Yup.  "Hammers and nails"!

I am 65 years old.  I had a stent inserted in the "widow-maker" artery (80% blockage) a year ago.  I had passed out a couple of times (heart rate dangerously low - 30s).  I rode to the hospital in an ambulance.  Tests revealed short LBBB episodes; mild mitral regurgitation, mild tricuspid regurgitation. Catherization showed 3 vessel CAD. I was told that a medicated stent was absolutely necessary given the situation; regardless, I have to accept that.   A pacemaker was installed to prevent bradycardia and keeps heart rate from dropping below 60.   I have 20% L distal main blockage and 90% lesion of the high first obtuse marginal at the takeoff.  The right coronary had 60% posterior lateral branch stenosis.  

Since then I have reduced TG from 360 to 60,  LDL from 89 to 82 (although a few months ago it was in the mid-70s), and increased HDL from 30 to 46.  I went from 365lbs to 190lbs and hope to eventually get to 180lb this Spring.  I did it by progressing from walking to trotting (slow run) and dietstyle changes (low-GI veggies, fruits, etc.) .

On a recent visit the cardiologist said the the LDL needs to be 70 or below to "freeze" the 90% blockage and gave me a prescription for Lipitor.  I asked if there were alternatives, like diet, supplements, etc.  He admitted that he did not know about those alternative but did know Lipitor.   When the only tool you have is a hammer then everything is a nail.  I understand that the 90% blockage is important but will not take the Lipitor to achieve the 12 points reduction.  Seems like an overkill.  

I asked him if there was a way to evaluate my current condition.  I was told there was no way.  Basically, if I have no symptoms, good.  If I have symptoms then it will have to be evaluated.  Death could be the only symptom.   I swear he was about to say bypass surgery ($$$$$$!) was inevitable.  Something is wrong with this "fly-in-the-fog-and-hope-you-don't- hit-a-mountain" approach. Hope is not a strategy!

I am confident that I can reduce LDL to below 70 based on eliminating wheat-products in my diet plus increasing oat bran in my diet.  I also take fish oil daily (EPA/DHA-2g).  I am looking for a new cardiologist.  I just recently purchased your book and find it very instructive.  In the meantime I have an appointment with my primary care physician to discuss implementing the Track Your Plaque program.  I realize that the one stent will skew the scan numbers but can be used as a baseline number.

Anyway, onward . . .

As an ancient engineer, I often use your aphorism.
Your publicly expressed viewpoint must earn a lot of criticism from your colleagues, and undoubtedly there have been financial and other sacrifices on your part.
I would like to offer heart felt appreciation for what you do.
I assume that many colleagues share your point of view. Are there others who have the 'cojones' to speak out?  Is there any degree of cooperation?

I would like to know something of your perspective on potential solutions for cardiology in particular, and healthcare in general. In fact, on the whole "medical-pharmaceutical-insurance-government complex" (to paraphrase the warnings of Dwight Eisenhower).
I grew up under British socialized medicine, and while the delivery to the people is more even, it is not a  solution. Do you foresee some kind of compromise as workable? Should the solution be patient driven? Business driven? Govt. driven?
I recall that in the UK, doctors and the system tend to be viewed as almost god like in their authority, although a few individual Dr. rebels such as. Malcolm Kendrick come to mind.

Yes, I know. This is far too big a topic for your blog, but with the elections coming up, my curiosity just got the better of me!
Note: I promise not to ask any more difficult questions until next Feruary 29!
MikeV

I'd like to echo the comment by Mike V.  The current health care situation in the US is so "unsustainable", to borrow an agricultural phrase, yet having a good view of the UK's NHS (I have English in-laws) doesn't inspire me to wish all of that on myself or the US public, either.  My in-laws in Norway seem to have it better in many ways, but I see some dangerous aspects creeping in over there, too.  We need better options for our nations's healthcare, but I only seem to hear about how well our current system works (for some people) with all the costly high-tech procedures and diagnostics or else warmed-over versions of the UK and Canadian systems, which has some serious flaws, too.

I want healthcare that takes prevention and health promotion into account, not just "disease care" that catches disease "just in time".  I don't want "checkbook science" or "concensus science" dictating what options I have or what information is available to me.  I don't want a "nanny" nor do I want my care determined by healthcare industry lobbyists.  

There must be something better, that does a better job of balancing promotion of good health with treatment of disease, with balancing good intentions without nannyism, with balancing  access to care without over treatment.  We need a system that allows medical personnel to make the best decisions for each individual patient, with a better way of managing the associated costs and compensation for all participants.   It is very hard for physicians to "buck the trends" these days.

