Dr. Davis,

You keep making posts about things this newcomer to the Track Your Plaque program is thinking about.

I was thinking just last night that I would soon make a post at the Track Your Plaque (TYP) forum asking about what a TYP+ Supplement program might look like.

For people like me who have already experienced cardiac events this would be a huge thing.

I've now got my blood testing done.  I appreciate your providing feedback yesterday at the forum to my posting my blood test results there.

I also had a heart scan done even though I know it's of more limited use given my cardiac history and that you basically don't recommend it.  Frankly, I disagree with you a bit on the usefulness of a heart scan with preexisting cardiac events.  I'll explain why later.

So, I'm ready to go with TYP+ Supplement Program.

I have some specific supplements in mind that aren't among the current recommended TYP Supplements.  I'll make a note of the ones you mention in this post.  I'd like your feedback on a comprehensive list to try for inclusion in a TYP+ program of supplements.

I'll make that post to the forum soon now that I know you're thinking about this already.

Dream big my friend!

I am thinking a resort off the coast of Thailand. You take a month for the treatment. Fly in to a first class medical resort - do your fast while lounging in a tropical paradise - get lots of sun lounging by the pool (aids in Vit D absorption). While you are receiving the various medical and supplement treatments for your heart disease you might want to look into getting a little "touch-up" plastic surgery  or maybe that hip replacement you've been putting off...

I bet your "instant Heart Disease" treatment, some plastic surgery and a hip replacement in total would still be less money than a cardiac cath and stenting back in the United States!

I being somewhat facetious in writing this post...but I truly believe that scenario I discribed  
will be the norm in the next 10 or 15 years - as the rest of the world becomes richer and the regulatory environment in the US and Europe slows cutting edge development i could see some fast developing nation such as Thailand assembling a team of highly skilled Doctors in order become the world leader in treat a particular disease.


Peace

Joe E O

Hi, Joe--

Interesting perspective. I hadn't thought of it in those terms. If nothing else, it would make a fascinating experience to watch.

I think that method exists since the fifties and is known as chelation therapy.

Admittedly the mix, which is often vitamin C and other supplements plus EDTA or something similar, needs to be improved with the current knowledge about amino acids etc. But it could do the job.

Diet on the other hand is unbeatable. One could spend two weeks in a resort and eat ideal meals to improve health.

Sorry, but the chelation in my experience has never worked. I personally have seen several people go through it, usually provided by shady types, with huge rises in heart scan score. Until genuine evidence suggests otherwise, chelation falls in my scam file.

Hi Dr. Davis,

I have now got my intake of Niacin up to 3g a day using Slo Niacin.  I'm wondering if I shouldn't attempt to get it higher to impact my Lp(a) number.

I'm 6' tall and at 250 pounds am a "big person".  I'm working on the weight of course.

I understand there are potential impacts on the liver.

I have been told and found in the past that Silibinin Plus from LEF and n-acetyl-cysteine work pretty well to keep liver numbers under control.

What would you think about my taking my niacin dose up to 4g a day (or even potentially higher) if I could keep my liver numbers under control.

Thanks.

I'm a big believer in going slow with niacin. It may take a year or more for it to exert full effects, including reduction of Lp(a). I am generally not in a hurry to raise doses.

I do favor periodic cycles off niacin, however, especially in people with Lp(a). In my many hundreds of patients with this disorder who take niacin for several years, there is a peculiar creep back up of Lp(a) levels back to the starting values. I believe that periodic "vacations" off niacin are necessary from the start, e.g., one month off every six months. Resume dose gradually and work with your doctor if/when you do this.

Re: liver protection. I'm only superficially familiar with those agents, and I cannot say specifically whether they spare the liver from niacin effects. Interesting idea, though. Phosphatidylcholine? The liver-sparing effects of this agent are interesting, also. But I know of no specific experience with niacin, unfortunately.

Thanks for the reply Dr. Davis,

I understand that, because you're not my doctor, you can't give me specific medical advice.

It's also true that I know of no other doctor who has more of the scientific literature and practical supplement experience than you have.

First, however, thanks for the tip on periodic Niacin vacations.

Let me then put another question to you this way...

I'd like to propose to my doctor the following to get his expert insight but before I do, having your opinion would come in handy.

Suppose I pumped up my intake of niacin to 5 grams.  After a month of that, I get a liver numbers test.  Then I begin the Silibinin Plus - N-Acetyl-Choline regimen.  Then after another month, I take another liver numbers test.

