Fractures and vitamin D

27. April 2010 William Davis (25)
This is a bit off topic, but it's such an interesting observation that I'd like to pass it on.

Over the past several years, there have been inevitable bone fractures: People slip on ice, for instance, and fracture a wrist or elbow. Or miss a step and fracture a foot, fall off a ladder and fracture a leg.

People will come to my office and tell me that their orthopedist commented that they healed faster than usual, often faster than anyone else they've seen before. My son was told this after he shattered his hand getting slammed against the boards in hockey; his orthopedist took the screws and cast off much sooner than usual since he judged that healing had occured early. (My son was taking 8000 units vitamin D in gelcap form; I also had him take 20,000 units for several days early after his injury to be absolutely sure he had sufficient levels.)

My suspicion is that people taking vitamin D sufficient to enjoy desirable blood levels (I aim for a 25-hydroxy vitamin D level of 60-70 ng/ml) heal fractures much faster, abbreviating healing time (crudely estimated) by at least 30%.

For any interested orthopedist, it would be an easy clinical study: Enroll people with traumatic fractures, randomize to vitamin D at, say, 10,000 units per day vs. placebo, watch who heals faster gauged by, for instance, x-ray. My prediction: Vitamin D will win hands down with faster healing and perhaps more assured fusion of the fracture site.
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Comments (25) -

  • River Rat

    4/26/2010 11:18:16 PM |

    Just anecdotal, but I had an experience that confirms your theory.  In the middle of a 21-day trip down the Colorado through Grand Canyon, I fell and fractured my arm.  I decided just to splint it up and continue the trip, since the pain wasn't too bad.

    By the time I got to a clinic in Flagstaff, 10 days later, the doctor said everything had healed so well I didn't even need a cast.  

    Needless to say, there is lots of free Vitamin D in the Grand Canyon in summer!  We were in the sun all day long.  Maybe it made the difference.

  • ithink

    4/27/2010 12:18:12 AM |

    probably also has to do with the fact people are calcium deficient without vitamin d.

  • DrStrange

    4/27/2010 12:51:24 AM |

    Isn't there evidence that the blood level vs benefit curve reverse itself ("U" shape) above around 60 ng/ml?  Maybe just under or at that safer???

  • mongander

    4/27/2010 2:02:11 AM |

    Last fall I was happy with my blood level of vit D, 79 ng/ml, so I reduced my daily dose from 10,000 iu to 5,000 iu.   I just got my spring test result and my level dropped 23 points to 56 ng/ml.  I'm gonna go back to 10,000 iu, except maybe during the summer when I get a lot of sun.

  • TedHutchinson

    4/27/2010 12:23:13 PM |

    How to Optimize Vitamin D Supplementation to Prevent Cancer, Based on Cellular Adaptation and Hydroxylase Enzymology" You can read Reinhold Vieth's justification for keeping 25(OH)D both high and STABLE here.
    In order to regulate any system there has to be a means of both increasing and decreasing responses.
    Where the upregulation and down regulation is performed by different substances both of which are derived from Vitamin D, it follows these have to be kept tightly controlled and always in balance.
    Sudden rise in 25(OH)D causes a period of imbalance between those forces, during which too much immunosuppression may occur.
    The further north people live the more extreme differences between Summer/winter status. It isn't surprising those flying to the tropics for short midwinter sun breaks end up catching something from recycled germs during the flight home.
    Making sure your Vitamin D needs are met daily throughout the year evens out the percentage change in levels as naturally more vitamin D3 is made in low 25(OH)D skin than when 25(OH)D is high.

    Correcting vitamin D deficiency BEFORE a winter sun break results in a lower increase in 25(OH)D.
    Less change in status = shorter period of imbalance.

    I don't have to remind readers here Ergocalciferol speeds up the catabolism of vitamin D Cholecalciferol has a longer half life. Using Vitamin D2 therefore promotes greater/faster swings in status and should be avoided.

    Using Vitamin D3 supplements daily at amounts no greater than UVB exposed skin would naturally produce, most nearly replicates the changes in status human DNA would have evolved with.

    Apologies to Dr Vieth for assuming the copy of the paper linked to above was non-copyright and putting it online.  I think it's important the public have access to the full text rather than just my garbled version of this important paper.

  • Ned Kock

    4/27/2010 1:17:02 PM |

    Thanks Dr. Davis for the post sharing you personal experiences.

    DrStrange:

    The relationship seems to follow a U-curve pattern, with very high levels being associated with hypervitaminosis D problems.

    The levels mentioned by Dr. Davis seem well below the ones that can lead to toxicity. For example, a farmer in Puerto Rico had a level of 225 nmol/L (90 ng/mL), and had no signs of toxicity:

    http://healthcorrelator.blogspot.com/2010/02/vitamin-d-levels-sunlight-age-and.html

    From the post above, toxic doses seem to start around 50,000 IU per day. That's way more than the 10,000 IU or so that we get from sun exposure.

    My only point of disagreement with Dr. Davis is about our ability to produce vitamin D from sunlight after age 40. There is research (post above too) showing that the elderly can produce as much as 80 percent vitamin D from sunlight as do 20 or 30 year olds.

  • homertobias

    4/27/2010 3:21:19 PM |

    Hi Dr.Davis.
    I just wanted you to know that THIS PRACTIONER is running her own open label trial on 5-10 people with lp(a).  I will let you know the outcome.
    I just read your trial on 45 CAC high scorers that you published in Am J of Theraputics last year.  I hear that the registration process to publish is a horrific process. I am glad you persisted,  I really wanted your raw data but...

  • Tom

    4/27/2010 6:58:50 PM |

    I hope I'm not diverting from the topic here....I'm confused about the Vit D-Calcium interaction.

    I believe I understand correctly that high Vit D levels allow the body to more effectively process calcium.

    I don't understand how calcium requirements change with increased Vit D levels.  I have a blood level of 72 (D3) and 3 (D2).  But I haven't paid attention to my calcium intake.

    Can anyone clarify the relationship between Vid D and calcium please?