As an insider with an insightful view from the trenches of the healthcare industry, I'd love to read more of your thoughts on these issues in future posts, Dr. Davis (your busy schedule allowing, of course).  How can we reform healthcare without pushing the pendulum too far into another harmful direction, in a way that it beneficial to all - patients, medical personnel, medical institutions, medical research, etc?

And then, how do we make it happen?

Webmaster, I love your site. Thank you sooo much for working on it.

Do you happen to know if there's anything to adult stem cells & heart disease? My take so far has been that they do not work in a stem cell way (bona fide regeneration) and any benefits can be attributed to local secretion of growth factors or other molecules.

Absolutely incredible!  Good for them!

In Nov 2007 my lab tests showed blood calcium too high. Further tests showed parathyroid hormone too high. I had ultra sound and various scans ordered by the endo. In June 2008 I had one parathyroid gland removed. During this time my Vit D was 25 and 27. The endo was not concerned because "it was winter". I talked my PCP into OKing 1000 iu of Vit D but she said she had never seen the supplement increase the Vit D levels in any of her patients. No advice re D2 vs D3 or tablets vs get caps. Following your advice I am taking 1000 iu D3 gel caps. After some months I increased it to 2000 iu. Of course, I am wondering if the low Vit D might have had some bad affect on the parathyroid. Also I would like to know how much Vit D3 I should be taking but don't have a doc who seems knowledgeable. Any suggestions?

BettyB

Bettyb,

Doctor Davis doesn't often have time to answer questions posted at his blog. If you really want to know about how much vitamin D to take and how to get tested, you can learn more at the Vitamin D Council:

www.vitamindcouncil.org

Congratulations on your magnificent article "Halt on Salt Sparks Iodine Deficiency" for
October's Life Extension Magazine.  It should be required reading for all Doctors.  
Iodine is looking like the last piece of the puzzle for me reaching 60/60/60 without statins.  Thanks
for fighting the hard fight.

Matt W.

I have heard that excitement is a risk for heart patients. But this funny Cartoon says it excitment can kill anybody. See this cartoon

Thought I'd share this article from the UK about Vitamin D. I remain shocked some in the medical profession (or should that be industry) still do not understand the importance of D3 for children, and of course adults.

http://www.telegraph.co.uk/health/children_shealth/3350394/Why-vitamin-D-is-so-vital.html

I was very interested to read this post because I too have a congenital heart defect (not nearly as bad as this boy) which has led to aortic valve stenosis and I've been keen to know how much vitamin D might help with this since 2007 when I first started following Dr Davis' blog.

I live in the UK and I'm lucky that I have both a good cardiologist and good endocrinologist. My endocrinologist is keen for me to supplement with vitamin D3, both for my heart and for osteoporosis, which I also have, and I get regular 25(OH)D tests. I take 2,000 IU of D3 gelcaps per day and my level of 25(OH)D varies between 125 nmol/L (50 ng/dl) and 250 nmol/L (100 ng/dl), once rising as high as 384 nmol/L (154 ng/dl) so it's lucky a close eye is kept on these levels so my dosage of D3 can be adjusted. Lab error was thought, but every time the 25(OH)D has risen too high my alkaline phosphatase levels (bone specific) have also risen above normal, and every time the 25(OH)D is lower they are in the normal range.

My cardiologist is also supportive of the D3 as well as supportive of me using omega-3 fish oil and he prescribes it for me since it works out cheaper on prescription here in the UK than it does from a health food store.

The pressure gradient across my heart is increasing gradually and I will need an aortic valve replacement at some point...but who knows, things might have got worse faster without the D and the fish oils.

Anne

Bettyb,
I started on 1000iu of vitmain D3 then upped it to 2000, 5000 and 10000iu per day. At this dose my vitamin D results had achieved the magic 50 level. It is now six months since being on 10000iu and I am feeling fine. No side effects that I am aware of.

It's no wonder there is nutritional ignorance among MDs worldwide as they have only 1-2 nutrition classes during their training.  

We need to empower those who do have the training and education by expanding their resources and accessibility to patients.  Nutrition needs to be recognized as a vital part of healthcare, needs required post-graduate training for specialization in various disease states, and needs to be covered by insurance.

I agree that ignorance about nutrition is mainstream, however the problem seems to run deeper than this.

Taking supplements of any kind is thought to be unnatural and a compromise of some kind. Only nutrients from fresh food (preferably organic, local produce) are considered valid by the progressive class here in the UK. Supplements are pills and therefore are evil 'chemicals' and products of greedy pharmaceutical companies.
One or two vitamins/nutrients no doubt *are* poorly absorbed when isolated in pill form. This argument is used to condemn all supplements. Repeated headlines appear in the MSM which intimate that taking vitamins is actually harmful.