Would a scenario like that provide me with useful information for long term Lp(a) treatment without doing permanent damage to my liver?

Any suggestions for improving the idea?

One last thought...

Because Lp(a) is believed to be formed in circulation (per McCormick, Marcovina, et al), it seems to me that continuous availability of niacin in circulation is important.  So, I'm thinking 2 or 3 doses of niacin per day at 1.5g to 2.5g per dose.

Seems to me that dosing like that would be beneficial to assessing the impact of the Silibinin Plus - N-Acetyl-Cysteine regimen.

Does that make sense?

Thanks for all you do!

wccaguy--

I think that it depends on your endpoint.

If Lp(a)reduction alone is your endpoint, then raising niacin even to 5 g per day is reasonable.

However, if control of plaque growth is your endpoint, then you might make do with far less, e.g., 2000-3000 mg per day. It can vary enormously. (In fact, I have even seen an occasional person reverse without Lp(a) control, though this is unusual.)

One warning re: the frequent dosing of niacin. Far more likely to yield liver toxicity than dose is frequency. Taking niacin three times a day as SloNiacin virtually guarantees serious liver toxicity--I would strongly urge you to NOT do this. You are safest with once daily dosing of the SloNiacin preparation.

Re: liver toxicity gauged by liver function tests. Unfortunately, these are not really good tests for quantitative assessment of liver toxicity; they are rather weak, qualitative tests. So I do not believe you can make much of shifts within the normal range.

Thanks Dr. Davis for the niacin regime tips:

To sum up.

1   I will try to get my Slo Niacin dose to 5g per day in a single dose.

2   I will monitor Lp(a) test scores.

3   I will take a one month niacin vacation every six months.

Thanks again.

Your blog is very informative i must say. I like such dedicated blogs. I too write a blog on fitness and health and life. it is http://dreamfit.blogspot.com
do stop by sometime.

Dear Dr.Davis,

I just came across your site for the first time and very much like the content and layout.

I'm aware that you don't answer personal questions but am not quite sure with what one can post or comment on? I hope my post is considered acceptable and I hope you will take the time to comment briefly.

I'm in a desperate need to help my mother who had a hearth attack a month ago. She's always had a low blood pressure and considered herself to be very healthy. She is 63 and never been on any medication, no pains or complaints. And all of a sudden-a heart attack! She has had two stents put in and is on several medications-Plavix 75mg, Beloc Zok 25mg, Triatec, Sortis 40mg, Aspirin 100mg and Nexium 40mg.
I'm aware of the interactions of Plavix and Aspirin-Nexium and am terrified of the complications. She started taking a nattokinease supplement and thought that it will be better if she didn't take the Aspirin-Nexium. However after reading all your comments on natto-i feel this might not be a wise idea. I've been a regular reader of Dr.Mercola.com for many years and ordered a product called Cardioessentials from the site. I must say am not a fan of the statin drug as well but have only insisted on CoQ10 as ubiquinol of 200mg a day.
She has become more thoughtful of her diet and exercise. I know that thing rarely happen without warnings and am sure she  could have taken a better care of herself. She did gain a bit of weight lately and I know that visceral fat does come with a price on heart health! She is following a diet rich in vegetables and fruits, lean meat and fish, nuts and seeds and low in grains. She takes fish oil, flax oil an olive oil,garlic, green tea, vit C in high doses, vit E and D, ALA, vit B complex, grape seed extract and chlorella. I'm considering L-carnitine, L-arginine, taurine, lutein and NAC.

Please share a few wise words on this protocol and let me know if there is anything she is missing out on or should not be taking.
I would greatly appreciate your comment. Thanks in advance,

Lidija McLaren

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

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

This is a routine widely practised in Japanese hospitals for many diseases. They also use an IV glucose solution with electrolytes.

I am doing exactly what you suggest at the moment.

Supplements:

1/2 teaspoon of salt and 1/2 teaspoon of salt substitute (potassium chloride) dissolved in 2L of water. This provides very roughly 2g sodium and 2g potassium/day.

300mg magnesium and 800mg to prevent cramps.

A single multivitamin tablet.

A high potency B group supplement.

500mg vitamin C.

5g fish oil.

After 3 days I have never felt better in my life

This is simply whimsical at this point. I don't know if such an approach would work. But if it did, you might imagine that it would offer an opportunity--for the properly motivated--as an alternative treatment for angina, advanced coronary disease, a means to pull someone back from the brink.