    Thank you in advance.

  • DrStrange

    4/27/2010 7:00:05 PM |

    "The relationship seems to follow a U-curve pattern, with very high levels being associated with hypervitaminosis D problems."

    Not hypervitaminosis D but rather reversal of D's benefits.  I had read that above 60 ng/ml the risk of prostate cancer increased again.  Just now searching for the study found on D council site, a recent article showing the likelihood that this outcome was because the research subjects had all gotten their higher D levels from Cod liver oil and the vitiman A in that is what reversed the benefits of D, not the high levels of D!  So seems I could well have been misinformed about that.

    http://www.vitamindcouncil.org/newsletter/vitamin-d-vitamin-a-and-cancer.shtml

  • sonny

    4/27/2010 11:32:00 PM |

    Just threw out all multivitamins in the house after hearing about vitamin A interfering with vitamin D absorption.

  • TedHutchinson

    4/28/2010 8:27:12 AM |

    @ Dr Strange
    Tuohimaa's team claiming they have found a U shaped curve for Vitamin D is based in Tampere, Finland latitude 61N
    People at that latitude with high 25(OH)D levels have experienced a greater change in level from summer to winter or if they choose to take a winter sun break will experience further re-balancing of the immune system. Vieth argues it is the length and number of periods of imbalance that drive the effects Tuohimaa reports.

    Now we have greater availability of effective strength D3 it will be easier for people at that latitude to attain and maintain the levels that enabled the Inuit to survive long winters with over 6000iu daily vitamin D3 provided from traditional diet.

    @ Tom
    Video of Heaney explaining the calcium/vitamin D story

    The Vitamin D requirement in health and disease Heaney similar information in PDF form but in greater detail.
    Bear in mind when considering Vitamin D and Calcium absorption that other co-factors work in synergy with Vitamin D.
    Magnesium is required to power the  production of the active hormone Calcitriol that lowers PTH and magnesium also counterbalances the role of calcium as magnesium is a natural calcium channel blocker.
    Each Vitamin D Receptor requires zinc.
    Also Vitamin K2 mk4 is critical for healthy bone density transporting calcium from bloodstream to bone.

  • Kent

    4/28/2010 8:13:45 PM |

    There has been at least one study done. Here's one with guinea pigs.
    http://www.springerlink.com/content/w734p41874205516/

    This is another area where common sence and experience shouldn't really require a study to initiate this course of action. Example; I saw the other day there was a "study" done on children that proved that what they saw on TV affected their actions. I'm sure many parents are glad that study "finally" came through!

  • Jason

    4/28/2010 9:40:56 PM |

    New study on grains:

    http://www.lef.org/news/LefDailyNews.htm?NewsID=9615&Section=Nutrition

    "Published research shows eating two to four serves of wholegrain foods a day can reduce the risk of heart disease by as much as 40 percent - equal to the effect of cholesterol lowering drugs,"

  • Tom

    4/29/2010 1:03:42 PM |

    To TED,

    Thank you Ted for the information.  The Heaney video was very interesting and worthwhile.  It's interesting that he says optimal D3 for calcium absorbtion is between 80 and 120 nmol.  I'm at 70 nmol and thought I was fine!
    The video is well worth watching.

    nevertheless, I'm still trying to understand how much calcium I should be taking, assuming I get my D3 to 80 or so.

    Your remarks about Magnesium, etc. are helpful.  Thank you.  But again, I struggle with how much?  

    Tom

  • Daniel

    4/30/2010 4:23:49 PM |

    Ted,
    Another explanation, this one from Cannell, for the U curve found in Scandinavia is cod liver oil.  

    People with the highest vit D levels may be consuming enormous amounts of cod liver oil and, thus, vitamin A.

    Excess retinol may thwart the action of vit D by competing for certain nuclear receptors.

  • P90X Results

    5/3/2010 9:57:44 AM |

    This is very useful information of Obesity. You can find more information about how to prevent heart diseases. I am very excited about your post, it's really amazing.

  • Tom

    5/3/2010 10:45:10 PM |

    To Ted,

    Thank you once more for this information.

    I just read that calcium has been implicated in Prostrate cancer.  have you heard anything about this?

  • Anonymous

    7/28/2010 5:01:59 PM |

    Do you know if anything helps for soft tissue injuries? I am still not fully recovered from a foot injury 5 months after the acute phase. The orthopedist expected it to take 4 weeks to heal and I'm a little concerned about how long it will take.

  • Troy @ shipping quote

    12/31/2010 5:44:10 AM |

    The above blog post is quite informative. Having good information related to bones and its requirements. I was not knowing that Vit D is so important for our bones. But good to know about that. Want to ask what are the natural resources of Vit D in our daily diet?

  • CatinaAgilar6368@hotmail.com

    1/1/2011 12:48:29 PM |

    Quite an informative blog post. I know that inadequate amount of vitamin D in diet can lead to osteoporosis, which is a brittle bone disease. But are there any side effects of excessive intake of vitamin D.

  • Nevil - same day courier

    3/22/2011 12:13:49 PM |

    Great post William, my friend is really having some bone problem, so this information will be quite useful for him. Looking forward for more post on the same topic.

  • Hal

    5/7/2011 4:11:01 PM |

    I know someone who was in a car accident that resulted in very serious fractures of one arm and wrist.  He is in his late 60's and his injuries were not healing.  

    I came to know this person about 6 months after the accident.   He was taking about 2 grams of  calcium per day thinking that this would help his bones, perhaps because the doctor told him to talk more calcium, but no supplemental  Vitamin D.   I told him that the should be taking at least 5000UI D3  per day pointing out that Walmart has 5000UI gel caps for cheap ($5 per 100 at that time) and that he was likely taking too much calcium.  He started taking more D3 although I am not sure how much since I didn't want to be pushy.  

    It has been about 9 months now since he started taking more D3 and his injuries have healed and he has had surgery to remove most of the plates and screws that had been put in place.    Was D3 the reason for this?    I don't know but I am sure that it didn't hurt either.

