It doesn't matter what I eat!

9. July 2006 William Davis (0)
"How are your food choices?" I asked.

"What does it matter, doc? I take Lipitor. Doesn't that take care of it? I eat what I want!"

So declared Matthew. What he "wanted" was pretty much the diet of a teenager: pizza, cheeseburgers, soft drinks, snacks. His "beer belly" (visceral fat) gave it away. So did his blood work that showed flagrant lipoprotein abnormalities--small LDL, an HDL of 37 mg, and a severe after-eating flood of fat represented by increased "intermediate-density lipoprotein" (IDL).

Like many people, Matthew had been persuaded (or chose to believe) that LDL cholesterol was the sole cause for heart disease. Lipitor was therefore was all he needed. It must be great--how else could they afford all those slick TV commercials?

Well, it is definitely not true. In fact, with the persistence of Matthew's abnormal lipoprotein patterns, we should expect his heart scan score to continue to grow by 30%--the very same rate of increase as if he were taking nothing.

Specifically, Lipitor and drugs like it do not:

--Raise HDL.

--Correct or reduce the proportion of small LDL.

--Block after-eating flood of fat, nor do they accelerate clearance of unhealthy fats persisting in the bloodstream after eating.


Yes, what you eat does have real consequences, even if you take a statin drugs. In fact, the foods you ingest have a remarkably rapid and dramatic effect on what your blood contains. Any diabetic who checks his/her blood sugar knows this. They eat a slice of whole wheat toast and watch their blood sugar skyrocket.

Mind what you eat. Make it enjoyable, of course. But drugs do not provide impunity.
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Should you take Plavix?

Should you take Plavix?

22. April 2006 William Davis (2)
A question I get fairly frequently nowadays is, "Should I take Plavix?"

For the few of you who've managed to miss the mass advertising campaign for this drug on TV, USA Today, etc., Plavix is a platelet-blocking drug, known chemically as clopidogrel, that "thins" the blood and helps prevent blood clot formation in coronary arteries and carotid arteries, thus potentially reducing heart attack and stroke risk.

What if you have a heart scan score of, say, 450--should you take Plavix?

In general, no. First of all, aspirin and Plavix (generally taken together, since the effect of Plavix is incremental to that of aspirin) only block blood clot formation. They have no effect whatsoever on the rate of plaque growth. Aspirin and Plavix will neither slow it or increase it.

What they do is when a plaque ruptures like a little volcano and exposes its internal contents (inflammatory cells, fat, etc.--like a raw wound), a blood clot forms on top of the ruptured surface. If the clot is big enough, it can occlude the vessel and causes heart attack. Or, if it's a carotid artery, debris from the clot can break off and find its way headward to the artery controlling your speech or memory center. Aspirin and Plavix simply help inhibit clot formation once a plaque ruptures. That's it.

Interestingly, if you view any of Sanofi Aventis' commercials for Plavix, you'd think they came up with a cure for heart disease. It ain't true.

When is Plavix helpful? It's clearly an advantage after someone receives a coronary stent, drug-coated or uncoated;, after coronary bypass, particularly if certain metal punch devices are used to create the grafts in the aorta; and during and after heart attack. These are all situations in which blood clot formation is a forceful process. Blocking it helps.

In general, in asymptomatic people with positive heart scan scores at any level, we do not recommend taking Plavix. The Plavix people are extremely aggressive pushing their drug (hang around any medical office and see!) and, I believe, have gone overboard in promoting its benefits. Rarely, in someone with a very high heart scan score, say 2000 or more, we'll use Plavix for a period of a few months until lipids/lipoproteins and other risk measures are addressed, just as an added safety measure. But, in general, the great majority of people with some heart scan score or another do not receive it and I don't believe that they should.

As always, look beyond the marketing. The purpose of marketing is to increase profits, not to educate.
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Comments (2) -

  • Anonymous

    1/27/2009 5:11:00 AM |

    My father died of a heart attack on January 16, 2009 while taking Plavix. He has been taking this drug for a couple of years, and I believe that it killed him.

    Pharmaceutical companies, such as Bristol-Myers Squibb and Sanofi Aventis, who knowing sell medications which kill the people who are taking it should be criminally prosecuted!

    I’m mad as hell, and I’m looking for legal advice concerning this medication and how it may have caused my father’s death.

  • buy jeans

    11/3/2010 2:21:37 PM |

    When is Plavix helpful? It's clearly an advantage after someone receives a coronary stent, drug-coated or uncoated;, after coronary bypass, particularly if certain metal punch devices are used to create the grafts in the aorta; and during and after heart attack. These are all situations in which blood clot formation is a forceful process. Blocking it helps.

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Good time for a heart attack?

Good time for a heart attack?

22. January 2007 William Davis (0)
Man Has Heart Attack At Right Place, Right Time

If Robert Ricard had picked the wrong restaurant for lunch, he might have died.

The 71-year-old Michigan man suffered a heart attack shortly after ordering a glass of wine with friends at Bentley's Roadhouse on Saturday.

Luckily, a disaster medical team was sitting nearby.


A TV station in Michigan reported the above story. You've heard these "if it wasn't for ___, so and so would have died" stories. They're reported in all cities at one time or another.

What amazes me about these common local stories is that they're accepted at all. The question that comes to my mind is "Why couldn't the heart attack have been averted in the first place?" Early identification then, as close as humanly possible, elimination of risk would have been a preferable path.