I can't rememeber exactly when but several years ago a melting glacier uncovered a 5000 year old man in the Pyranees area. He was dubbed 'Oetzi'.  Since he carried a bow and arrow and kit with seeds he was certainly a hunter-gatherer.   It's logical that he was hunting and carried seeds to sustain him during the day.  But he died of an arrow attack so possibly he was killed for the game he had found, or perhaps by a tribe mate wanting to move up the social ladder.  Who knows.  

kevin

And what about 3-4 small high fat (Omega 6 free) low carbs (no glycemic) meals during the day? Its for example my case

Plus grazing would result in higher levels of digestive acid present in the stomach more often. More acid, more often.......This too is unhealthy...is it not?

Excellent data, doc.

I rarely eat anything big during the day, and almost never before 10am. It's now 12:00 noon and I'll be headed for an intense workout at 12:30 lasting for 30 minutes and will include a lot of pushing weight around. I may eat a bit in the afternoon, but most probably will have a large meal this evening.

This approach has worked wonders in terms of body comp and especially, hunger. I'm just almost never ravenous as I was with all the junk, which I think is the root cause of the grazing dysfunction.

Also, note that it's probably far easier for them to keep their minds off food when they're busy hunting and gathering it.

ting caught up on what meal frequency or timing is "best" and shift the focus toward ensuring an adequate micro and macronutrient intake that supports your goals and lifestyle?

If I am highly active and making quality food choices that fall in line with that activity level, it seems like there wouldn't be anything inherently wrong with eating 4-6 small meals/snacks per day .  That's not to say that 1 or 2 relatively larger meals wouldn't work as well, but I can't see there being much overall difference provided overall daily intake is roughly equivalent (if not the same) and and the focus is on undamaged fat sources, lean protein sources, plenty of vegetables, and a modest intake of fruit (especially things like berries).

Some folks find that various styles of intermittent fasting work best for them when it comes to controlling intake, and others have found that a higher number of smaller feedings work better. So while I do not dispute the wisdom in observing patterns from various hunter-gatherers, I don't feel that mirroring their patterns is something that fits my lifestyle and individual tendencies.

Of course I could be living with my head in the sand and the joke is on me, but I figured I'd just offer up my general thoughts.  I am far from being an expert on these issues.

In any event, thank you for sharing this post, Dr. Davis.

I'm against grazing (especially since it's usually crap that people graze on), but I do have a question about this.  I recently read that the rate of strokes increases during Ramadan, which mirrors this pattern - a large evening meal every day.  

http://www.thaindian.com/newsportal/world-news/does-ramadan-fasting-increase-risk-of-stroke_10038409.html

My father used to just eat one big meal a day at night.  He had a massive heart attack in his 50s.  He ate a lot of meat, butter, eggs, and bacon grease.  I doubt that all of that caused it - I think the primary cause was his two-pack-a-day unfiltered Camels habit.  But all of that didn't prevent it, either.

I've found going down to 2 main meals a day, and only eating between 11am and 6pm that my body fat has dropped considerably.  

I was stuck on about 70kgs for 12 months after starting a high fat, low carb diet, since I've started IF I've dropped nearly a kg of body fat a week for the past 6 weeks (you can see photos on my blog) And I know its body fat because I'm maintaining and even increasing the amount of weight i'm lifting at the gym.

I also feel great too

Then, why the insistence, heard over & over that breakfast is so important?  My body just doesn't seem to want something early in the day, & i've been trying to trust instinct.  But then i wonder if it is just a habit i've gotten into?  

I'm not eating a lot of calories & i eat no wheat (on rare occasion i break this, but have been 95% gluten-free for about 4 years or more).  But no weight loss.  I sometimes wonder if it is because i'm resistant to having breakfast.  

I really don't understand.

I borrow here from the Diabetes community. Blood sugar spikes may be the root cause of or a major contributor to Type 2 diabetes. The bigger the meal the bigger the spike. Most of us that have endured the SAD for most of our lives are well on our way to Type 2 (in my opinion) even after taking to the Low Carb WOE. Thus we are damaged goods and probably would be well advised that if we eat fewer meals per day, we should test the effects on our blood sugar. I do this. Blood meters are dirt cheap. Low carbing no doubt helps but does not assure "no spikes".

Kathryn, the answer to your question "then why the insistence" is because the people who are doing the insisting are basing their advice on little or no real evidence, just pseudo science and old-wivery. Don't confuse exposure with validity. Bad ideas very often get more air time than good ones and the world of medicine and nutrition is rich with examples.