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Hospitals: Then and Now

Hospitals: Then and Now

2. September 2006 William Davis (0)
It's 1920. The hospital in your city is a facility run by nuns or the church. It's a place for the very ill, often without hope of meaningful treatment, but nonetheless a place where surgeries take place, babies are born, the injured and chronically ill can find care. No one has health insurance and there's no Medicare. Everyone pays what they can. The hospital is accustomed to doling out plenty of care without compensation. For that reason, they welcome donations and sometimes will build new additions or other facilities in honor of a major donor.

Volunteeers are common, since the wards are understaffed and generally suffering from a shortage of trained nurses and personnel associated with the church. Drugs, such as they are, are often prepared from basic ingredients in the hospital pharmacy. Product representatives hawking medicines and devices are virtually unheard of.

Though their therapeutic tools are limited, the physicians are a proud group, dedicating their careers to healing. The majority of the medical staff volunteer large portions of their time to care for the poor who come to the hospital with very advanced stages of disease: metastatic tumors, advanced heart failure, debilitating strokes, overwhelming septicemia, etc.

Hospitals are usually governed by a board of clergy and physicians who make decisions on how to apply their limited resources and continually seek charitable donations.


Fast forward to present day: Hospitals are high-tech, professional facilities with lots of skilled people, complicated equipment,and capable of complex procedures. While they still house people with advanced illnesses, the floors are also filled with people with much earlier phases of disease. In general, they do a good job, with quality issues scrutinized by a number of official agencies to police practices, incidence of hospital-related infections, medication errors, care protocols, etc.

The hospital of 2006 is a more more effective place than the hospital of 1920. But its aims and operations are different, also. Though some churches are still involved in hospitals, more and more are owned by publicly-traded companies that answer to shareholders--shareholders who want share value to increase. Though donations are still sought, much of the revenues are obtained by concentrating on profitable, large-ticket procedures. More procedures are often generated by advertising.

Because they operate to generate profits, several hospitals in a single city or region compete with one another. The 21st century has therefore witnessed the phenomenon of hospital-owned physicians: more and more practicing physicians are employees of their hospital. That way, the physician brings all his patients and procedures to his hospital, not to a competitor. The top of the funnel is the primary care physician, who tends to see all disease when it first occurs. The primary care physician then sends the patient to the specialist, who is obliged (by contract) to perform his/her procedure in the hsopital paying their salary.




Representatives from companies manufacturing and selling expensive hospital equipment and drugs are everywhere, falling over themselves to gain attention of the physicians using their equipment and the hospital buyers who make purchasing decisions. Millions of dollars can be transacted with just one sale.

The number of volunteers has dwindled. The poor and uninsured are commonly diverted elsewhere, often to a government-funded, and often second-rate, institution. Hospitals measure success by comparing annual revenues and numbers of major procedures.

The hospital of 2006 is a vastly different place than 1920. If you're expecting charitable treatment, compassion, and selfless care, you're in the wrong century. In 2006, the hospital is a business. You don't expect charitable treatment at Wal-Mart or from your car dealer. Don't expect it from your hospital. They are businesses and you are a customer. Recognize this fact, lose the nostalgia for the hospitals of yesterday, and a lot more will become clear to you.
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Real men don't eat carbs

Real men don't eat carbs

27. April 2011 William Davis (0)
Real men don't eat carbs. At least they don't eat them without eventually paying the price.

How do carbohydrates, especially those contained in "healthy whole grains," impair maleness? Several ways:

--Consume carbohydrates, especially the exceptional glucose-increasing amylopectin A from wheat, and visceral fat grows. Visceral fat increases estrogen levels; estrogen, in effect, opposes the masculinizing effects of testosterone. Overweight males typically have low testosterone and high estrogen, a cause for depression, emotionality, weight gain, and low libido.

--Sugar-provoking carbohydrates like wheat cause visceral fat to accumulate which, in turn, triggers prolactin to be released. Increased prolactin in a male causes growth of breasts: "man boobs,""man cans," "moobs," etc. This is why male breast reduction surgery is booming at double-digit growth rates. In cities like LA, you can see billboards advertising male breast reduction surgery.

--Carbohydrates increase visceral fat that sets the stage for postprandial abnormalities, i.e., markedly increased and persistent lipoproteins, like chylomicron remnants and VLDL particles, that impair endothelial function literally within minutes to hours of ingestion. Impaired endothelial function underlies erectile dysfunction. This is why Internet spammers so enthusiastically send you offers for discounted Viagra.

--Carbohydrates increase blood sugar which provokes the process of glycation, glucose modification of proteins, that also contributes to endothelial dysfunction followed by erectile dysfunction.

Real men therefore avoid carbs.
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Money, money, money, money

Money, money, money, money

3. October 2007 William Davis (3)
I've been asked the question numerous times:

Why aren't heart scans more popular?

First, let me qualify by saying that heart scan have indeed grown in popularity over the past decade. I think the real question is:

Given the enormous usefulness of CT heart scanning to detect hidden, asymptomatic coronary atherosclerotic plaque, why haven't they more readily been incorporated into conventional medical practice?

That's easy: There's no money in it.


Say, for instance, your doctor orders a heart scan and somehow receives a $1000 for the test. Scan centers would be scanning 100 people a day, falling over themselves to do scans.

This would be similar to a heart catheterization. Order a catheterization, do 30 minutes of work, and get $1000. Or, order a nuclear stress test. Depending on how its done and where, $1800-4000 is paid by the insurer.

Order a CT heart scan and how much is paid to the doctor? Usually nothing. At most, a nominal fee might be paid if the doctor reads the scan.

With heart scans, there simply is no big payoff.

We learned the implications of this situation 10 years ago when I was trying to help my friend, Steve Burlingame, the owner of Milwaukee Heart Scan. (I am NOT and NEVER WAS an owner.) Steve was trying to let everybody know about this great new $2 million dollar heart scan device in the Milwaukee area.