I'm trying to explain the feelings that cause many otherwise thoughtful people not to supplement. If it sounds vague and illogical that's because it is.

For example, in the cases of at least four of the most helpful supplements (vitamin d3, iodine, magnesium, vitamin k2), for most people it simply isn't feasible to obtain optimum amounts *without* supplementation.

Yet fashionable orthodoxy tends to prevent them from supplementating.

The importance of Omega-3 fatty acids is more widely accepted. If you examine it carefully, mainstream advice recommends averaging 2-3g per day without supplementation. It's very hard to take this seriously.

The weight of mackerel and oily fish you would have to eat is staggering.

It's a kind of doublethink.

Hi, Kismet--

This post wasn't meant to endorse nor critizie stem cell therapy for heart disease, something I have no experience nor strong opinions about.

Here's a paper on it:

http://www.ncbi.nlm.nih.gov/pubmed/19274033

Betty--

You really need to find a helpful healthcare provider who can coach you through the vitamin D and calcium issues. This is something you shouldn't do without assistance when calcium issues are involved.  

However, we have seen many cases of "secondary" hyperparathyroidism improve with vitamin D supplementation. Dosing is by blood levels, particularly important in your situation.

Michaela,
I read a post today that you should be interested in.  It is relative to ejection fraction and how blueberries increased EF by 82%.  You will find it at "nephropal.blogspot.com".  Dr. T is a nephrologist who is the author of the blog.  He is one of those brave hearts like Dr. Davis who is interested in helping people.

Safe Remedy for Heart Patients:Tashi Cardio Pro Capsules developed by face doctor is really a great help for most of the heart patients.

How cool to be able to give that to someone, to change their life with an email.

wew. it's not a good story..

Hi, Tom--

This is why we need to stage a "revolt" in the form of self-directed health, putting many strategies, including access to nutritional supplements, out of conventional healthcare and in the hands of everybody. This includes access to lab services, even diagnostic testing.

Off-topic, Dr. Davis, but this will be your new favorite photograph:

http://www.frigginrandom.com/images/beer-belly-master/

Lifting of Calcium Scan Ignorance?

http://www.sciencedaily.com/releases/2009/09/090930102536.htm

The ScienceDaily Press Release article is below.  You probably already knew this, but, just in case.

Calcium Scans May Be Effective Screening Tool For Heart Disease

ScienceDaily (Oct. 1, 2009) — A simple, non-invasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death. Coronary artery calcium scans can be done without triggering excessive additional testing and costs, according to the multi-center EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study, led by investigators at the Cedars-Sinai Heart Institute.

The findings appear in the September 30 issue of the Journal of the American College of Cardiology.

Coronary artery calcium scans that detect plaque in the coronary arteries have been shown to be more effective than standard cholesterol and blood pressure measurements in identifying patients who are most vulnerable to heart disease. Currently, these scans are not covered by private insurance carriers, in part because of concerns that detection of low levels of cardiovascular disease will result in unnecessary and expensive further testing, including exercise imaging and invasive cardiac catheterization procedures. "Over half of patients who suffer heart attacks have no warning that they have heart disease until the heart attack occurs. If we knew the patients were at risk, current treatments could prevent the majority of these unnecessary events. We had to address the concerns about unnecessary testing and costs related to this potentially lifesaving procedure," said Daniel S. Berman, M.D., the study's principal investigator and chief of Cardiac Imaging at Cedars-Sinai's S. Mark Taper Foundation Imaging Center in Los Angeles.

In the EISNER study, supported by The Eisner Foundation, researchers performed coronary calcium scans on 1,361 volunteers at intermediate risk for coronary artery disease, and followed them over a four-year period, from May 2001 to June 2005. The objective was to determine the relationship between coronary artery calcium scores and subsequent cardiac events and to evaluate the performance of additional cardiac diagnostic testing. Coronary artery calcium scores of 0 indicate no plaque, 1-9 minimal, 10-99 mild, 100-399 moderate, 400-999 extensive, and 1,000 or more very extensive plaque.

SNIP
Recent evidence has demonstrated that screening with coronary artery calcium is a better prognosticator of risk than the Framingham Risk Score—the traditional way of assessing risk based on blood testing and blood pressure--in middle aged and elderly patients. Yet controversy surrounds expansion of cardiac screening to include coronary calcium scanning imaging because of concerns that the extra costs may not outweigh the benefits. The findings of the EISNER study, the researchers note, is the first direct evidence that coronary artery calcium scanning could be an acceptable cost-effective screening test for coronary artery disease, since it is able to identify high risk subgroups in need of aggressive medical treatment, and patients who undergo additional testing constitute only a small fraction of the screened population.