I stress this point because I see that the notion of grazing has seized hold of many people's thinking. In my view, grazing is a destructive practice that is self-indulgent, unnecessary, and simply fulfills the perverse non-stop hunger impulse fueled by modern carbohydrate foods.

If the typical hunter-gatherer tribe eats only once a day and if humans can only absorb around 35g of protein at one time, this would mean that even H-Gs eating very high protein diets would ACTUALLY be on very low protein diets. This is huge no?

I keep hoping nutritional advice will get simpler, but it seems like to know what to have for dinner we need a lot of blood tests and a very savvy doctor to interpret them.

Dr. D,

Get the ldl-fructose connection but still confused about the small particle ldl/Lp(a) and eating fats.  Is it beneficial or not to include "good" fats like olive oil, coconut oil,butter, grass-fed meats, etc. when you have a the small ldl/Lp(a)pattern?  Being a woman and not the skinny male, I do think my pattern is genetic and I'm doing all of your recommendations for diet/supplements and want to be sure I am not making things worse by including fats in my diet.

Thanks.

Jan

~Peter

amen.

regarding fructose, maybe eating fruit instead of sugary junk for dessert and whatnot is the way to go. i can't bring myself to believe that, in the context of a truly simple whole-food diet, an amount of fruit each day is going to contribute to future ills.

~Dr Davis, i wonder if someone who eats a simple paleo diet free of sweetner, added fats and oils, dairy, legumes and grass seeds, and eats plenty of fruit, fatty grass fed meat, fish, greens, and some tubers has an increased risk of s-ldl compared to an average nutritionally ignorant patient who eats a typical SAD and is now trying to "clean it up" a bit.

just musing aloud.

Jan and Shel--

Yes, fats are good. We've just got to be selective in our fats.

My recent comments about "genetic small LDL" were not meant to scare everyone off of fat, but just to make the simple point that there is a subset of people with small LDL whose pattern responds somewhat differently than most other people.

...sorry. i meant to say "...has a 'lowered' risk of s-ldl compared to..."

I notice that you don't include actual measured TOTAL LDL cholesterol. If this is substantially different from the calculated total LDL cholesterol, then your point about the inaccuracy of the Friedewald calculation is proven. As it is, it seems to me that you've merely shown that it may not be very useful (because size, density, and degree of oxidation may be more important), rather than actually inaccurate.

the stanhope study is only useful for those who are already fat and getting fatter and considering supplementing their already excessive intake with fructose sweetened beverages.

self experiment 2 months ago lasting 5 weeks: as much fruit as i wanted and more (i wanted to make sure i got at least my normal intake of approx. 2300 cals) and whey protein to get about 100 g protein/day. my calorie intake per day came to averarge approx. 2700 cals. maybe if i account for fiber the actual calories would be closer to normal.  with that amount of fruit i was consuming i was constantly full (uncomfortbably so at times). i was basically force feeding. i didn't gain weight, i still have six pack so there was no undesirable body recompostion. pure fructose consumption may have no associated feedback mechanism  and induce hunger as stanhope study states, but we can't say fruit does the same thing. i think the addition of fruit to diet maybe helpful to those with weight issues as it could displace more calorie dense stuff sweetened with sugar and has added fat(eg doughnuts, cookies). did i screw up my lipids? don't know.  may be when a study comes along that induces bad things using only fruit as the fructose source i'll know. my point: may be we shouldn't worry about SOME fruit in the diet. may be if i continued experiment longer i would get fat. i'll never know because the diet was unsustainable. turds were monstrous, but passable with more effort than i'm accustomed to or desire.

Professor Lustig hates fructose yet claims that it`s toxic effetcs are blunted by fiber in fruits versus sweetened beverages. Obviously the speed of ingestion is somewhat critical in case of fructose.

Wondering... Was his diabetes also being treated with medication?

Yes:  pioglitazone (Actos). This could have played a role though, of course, plaque regression (dropping your heart scan score) can develop without it, as well.

Dr. Davis,
would you please explain, in layman's terms, why chiceking blood glucose can be so important for not only keeping track of blood sugar but for weight loss? I think I get it, but my mother, who was recently diagnosed as "pre-diabetic", says she is going to return the glucosometer she based bought upon my suggestion, as she is going to eat low-carb and track calories, etc.  Help me help my mom out!  Thanks so much,
emily

Dr Davis, thanks for the site.

There's a history of Diabetes in my family.
My dad and his father were both Diabetics and they both died of Pancreatic Cancer in later years.
They never watched any of their habits though.
My dad's doctor used to call him a "food and lifestyle" liar. Dad shrugged it off.. and kept on lying.