The first few years were tough for Steve: Carrying the substantial expense of this device while doctors essentially gave the technology the cold shoulder. It simply did not fit into the financial equation. Why change the way things were, particularly when there was virtually no financial reason to do so? To counter this, Milwaukee Heart Scan followed the model many other scan centers have followed and marketed directly to the public.

I see this as yet another example of why people need to take control of health care away from doctors and hospitals, the current controllers of the system who are providing a disservice to the public they are supposed to be serving. These institutions, for the most part, serve their self-serving financial interests, not your health interests. It's the same equation that drives food manufacturers to make more and more processed carbohydrate foods that they sell for substantial markups, not green peppers and cucumbers that make little money.

I regard heart scans as among the greatest self-empowering tools in health ever conceived. It was that way in 1997; it remains that way in 2007.
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Comments (3) -

  • Anonymous

    10/3/2007 5:41:00 PM |

    I personally get the word out on how heart scans are superior to regular cholesterol testing in predicting future heart health to family and friends.  Honestly many times I'm greeted with skepticism, "if a CT scan is so great, why hasn't my doctor recommended one?"  When that happens, your blogs are a wonderful tool to me in convincing them of there importance.    

    Many place doctors on a very high pedestal, too high I believe, and so in this case I find it bad that doctors do not make money on CT heart scans.  I do not have anything against people making money in an honest manor and if it takes some cash to change a few more healthy care providers’ ways on heart scanning, I'm in favor of it.

  • JoeEO

    10/3/2007 7:41:00 PM |

    Dr Davis,
    You are creating an "Army of Davids"! The phrase is from a book written by Glenn Reynolds (aka Instapundit.com ). The premise of the book is that "a society that's rich and free will have citizens who-entirely on their own-develop a wide range of skills."

    That is what we are doing here (and at Trackyourplaque.com) we are learning to manage and diagnose and treat our various lipid profiles and tracking our levels of coronary artery disease (plaque).

    I think I mentioned this in a post on typ's member forum, but I still can't understand why every person in the US who is taking a statin is not also taking niacin. If the your sites didn't exist I doubt I would have found out about the HATs study until I had a coronary event (if then)

    Now I am empowered (it is a little scary!) and have the ability to find out detailed information about my condition and the ways I can address that condition thanks to you Dr Davis!


    We live in amazing times...


    Peace

    Joe E O
    P.S. Here the whole title from Amazon.com:
    An Army of Davids: How Markets and Technology Empower Ordinary People to Beat Big Media, Big Government, and Other Goliaths (Hardcover)
    by Glenn Reynolds (Author)

  • Dr. Davis

    10/3/2007 8:30:00 PM |

    Thanks, Joe. It is an exciting time for immense change.

    Would you recommend Reynolds' book?

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Take a walking vacation

Take a walking vacation

20. May 2006 William Davis (1)
If you're planning a vacation, why not consider a walking vacation?

The concept is really taking off. All you need is a pair of comfortable shoes and an interesting locale. More and more services are popping up to help you plan fun and interesting destinations and itineraries. One such catalog can be found at http://walking.about.com/od/tours/a/walkingvacation_3.htm

Lengthier walks may require some advance planning and toting some supplies. Don't forget the water!

From a health viewpoint, a walking vacation sure beats the heck out of a cruise that packs on 12 pounds of extra weight from the 24-hour a day buffet. If you're in the midst of a weight loss effort, several hours of walking through interesting locales and scenery can make it effortless.

There's loads of neat places to visit from a walker's perspective. One interesting website is www.waterfallwalks.com that lists trails that provide spectacular views of waterfalls.

Another variation on this theme is biking vacations. My wife and I are trying to set the time aside for a biking tour of wineries in the French countryside. That's our kind of multi-tasking!
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  • Physical Therapy Supplies

    6/14/2011 5:47:58 AM |

    A walking vacation. I loved it! I ask people to stay in touch and share their story with me when they reach their final destination. Plan your walk spontaneously or consult a tour company who will book hotels ahead of time, arm you with a map, and lighten your load by transporting your bags to the next destination.

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Optimal medical therapy

Optimal medical therapy

9. April 2007 William Davis (6)
I was re-reading some of the details behind the recently announced COURAGE Trial comparing angioplasty/stent in 1100 people compared to "optimal" medical therapy in another 1100. You'll recall that no difference was found.

In particular, over approximately 5 years, 20% of participants in each group died, experienced heart attacks, or strokes. Of those treated with "timal" medical therapy, 32% ended up getting a procedure like stents or bypass anyway due to deteriorating symptoms.

What is "optimal" medical therapy? I bring this up again because the study investigators in COURAGE, as well as in similar trials, say this with a straight face. Optimal medical therapy means aspirin and/or Plavix (the anti-platelet, aspirin-like blood thinner); "aggressive" statin drug therapy to reduce LDL cholesterol to 60-85 mg/dl; and "anti-ischemic" therapy (that reduces angina and the phenomena of poor coronary blood flow) using nitroglycerin preparations, beta blockers, and other drugs.

I do give credit to the investigators for having the courage to perform this trial in a world hell bent on doing procedures and still reporting the neutral outcome. But the notion of "optimal" medical therapy begs for comment.

Indeed, this is regarded as optimal by most practitioners. Some would even argue excessive, based on the low LDL target achieved. Would you be satisfied with a 20% likelihood of heart attack, stroke, or death or 5 years, a 1 in 5 roll of the dice? I would not. Recall that we aim for near-total elimination of risk.

What could have been further "optimized"? Plenty. For instance:

--What is the real LDL, not the fabricated, calculated LDL? The two can be commonly 100 mg/dl different.

--How about raising HDL to 60 mgd/?

--What about reducing the proportion of small LDL particles? After all, small LDL is the number one cause of heart disease in the U.S., not high LDL.

--What is Lp(a)? If you treat LDL with a statin drug, Lp(a) is unaffected and continues to trigger huge plaque growth. You will fail if this is not identified and corrected.

--What is vitamin D3? One of the most powerful facilitators of plaque reversal I know of.