Of course, it may not be the role of the media to cast judgement on why and how the entire episode could have been completely prevented from occurring. But you shouldn't fall into the same trap of complacency. We cannot expect others to save us when the "big one" hits. Your best assurance is to never have one in the first place.
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Cath lab energy costs

Cath lab energy costs

22. April 2009 William Davis (6)
In honor of Earth Day, I thought I'd highlight the unexpectedly high carbon costs of activities in hospitals, specifically the cardiac catheterization laboratory.

A patient enters the cath lab. The groin is shaved using a plastic disposable razor, the site cleaned with a plastic sponge, then the site draped with an 8 ft by 5 ft composite paper and plastic material (to replace the old-fashioned, reusable cloth drapes). A multitude of plastic supplies are loaded onto the utility table, including plastic sheaths to insert into the femoral artery (which comes equipped with a plastic inner cannula and plastic stopcock), a multi-stopcock manifold that allows selective entry or removal of fluids through the sheath, a plastic syringe to inject x-ray dye, plastic tubing to connect all the devices (total of about 5 feet), and multiple plastic catheters (3 for a standard diagnostic catheterization, more if unusual arterial anatomy is encountered).

All these various pieces come packed in elaborate plastic (polyethylene terephthalate or other polymers) containers, which also come encased in cardboard packaging.

Should angioplasty, stenting, or similar procedure be undertaken, then more catheters are required, such as the plastic "guide" catheters that contain a larger internal lumen to allow passage of angioplasty equipment. An additional quantity of tubing is added to the manifold and stopcock apparatus, as well as a plastic Tuohy-Borst valve to permit rapid entry and exit of various devices into the sheath.

Several new packages of cardboard and plastic are opened which contain the angioplasty balloon, packaging which is usually about 4 feet in length. The stent likewise comes packaged in an 18-inch or so long package with its own elaborate cardboard and plastic housing.

At the conclusion of the procedure, another cardboard/plastic package is opened, this one containing the closure device consisting of several pieces of plastic tubes and tabs.

If the procedure is complicated, the number of catheters and devices used can quickly multiply several-fold.

By the conclusion of the procedure, there are usually two large, industrial-sized trash bins packed full of cardboard, plastic packaging, and discarded tubing and catheters. The trash is so plentiful that it is emptied following each and every procedure. None of it is recycled, given the contamination with human body fluids.

That's just one procedure. The amount of trash generated by these procedures is staggering, much of it plastic. I don't know how much of the U.S.'s annual plastic trash burden of 62 billion pounds (source: EPA) originates from the the cath lab, but I suspect it is a big number in total.

So if you are truly interested in reducing your carbon footprint and doing your part to be "green," avoid a trip (or many) to the cath lab.
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Comments (6) -

  • Anonymous

    4/23/2009 8:05:00 AM |

    Dr. Davis,
    Isn't a catheter used for an angiogram?  I thought an angiogram is a necessity before surgery for an aortic abdominal aneurysm?  What are the other alternatives if catheters make so much rubbish?  Just wondering since my mother is considering having surgery for her AAA and needs to have an angiogram first.
    Thanks,
    Josephine Keliipio
    Hawaii

  • Anonymous

    4/23/2009 2:19:00 PM |

    Dr. Davis doesn't answer questions posted to his blog any longer. He announced this some time ago.

    I think the point of his little story about being green is to avoid having to have such a procedure done in the first place. I don't believe he is suggesting that you ask the Hospital to recycle all the left over rubbish from such a procedure. At the rate of pay of those people, they'd probably have to charge you a couple of hundred dollars to sort everything out that could be recycled..  Frown

    I am only a lay person but I believe there is no alternative (less rubbish producing that is) to the procedure your Mom needs done. Don't worry about the trash and focus on your Mom's outcome instead.

    Good luck with your Mom's procedure.

  • Anonymous

    4/23/2009 5:10:00 PM |

    Catheter angiogram is no longer needed to demonstrate arteries, especially arterial anatomy in the abdomen, extremities,head and neck, including, carotids and intracerebral arteries, arteries in the arm or legs. There is now, an alternative, non-invasive. This consist of CT, CTA, or even better, without radiation an MRI,MRA. The only indication for catheter angiogram is if there is plan for angioplasty, or placement of a stent.
    No one or nobody should be subjected, to a catheter angiogram, in this day and age.
    I hope this helps.

  • Jonathan Selwood

    4/23/2009 5:55:00 PM |

    Dr. Davis,

    Much obliged for the post.  It provides me with a wonderful counter to claims that a grain-based diet has less of an environmental impact.

    Wheat=Heart Disease=Medical Waste

    jonathan

  • Anonymous

    4/24/2009 9:41:00 AM |

    Anonymous #2,
    Thanks for your comment about angiograms. I am still learning about this procedure and am glad to know that there may be other alternatives. My mom had no plans for a stent or an angioplasty but it seems that angiograms are the standard for elderly patients electing to fix AAAs. Anyway, lots of questions to ask the cardiologist when we see him again in a few weeks. Josephine

  • jean

    4/25/2009 5:53:00 PM |

    Mmmm...stay out of the surgical ICU also, if you can help it. We generated on average 3-4 large cans of waste per room (14) per shift (12hr) per day. Efforts to separate out recyclables were futile. And let's not even get into hand washing. This was in 2000. I hope things have improved.

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