Yes, I know about the genetic odds here.
I do watch what I eat, Vit D3, no cigarettes and I exercise and live life.

I've never seen a conclusive study relating Diabetes and Pancreatic Cancer.
Any thoughts on that ?
I'm not Diabetic. FBG today of 89.
But I still watch myself and I have started to use a BG monitor to watch post-prandial numbers.
It's interesting how different foods affect everyones's BG differently.
I'm continually learning.
Thanks again for the site.

I'm new to all this but have a question if anyone is willing to indulge me an answer...

I frequently fall to sleep after lunch and/or after dinner, just "nod off" type of thing.  Is this a result of high BG and then the insulin response driving sugar low?

I am not diabetic and try to eat reasonable healthy meals, moderates amount of lean meat, vegetable and starch like rice or potato.  I wonder if I have insulin insensitivity...guess I need a meter. Thanks

Thanks for explaining why.

Could you maybe elaborate a little?

Carbs cause blood sugar to rise. Indulge in excess carbs, and you can walk, run and bike till you drop and not lose an ounce.

Awesome post Dr. Davis. I check my post-prandial BG constantly and have eliminated many so called low glycemic foods. ALso, nice simple explanation Lori.

@ Larry said...
I've never seen a conclusive study relating Diabetes and Pancreatic Cancer.
Any thoughts on that ?
It's not a straightforward connection, they are still arguing about it.
This abstract suggests  
the development of diabetes in subjects prone to pancreatic cancer could be a red flag for malignancy.

And this full text article
Is Type 2 Diabetes a Risk Factor for Pancreatic Cancer? explains why it's difficult to definitively identify type 2 diabetes mellitus as a risk factor for pancreatic cancer.

Worth pointing out for those with Diabetes who are concerned about the threat of Pancreatic cancer that Metformin monotherapy carried the lowest risk of cancer. However that was comparing medical diabetes treatments, so didn't include people using Dr Bernstein's or similar approaches to controlling diabetes through diet, exercise.

I found this paper Cancer as a metabolic disease worth studying. It's not specifically about pancreatic cancer. It makes the point that Reduced glucose availability will target aerobic glycolysis and the pentose phosphate shunt; pathways  required  for  the  survival  and  proliferation  of many  types  of  tumor  cells.
Maybe it isn't just the risk of heart disease that is reduced by lowering circulating  glucose levels.

@  Emily
Please try to persuade your mum the glucose meter is an essential tool to understand which foods really raise BG levels.
I thought, a bit like your mum, that because I followed a Low carb eating plan I wouldn't have a problem with high glucose.
Only after readingTo get low-carb right, you need to check blood sugars did I get a meter and start checking.
Despite eating almost exclusively low carb I was regularly spiking up to 199.8 ~ 11.1.
Adding into my diet a variety of things to slow gastric emptying has reduced the height of 1hr after meal spikes and I've now gone a week under 133.2 ~ 7.4 and the trend is towards lower numbers mostly under 108 ~ 6

I've not restricted my calorie intake nor am I able to exercise much but I have, unintentionally, lost weight. A month ago I was 168lbs and am now 163 lbs.

I went out and bought a glucose meter yesterday.  I bought the one Dr. Davis recommended, the OneTouch mini purchased at Walgreens.

In hindsight though, it turned out to be an expensive choice.  I had to buy the OneTouch test strips as well, and they are fairly pricey.

For anyone considering buying a glucometer, buy the Walgreen's version.  I think it had a mail-in rebate, cost a bit less than the one touch, and also, the generic Walgreen's test strips are half as much as the One Touch.

And thank you Dr. Davis for this great blog.

Consumer Reports magazine recommended the ReliOn Ultima and their strips. The meter is, like, $9 and the strips are very inexpensive (compared to "branded" ones). (I'm pre-diabetic.) I don't have any hesitation checking my b.g. anytime, because the strips are cheap.  (No insurance, I have to pay for all my supplies.)  If you have insurance but they limit your strips (as with my nephew, a Type 1), you can use the  cheap one to fill-in your testing.

From my research and experimentation, the Accuchek Aviva shown in picture is the most accurate and precise meter currently available.  Over the long run, an accurate and precise meter will save you money and a lot of trouble, versus one whose results are not as reliable, and which forces you to test more.

btw, most precision issues are due to the strips, and cheap strips will simply result in lots of unnecessary holes in your fingers if you're serious about knowing what's going on with BGs.

thanks

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