--What are triglycerides? Triglycerides create hidden particles in the blood like intermediate-density lipoprotein, potent triggers for coronary plaque growth. Speaking of intermediate-density lipoprotein, that's another very important pattern to identify, the after-eating persistence of dietary fats.

--Why aren't they taking fish oil? With a 28% reduction in heart attack and 45% reduction in sudden death from heart attack, this alone would have halved the number of "events" in the "optimal" medical treatment group.

Of course, there's more. But the idea that aspirin, statins, and anti-ischemic therapy is somehow optimal is silly and sad at the same time. But that's the bias. The COURAGE Trial does represent a step forward, a step away from the "stent everyone and everything" mentality that motivates my colleagues, aided and abetted by their co-conspirators, the hospitals. But you and I know better. "Optimal" medical therapy, in truth, can mean a far better approach that can dramatically reduce, perhaps eliminate, risks for events like heart attack. The conventional "optimal" medical therapy will suffice only if you're content with a 20% likelihood of heart attack, death or stroke, or a 32% likelihood of an urgent procedure in your future.
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Comments (6) -

  • David

    4/9/2007 8:54:00 PM |

    A year ago I had what was termed  a "minor cardiac incident". An angioplasty procedure identified 95% blockage in one coronary artery (at the back of the heart), and another 35% blockage in another coronary artery. A stent was implanted in the back artery.
    Your observations on the COURAGE Trial has caused me to question my treatment decision. Does 95% blockage in one coronary artery represent a necessary condition for stenting, as opposed to say, following clogging prevention therapy and a diet regimen that includes fish oil and D3?
    There must be a certain point in plaque conditions beyond which intrusive treatment (ie a stent) is considered essential to survival.

    I appreciate your blog. It's provided lots of valuable informtion.

  • Dr. Davis

    4/10/2007 12:57:00 AM |

    David--

    The fact that you had what you called "a minor cardiac incident" might suggest that you did not fit into the criteria of the people who were entered in the COURAGE Trial, who had stable symptoms. I suspect that your "incident" means that you released "cardiac enzymes" into the blood, meaning that your artery may have closed momentarily. This is an entirely different situation, a blood clot driven event that is different than the disease we focus on with heart scanning (and reversal) and the COURAGE Trial.

    Nonethleless, now is the time to 1) identify your causes, and 2) correct them, so that it doesn't happen again. With conventional therapy, it will.

  • warren

    4/11/2007 1:46:00 AM |

    I have often wondered the same thing as david - I had what was described as a 95% blockage in the right coronary artery.  For me, what got me in to the doctor was shortness of breath while playing my regular racquetball partner or hiking uphill strenuously.  The rest of the time, I had no symptoms.  If I am correct, these were stable symptoms, right?  But in my case, the symptoms were interfering with my ability to exercise the way I want to exercise.  That was a few months ago, and I am back to my routine and symptom-free for now (and also following the Track Your Plaque program).

    I was given the choice, but the momentum of the system's bias pushed me forward toward having the stent put in.  Before going in for the angioplasty, I asked a lot of questions.  I never really asked if the procedure was necessary or would save my life - that was just assumed.  The questions and answers all revolved around what would happen if I needed a stent or an operation, the different types of stents, the concerns about re-clogging, and references to treating any blockages that were not stented afterward with medication.  

    Everything happened in one day - from the stress test to the angioplasty to the stent.  It was all quite dramatic and all the professionals were very concerned, and the sense I got was that this procedure was necessary to save my life and prevent the artery from closing up completely.  But when I look back, I realize that nobody ever really came right out and said so.  It was just assumed and implied.

    Dr. Davis, how do you feel about implanting stents in cases like mine, where the primary benefit is relief of stable symptoms?

  • Dr. Davis

    4/11/2007 12:08:00 PM |

    Hi, Warren--

    There are some issues here which allow me to comment only superficially on your situation, e.g., the actual appearance of your "blockage," over what period of time your symptoms developed, its pattern, etc.

    However, I will say that stenting is a superior way to obtain immediate relief of symptoms. That is probably the only substantial difference.

    As COURAGE showed and many of us suspected, stenting only prevents heart attacks as they occur, or are about to occur. Stable plaques without blood clot-promoting activity can usually be managed "medically." I have to give credit to the investigators in COURAGE for using the lame tools they did in the "optimal medical therapy" arm and sticking to it. Personally, their brand of optimal medical therapy really makes me nervous because of its obvious and glaring inadequacies.

    Look on the bright side: Following the Track Your Plaque program makes another stent highly unlikely.

  • David

    4/16/2007 10:59:00 AM |

    In your reply to warren, you say "Stable plaques without blood clot-promoting activity ....". I'd appreciate your elaborating on what activity this refers to? From your blog, you've clearly provided valuable information on activity that promotes unhealthy plaque buildup, but "clog-promoting activity" is less clear (at least to me). TIA

  • Dr. Davis

    4/16/2007 12:53:00 PM |

    David-
    As lame as it seems, the decision about how actively a specific plaque is triggering blood clots is usually made by 1) the pattern of symptoms, with increasing or easy to provoke symptoms more likely to mean more blood clot-prone, and 2) the appearance of the plaque surface at time of angiogram. Occasionally, it can be made with examination of the plaque with intracoronary ultrasound.

    Unfortunately, these are observations that generally require your cardiologist's judgement. I am a big fan of providing people with tools for self-empowerment, but this is not something you can decide for yourself. Hopefully, you do it with the assistance of a trustworthy cardiologist.

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Apple Cranberry Crumble

Apple Cranberry Crumble

18. November 2012 William Davis (0)
Apple, cranberry, and cinnamon: the perfect combination of tastes and scents for winter holidays!

I took a bit of carbohydrate liberties with this recipe. The entire recipe yields a delicious cheesecake-like crumble with 59 “net” grams carbohydrates (total carbs – fiber); divided among 10 slices, that’s 5.9 grams net carbs per serving, a quantity most tolerate just fine. (To reduce carbohydrates, the molasses in the crumble is optional, reducing total carbohydrate by 11 grams.)

