hundreds-Prescription-Free-Remedies/dp/0071600310/ref=sr_1_5?ie=UTF8&qid=1292264829&sr=8-5

What is the best way to supplement iodine and how much?  Since cutting Mortons for sea salt I am sure I am not getting Iodine (except in occasional shell fish)  Any suggestions?  BTW my T4 Thyroxine was way below the reference range last visit to the DR.

Agree with most of your recommendations, but not sure iodine supplementation is the best idea:
http://thehealthyskeptic.org/category/health-conditions/thyroid-disorders/page/2
Amy

Two words: Google Scholar. A lot of my former health problems were due to lack of vitamins and poor absorption. The medical papers and abstracts there helped me figure out why I wasn't absorbing them and what to do about it. Eliminating grain helps with this--grain is full of anti-nutrients. There have been a lot of other little things I've done to help absorb them.

As for walking, I suppose 1000 steps equals a mile if you take 5'-3" steps.

Ken says:
"1% of our staff account for 35% of our plan expenses"
Is it possible that they are sicker? I mean of no fault of their own making?
"I see little evidence of motivation to change behaviors. Like most Americans they are going to come to a doctor like you and want a pill to fix it"
Don't get me started on this one.
BTW, Ken, what is your salary as a CEO? Isn't it driving the cost of health care?
Well, Americans who think that universal health care equals "socialism," that history is dead, that "the rich are rich because they deserve to be rich," that an illiterate apparatchik (sorry, manager) can one day be  president of an university and another - CEO of some steel plant and yes, that life is simple and "it's up to you - to be healthy or not among other things" are getting what they  probably deserve. Yes, of course, there countless innocent victims, sadly the most sophisticated and decent.

These suggestions all make sense, and will do absolutely nothing. The bottom line is that the United States spend 17.6% of our gross domestic product on healthcare (the highest % of GDP of any country in the world) to the tune of 2.5 trillion dollars. Until we remove profit from the equation and recognize that access to healthcare is a fundamental, universal right of every citizen in the year 2010, and establish a universal government-run healthcare plan, these suggestions will do nothing. They won't actually generate healthcare savings; they'll add profit to those who allow 44,789 Americans to needlessly die every year to preserve the perverse private insurer system that torments our country.

I'd like to know where you keep getting the idea that wheat is genetically modified. None of the commercially available wheat is genetically modified. The varieties we have on the market are the result of selecting breeding practices. Selective breeding is not the same as genetic modification in scientific terms. Furthermore, hybridisation of varieties is not genetic modification, it occurs naturally. Here is an exert from one of my recent publications:

The BBAADD genome was derived by hybridisation of a female tetraploid (2n = 4x = 28; genome BBAA) and a male diploid [Triticum tauschii L. (2n = 2x = 14; genome DD)] (Kihar 1944; McFadden and Sears 1944, 1946a, b; Kimber and Feldman 1987; Kimber and Sears 1987; Dvorak et al. 1998). The A genome originated from Triticum urartu L., while Aegilops speltoides L. is reportedly the donor of the B genome for both tetraploid and hexaploid wheats (Dvorak et al. 1988; Wang et al. 1997).

"What is the best way to supplement iodine and how much?" - anonymous

Judy B. gave you a hint... kelp.  It has the highest amount of iodine of any natural dietary source, AFAIK. I buy the dry powder form sold by Now Foods.  An 8oz. bottle only costs me $4 and lasts six months... not bad.

A quarter teaspoon has 300 mcg (200% DV) of iodine, so that's what I put in my little BCAA/whey protein shake every morning to ward off any thyroid problems, and so far so good at 50 y.o.  However, you may need a much different dosage protcol if you already have thyroid problems.  Dr. Davis has some blog posts on the subject.

Anonymous about wheat's genetic profile:

1) You're off topic here.

2) Nonetheless, I've never said that genetic modification yielded modern wheat. It has been the extensive hybridizations that have yielded this modern monstrosity called "wheat," the hexaploid dwarf that makes millions sick.

However, I suspect that this argument only matters to people who work in the wheat-generating industry. Who gives a damn how it was created if you have a debilitating illness from it?

I too have gone to the high deductible health care plan. It is a 10,000 deductible for each member but gives you a free annual exam with some standard bloodwork. Also gives a free gynecological exam, mamogram and pap test for women. An interesting difference with these policies is that they give you unlimited prescription coverage once you meet deductible where as prescription coverage on most taps out at $2000, a lot of which you paid for with prescription coverage. There are lower deductibles. With the $10,000 deductible, I pay around $370 per month for my husband and myself and opted to put my son on full coverage since it is so inexpensive for a young person.

Since I've been following your advice my LDL has shot up, and a bunch of other markers are all improved: CRP, HgA1c, triglycerides, HDL, fasting glucose.  How can I tell if this is a good trade or a bad one?