Other good choices for sweeteners include liquid stevia, stevia glycerite, powdered stevia (pure or inulin-based, not maltodextrin-based), Truvía, Swerve, and erythritol. And always taste your batter to test sweetness, since sweeteners vary in sweetness from brand to brand and your individual sensitivity to sweetness depends on how long you’ve been wheat-free. (The longer you’ve been wheat-free, the less sweetness you desire.)


Crust and crumble topping
3 cups almond meal
1 stick (8 tablespoons) butter, softened
1 cup xylitol (or other sweetener equivalent to 1 cup sugar)
1½ teaspoons ground cinnamon
1 tablespoon molasses
1½ teaspoons vanilla extract
Dash sea salt

Filling
16 ounces cream cheese, softened
2 large eggs
½ cup xylitol (or other sweetener equivalent to ½ cup sugar)
1 Granny Smith apple (or other variety)
1 teaspoon ground cinnamon
1 cup fresh cranberries

Preheat oven to 350° F.

In large bowl, combine almond meal, butter, sweetener, cinnamon, molasses, vanilla, and salt and mix.

Grease a 9½-inch tart or pie pan. Using approximately 1 cup of the almond meal mixture, form a thin bottom crust with your hands or spoon.

In another bowl, combine cream cheese, eggs, and sweetener and mix with spoon or mixer at low-speed. Pour into tart or pie pan.

Core apple and slice into very thin sections. Arrange in circles around the edge of the cream cheese mixture, working inwards. Distribute cranberries over top, then sprinkle cinnamon over entire mixture.

Gently layer remaining almond meal crumble evenly over top. Bake for 30 minutes or until topping lightly browned.
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What would life be like . . . ?

What would life be like . . . ?

29. July 2009 William Davis (16)
What if coronary heart disease could be prevented--no eliminated--applying methods that were accessible, easy, and cheap?

What if coronary heart disease and, thereby, angina, heart attack, sudden cardiac death, ventricular tachycardia, heart failure, and the cerebrovascular equivalent, stroke, could be eliminated using readily available tools available to virtually everyone in the U.S.? And, over a year, it cost less than a once-a-week latte at Starbucks?

How would the healthcare landscape change? What would become of hospitals, manufacturers of the billions of dollars of hospital equipment necessary to supply the cardiovascular hospital industry (e.g., stent manufacturers, catheter manufacturers, defibrillator and pacemaker manufacturers, pharmaceutical manufacturers who no longer have to produce the volume of antiplatelet agents, inotropic drugs, antiarrhythmic agents, etc.)?

How would our lives change? What would the end of life look like if people stopped dying of heart attack, sudden cardiac death, congestive heart failure at age 55, 65, or 75, but lived out their lives to die of something unrelated?

What if the solution had little or nothing to do with drugs but evolved from simple nutritional strategies, supplements meant to correct the deficiencies that accompany modern lifestyles, and a few unique strategies targeted towards the genetic predispositions that lead to heart disease?

What if all this were possible at a cost of a few hundred dollars per year?

It would certainly be a cataclysmic change. Hospitals would shrink to a small remnant of their current gargantuan, dozens-per-city presence. The need for hospital staff would be slashed by over half. The rare cardiologist would tend to congenital heart disease sufferers and other unusual forms of heart disease and he or she might have a colleague or two in all of a major city.

Healthcare costs would plummet, no longer having to sustain the enormous cardiovascular healthcare machine of hospitals, staff, industry, and long-term care. Health insurance, private or public, would drop by 50%.

It would free up nearly a trillion dollars that could be redirected towards other pursuits, like schools and research. Extraordinary leaps forward in quality of life and science would emerge, given that magnitude of funding.

It's not as grand a thought experiment as Alan Weisman's The World Without Us, in which he imagines what the world would be like without humans altogether.

How long would it take to recover lost ground and restore Eden to the way it must have gleamed and smelled the day before Adam, or Homo habilis, appeared? Could nature ever obliterate all our traces? How would it undo our monumental cities and public works, and reduce our myriad plastics and toxic synthetics back to benign, basic elements?

But I believe this thought experiment--what would life be like without heart disease because it was eliminated using inexpensive tools-- is more plausible, more likely to occur. In fact, it has already begun to occur.

See those vines growing up the side of the hospital?
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Comments (16) -

  • Jenny

    7/29/2009 12:39:12 PM |

    What would life be like without CVD deaths?

    For a while, the way you describe. But as more people lived into their 80s and 90s the rate of dementia would rise dramatically.

    If you visit any dementia facility you will find it is full of normal weight people many of whom are in otherwise "excellent" health--that's what got them to live to 88 or 92.

    But once demented, their lives are tragic. Saddest are those who are just demented enough to be totally confused, but not enough that they are oblivious to their condition. All people with moderate dementia  need round the clock care which is not covered by Medicare unless they have no assets. This depletes the savings of humble people who have worked for decades who are left with nothing to leave their children.  Depending on the cause of their dementia people may need full time care for a decade. Once they have no money they are turned over to the warehousing of nursing homes, many of which are horrendous  where those who are still conscious may pray daily for death.

    Right now one half of those in the 80-100 age group are demented. The humiliation  dementia inflicts on loved ones is so terrible that anyone who has a relative in this condition (and we have two in our family) will pray that they have enough heart disease to take them out before they go through that long, slow degrading decline.

    Many people have unrealistic ideas that they could take care of a loved one with dementia which stem from not having been put face to face with it since the truly demented are usually locked away somewhere.

    Note too that though there are attempts to blame dementia on diabetes, I don't buy it. The rate of dementia has climbed with the climb in lifespan though "senile dementia" has always been the fat of a good portion of those who lived to be old-old.

    The diabetes diagnosed late in life is part of the gradual failing of their organs and often not the same as diabetes diagnosed in the 40s. It may be associated with dementia but it is far from proven that it is causative.

    Beside that, eliminate CVD and the rate of people dying from the prolonged agony of cancer would go up too, because the older people get the more likely they are to develop cancers. Something many people don't know is that chemotherapy administered to older people id prone to cause dementia. It causes mild cognitive problems  in younger people too, but in the old-old it is much more likely to take out their memories.

    I'm all for eliminating the kind of CVD that takes people out young, especially since it is so often linked to genetic abnormalities.  But for those in their 70s and beyond, eliminating CVD might simply be to trade one condition for another far worse.

    No one lives forever.

  • Lucy

    7/29/2009 1:21:40 PM |

    It sure doesn't seem like that will happen anytime soon, at least not here... I spent all day calling around to local docs (including cardiologists) and NO ONE had even heard of advanced lipid testing...  I'm ashamed to say that I work for a large hospital system that wants to be "cutting edge" and all about research yet they have no knowledge of basic preventative care in regards to the leading cause of death in our country?!!

    Is advanced lipid testing really that advanced?

  • JPB

    7/29/2009 3:25:12 PM |

    That is part of my dream, too. But first, people have to have access to correct information, stop being so passive with medical professionals  and then take an active role in establishing and maintaining their own heath.  The real "health" care reform would do everything that you say but would come directly from the people who are receiving so-called medical "care."

    Of course, the vested interests will fight this tooth and nail but it would be tough to stop if our population would finally wake up to the way they are being manipulated!

  • Dr. William Davis

    7/29/2009 4:26:06 PM |

    Hi, Jenny--

    Thanks for your thoughts.

    But I would rather succumb to dementia at age 90 (that I helped delay with vitamin D and other mental-preservation methods) than heart attack at age 59, bypass at age 60, three stents at 63, four more at age 68, living a life of hospital revolving doors. Don't forget about the defibrillator that aborts the ventricular tachycardia that comes from the scar in your left myocardium from the original heart attack.

    Millions of people live this way and have not been told that it doesn't have to be this way. That's what I'm talking about.

  • Dr. William Davis

    7/29/2009 4:28:29 PM |

    Lucy--

    NOT having advanced lipid testing impairs the identification of the causes of heart disease. It is a big step towards better control over heart disease risk. It identifies treatments that often have nothing to do with more need for medication--that's why your doctors don't know about it.

    You probably already know that the bulk of medical "education" does not come from journals or scientific publications, but from the pretty drug representative with dinner invitation in hand waiting in the doctor's waiting room.

  • Anne

    7/29/2009 4:36:15 PM |

    Dear Dr Davis,

    Your mention of congenital heart disease sufferers made me wonder if you could possibly write a blog about how people with congenital heart disease can improve their heart health please.

    Anne

  • Helena

    7/29/2009 5:51:55 PM |

    Dr. Davis

    I am with you! And to be honest – it is actually horrible WRONG that we are not yet there. We (or at least many people) already know how to escape the dreadful C V and D. Why it is not already implemented in every hospital, doctors’ office, and even in education is scary! But most of it has got to do with a short-term money flow, I would guess.

    As boldly as I think we can put most cardiologists out of business I also believe we can eliminate many cancer diseases by natural remedies!

    No one has to believe me, but sometimes we are to do ourselves a favor and listen to those who have the degrees to say and act upon statements. What about these well selected and bold statements:

    John P. Cook M.D. Ph.D. in his book “The Cardiovascular Cure – How to strengthen your self defense against heart attack and stroke” In his book you can read this: “There is magic within all of us. It comes in the shape of a molecule known as nitric oxide.  A substance so powerful that it can actually protect you from heart attack and stroke.  Best of all your body can make it on its own.  Nitric oxide is your body’s best defense against heart disease.  The body is capable of healing itself.  What you do with the magic is up to you.”

    Dr. Louis J. Ignarro; Nobel Prize Laureate in Medicine, 1998; “NO more heart disease – How Nitric Oxide can prevent, even reverse, heart disease and stroke” and you can read this in the book: "You do not have to wait for the rest of the world to see the light--and the drug companies to put new Nitric Oxide-based prescription drugs on the market--in order to take advantage of what Nitric Oxide has to offer.  Even if you have high blood pressure, have suffered a heart attack, or are at high risk...You can beat the odds.  The power to lead an entirely new and healthier life is in your hands.  Carpe Diem--Seize the day!  Start boosting your Nitric Oxide production right now!“

    Dr. Jonathan S. Stamler; Professor of Medicine; Duke University Medical Center - "It [Nitric Oxide] does everything, everywhere. You cannot name a major cellular response or physiological effect in which [Nitric Oxide] is not implicated today. It's involved in complex behavioral changes in the brain, airway relaxation, beating of the heart, dilation of blood vessels, regulation of intestinal movement, function of blood cells, the immune system, even how fingers and arms move.“
            
    What these gentlemen are talking about is Arginine (arginine transforms into Nitric Oxide once in your body). And Arginine has also been found to: “Improve Memory & Cognitive Functions” (J Physiol Pharmacol 1999), and “May inhibit the division and proliferation of cancer cells” (Br J Surg. 1997)

    The list goes on and on… Arginine 5gr or more a day along with Citruline and antioxidants on a daily regularly basis can do all these things and we can at the same time fight cancer and dementia! It is all out there in the nature for us to use!!!

    Thanks again for a wonderful blog – if anyone is interested in learning about different product options they can email me (don’t want to advertise anything here – this is about people, not money) Helena.mathis@hotmail.com.

  • Helena

    7/29/2009 5:52:31 PM |

    Dr. Davis

    I am with you! And to be honest – it is actually horrible WRONG that we are not yet there. We (or at least many people) already know how to escape the dreadful C V and D. Why it is not already implemented in every hospital, doctors’ office, and even in education is scary! But most of it has got to do with a short-term money flow, I would guess.

    As boldly as I think we can put most cardiologists out of business I also believe we can eliminate many cancer diseases by natural remedies!