Iodine from the seaweed Kombu, Laminaria japonica gets stewed into anything you cook with it.
Take a small piece, say an inch square and simmer it for extraction. Dr. Davis probably ate it as Dashi when a boy.

Don't bother swallowing the cooked seaweed; you'll need unique genetics to digest it's poly-saccharide. Kombu has, among other good things, arsenate.

Kelp digestability raw is dubious; maybe the surface iodine could dissolve for you. And kelp, which can incorporate arsenic, does not contain arsenate; which is what binds to arsenic to keep it from bio-availability.

Rachael Ray on CBS today once again was pushing whole grains (especially wheat) as an important dietary component which “has been shown to reduce cholesterol 25%”. She doesn’t explain what type of cholesterol, nor provide her sources. This woman has done this often enough that I suspect she’s getting paid off by the industry.

I quit Lovaza after I learned of the absurd mark-up. Life Extension seems to work fine.  I recently added niacin (rotten triglycerides and low HDL). I had tried the flush free junk for over a year. Now I use plain old immediate release Rugby, which runs about $20 a year at 1 gram a day. That would buy maybe four days worth of Niaspan. My next project is switching from Androgel to compounded testosterone. I have good insurance but it's insane that someone is paying $13,000 a year for a few hundred dollars worth of raw material and no real research innovation.

I haven't seen a doctor in years. They won't give me herbs or real medicine - all they offer is toxic drugs. Conventional doctors are the enemy. They test for things behind your back and are essentially agents of the government. All medical information is used against you. Doctors hate me, because I won't go along with their way of doing things. They won't test vitamin D, hormones, or anything else I'm interested in. Doctors are very interested in my vaccinations and alcohol and illegal drug use, however. Marijuana is legal in my state for medical use, but I'd probably have to be on my deathbed to get a prescription from a regular doctor in this state. But they are more than happy to write a script for a toxic anti-depressant.

Anonymous - For iodine, I use kelp capsules from Nature's Way and also Life Extension Sea-iodine capsules. My thyroid seems fine, so I guess they work for me. I average about 800 mcg iodine daily.

Sorry, doc, but your advice really isn't entirely accurate.  Lovaza may only cost some patients a 30 buck copay per month which may be less than the cost of the appropriate dose of OTC fish oil if one takes it in the proper dose (which may be 8-10 caps per day as opposed to 2 BID of Lovaza).  Speaking of which compliance is therefore better with Lovaza too.  Personally, Walmart fish oil gives me terrible reflux and heartburn while I can't even tell I'm taking Lovaza.  Also, D2 in the form of prescription ergocalciferol is generic and the dose is 50000 Units per month at a cost of 15-20 bucks per year which is cheaper than D3 OTC.  There is also some reason to believe that D2 is more effective than OTC D3.  Cost efficient care needs to be individualized.  I am a physician and try to provide my patients with good medical advice that is cost effective as well.  And, BTW, I have no connections to the drug industry.

Anonymous Doc--

Wow. Your comments are so far from the truth that I don't know where to start.

If you read many of the previous posts on this blog, I hope you will see how far out of touch your comments are. D2 better than D3? Since when is the mushroom or invertebrate form of anything better than the real HUMAN form?

Note that the discussion is how to save money for the overall system, not just keep more money in your pocket.

Next time leave a name.

call me ignorant because i am not certain of this answer.  if the patient has a copay of say $30 on a prescription does the insurance also pay a certain amount for that prescription?

Yes, indeed, Chuck.

Insurance will then cover another $100 or so. This is the cost we all bear through our health insurance premiums. This money goes straight into the pocket of GlaxoSmithKline, who are presently salivating over the great print-more-money franchise they have, thanks to the ignorance of the American public.

I find it incredible that here and in related posts people have made comments like "So what? My insurance covers Lovaza." That is precisely the point: We all share the costs eventually, copay or no, with crippling health insurance premiums, while the drug industry makes out like bandits.

How about a fly-the-entire-sales-force-to-the-Bahamas sales meeting this year?

What's up with the coconut picture at the head of this blog?

I searched and didn't find any posting about coconuts...

Personally I have a severe coconut addiction and the picture flares it further.

The book Lights Out! make this point, too.

Dr. Gundry makes no distinction between whole fruit and fruit juice. Most vegan heart specialists says eat all the (whole) fruit and vegetables you want. Now Gundry wants to take away this last tasty food group. Is he recommending an all-vegetable diet? (Incidentally, as I recall, horses and cows have enzymes we lack, which allow them to extract more protein from vegetables than can we humans.)

Dr Gundry looks at our diet from an evolutionary point of view.  Today's fruits and veggies have been manipulated by humans to have a much higher sugar content than the starting plants.  Case in point: seedless grapes.  He states that you really have to consider what humans evolved to eat over millions of years compared to the western diet that has essentially been created over the last 50 years.

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.