    No one has to believe me, but sometimes we are to do ourselves a favor and listen to those who have the degrees to say and act upon statements. What about these well selected and bold statements:

    John P. Cook M.D. Ph.D. in his book “The Cardiovascular Cure – How to strengthen your self defense against heart attack and stroke” In his book you can read this: “There is magic within all of us. It comes in the shape of a molecule known as nitric oxide.  A substance so powerful that it can actually protect you from heart attack and stroke.  Best of all your body can make it on its own.  Nitric oxide is your body’s best defense against heart disease.  The body is capable of healing itself.  What you do with the magic is up to you.”

    Dr. Louis J. Ignarro; Nobel Prize Laureate in Medicine, 1998; “NO more heart disease – How Nitric Oxide can prevent, even reverse, heart disease and stroke” and you can read this in the book: "You do not have to wait for the rest of the world to see the light--and the drug companies to put new Nitric Oxide-based prescription drugs on the market--in order to take advantage of what Nitric Oxide has to offer.  Even if you have high blood pressure, have suffered a heart attack, or are at high risk...You can beat the odds.  The power to lead an entirely new and healthier life is in your hands.  Carpe Diem--Seize the day!  Start boosting your Nitric Oxide production right now!“

    Dr. Jonathan S. Stamler; Professor of Medicine; Duke University Medical Center - "It [Nitric Oxide] does everything, everywhere. You cannot name a major cellular response or physiological effect in which [Nitric Oxide] is not implicated today. It's involved in complex behavioral changes in the brain, airway relaxation, beating of the heart, dilation of blood vessels, regulation of intestinal movement, function of blood cells, the immune system, even how fingers and arms move.“
            
    What these gentlemen are talking about is Arginine (arginine transforms into Nitric Oxide once in your body). And Arginine has also been found to: “Improve Memory & Cognitive Functions” (J Physiol Pharmacol 1999), and “May inhibit the division and proliferation of cancer cells” (Br J Surg. 1997)

    The list goes on and on… Arginine 5gr or more a day along with Citruline and antioxidants on a daily regularly basis can do all these things and we can at the same time fight cancer and dementia! It is all out there in the nature for us to use!!!

    Thanks again for a wonderful blog – if anyone is interested in learning about different product options they can email me (don’t want to advertise anything here – this is about people, not money) Helena.mathis@hotmail.com.

  • Tom

    7/29/2009 5:57:35 PM |

    Alzheimer's and heart disease are thought to be connected -- they may both be the result of arterosclerosis.

    So a world with fewer CHD victims might not be a world with more dementia patients.

  • trinkwasser

    7/29/2009 6:41:32 PM |

    Yes I see both your points. I strongly suspect I am going to die significantly younger than others in my family thanks to the clueless doctors who decided not to diagnose my diabetes, and worse, put me on a high carb low fat diet to "cure" my appalling lipids.

    On the one hand going quick of a heart attack while in my prime would be far preferable to what happened to one of my mother's friends: after a quad bypass she gradually declined from being a fit active sociable person to someone who was blind, deaf and incapable but whose heart would NOT stop and give her the release she prayed for. Once you get into that state they can warehouse you for years.

  • Roger

    7/30/2009 3:10:19 AM |

    My mom was one who met Jenny's tragic fate.  She did Pritikin and McDougall for years, decades actually.  Though she was a lawyer, played piano and read constantly, Alzheimer's (or a similar dementia) overtook her in her 70s.  She spent several years with caregivers in her home, and then six long years in a deluxe nursing home, burning up all the assets she had saved her entire life.  All we could do was watch.

    I believe the low-fat diet she followed wasn't what her brain needed.  She was probably chronically starved for EFAs, especially Omega-3.  But we didn't know what we know now, so we couldn't help.  Of course, I can't know for sure this was the causative factor...maybe this is just my defense mechanism.  But I think Dr. Davis's point is that addressing CVD in no way excludes also addressing dementia.  There's tons of exciting research being done.  Plenty of folks make it to the very end with all their faculties intact.  Why?

  • Tara

    7/30/2009 3:15:35 PM |

    Dr. Davis,

    What is your opinion on genetic testing and it's potential effect on the treatment of both CVD and (since it's been mentioned in this discussion) dementia?   I know both my ApoE and KIF6, and find it all very fascinating.  I am a 4/3 and a noncarrier for the risky form of KIF6.  I do think there are some potential ethical concerns with genetic testing, but I do see benefits as well.  For instance, supposedly my KIF6 result means that I would likely not benefit from a statin.  So, it's extra leverage in my mind when discussing treatment options with my cardiologist.

  • trinkwasser

    7/30/2009 3:29:34 PM |

    "I believe the low-fat diet she followed wasn't what her brain needed. She was probably chronically starved for EFAs, especially Omega-3"

    My God, that's an excellent point! Nursing home/hospital food is almost always high carb low fat (and cheap)

  • Miki Ben Dor

    7/30/2009 9:41:55 PM |

    Dr. Davis
    From what I have learned here and in other like minded blogs (Eads, Stephan, Hyperlipid, BG and others)it seem that the whole metabolic syndrome can be prevented + autoimmune diseases and probably many cancers. This has the potential of really emptying out the hospitals and leaving maily the preventative medicine heroes like yourself and Eads in the front where you belong
    I have recently started a blog in Israel, translating to Hebrew some of your (and  the other's) posts. The spreading of ideas resemble sometimes the spread of epidemics. It picks up suddenly so lets be optimistic!
    keep up the good work!
    Miki Ben Dor http//

  • DIB

    8/6/2009 4:31:53 AM |

    Dr. Davis,

    Life without CVD is not something that can be dreamed about, but rather something that existed in the recent past.  I have heard stories from MD's who served in the US military during the Korean and Vietnamese wars, and while over there, and in Japan, during those years, were asked by local doctors to call them when the military MD was treating a patient (usually American) for a heart attack or having a heart problem, because they had never or very infrequently seen those kinds of problems in their practices, and wanted to see what it was all about.  So, some parts of the world escaped CVD problems already!

    DIB

  • Dr. William Davis

    8/6/2009 12:18:28 PM |

    Hi, DIB--

    Excellent point!

    I agree: Many lessons are being RE-learned.

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