Why are heart attacks still happening?

4. March 2012 William Davis (10)
I'm a cardiologist. I see patients with heart disease in the form of coronary artery disease every day.

These are people who have undergone bypass surgery, received one or more stents or undergone other forms of angioplasty, have survived heart attacks or sudden cardiac death, or have high heart scan scores. In short, I see patients every day who are at high-risk for heart attack and death from heart disease.

But I see virtually no heart attacks. And nobody is dying from heart disease. (I'm referring to the people who follow the strategies I advocate, not the guy who thinks that smoking a pack of cigarettes a day is still okay, or the woman who thinks the diet is unnecessary because she's slender.)

Two high-profile deaths from heart attacks occurred this week:

Davy Jones--The iconic singer from the 1960s pop group, the Monkees, suffered sudden cardiac death after a large heart attack, just hours after experiencing chest pain.

Andrew Breitbart--The conservative blogger and controversy-generating media personality suffered what was believed to be sudden cardiac death while walking.

It's a darn shame and it shouldn't happen. The tools to identify the potential for heart attack are available, inexpensive, and simple. The strategies to reduce, even eliminate, risk are likewise available, inexpensive, and cultivate overall health.

The followers of the Track Your Plaque program who

1) get a heart scan that yields a coronary calcium score (for long-term tracking purposes)
2) identify the causes such as small LDL particles, lipoprotein(a), vitamin D deficiency, and thyroid dysfunction
3) correct the causes

enjoy virtual elimination of risk.
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Comments (10) -

  • Alexandra

    3/4/2012 1:02:04 PM |

    Just read this about Davy Jones:
    http://blog.sfgate.com/dailydish/2012/03/01/micky-dolenz-bewildered-by-davy-jones-death/

  • nina

    3/4/2012 9:30:09 PM |

    I saw some recent photos of Davy Jones and thought ''wheat belly''.  Sad, but avoidable.

  • PeteKl

    3/4/2012 11:00:30 PM |

    I don''t claim to entirely know the answer to this question, but I am willing to venture a guess to what might be part of the answer.  My suspicion is that in the end, for better or worse, most people value the opinions of their social group more than they value their health.  Currently Doctor, your recommendations are just too far from mainstream opinion and sadly will be ignored by all but the most thoughtful people.

    As anyone who has tried to modify their diet has probably discovered, the greatest challenge often isn''t dealing with cravings for a missing food.  Instead it is dealing with the social backlash to your lifestyle change from friends and family.  

    At first everyone is interested in knowing why you have made the change and they attempt to accommodate your choice.  However eventually they become annoyed as they realize the change you made is permanent.  I can''t tell you how many times I have heard some variation on the following when deciding where to eat with friends (usually given with a thinly veiled snide tone of voice):

    “I would really like to check out that new Italian restaurant, but Pete won''t eat pasta, so I guess we have to go back to the usual place.”

    It doesn''t matter how many times I tell people that I can always find something to eat no matter where we go.  Someone will still insist on making an issue of my dietary choices.  Things aren''t always this blatant, but it is frequent enough that I eventually start wondering whether I should change my eating habits or stop eating with friends.

    While dietary modifications elicit the most direct response, these types of responses seems to occur with almost any health related change.  If your friends and family aren''t themselves doing something or think the change is a dumb idea (no matter how flimsy the reasoning), most people will avoid making a change.  

    Even my own partner, whose father died suddenly of a heart attack last month and whose relatively young mother has been diagnosed with chronic heart failure ignores my suggestions (which are based on your recommendations).  He has asked me several times for advice that might help his mother and the response to my suggestions is always that it won''t work.

    I finally realized that he simply doesn''t want to challenge the rest of the family.  His older brother, a pharmaceutical representative, is viewed as the “expert” on family health issues and my partner refuses to butt heads with him despite what is at stake.  So I keep quiet and wish his mother the best.

    Much of this is understandable.  Humans are social animals and we have evolved to depend on our social group for survival.  On a savannah in Africa 50,000 years ago this made perfect sense.  But in a modern world of science and technology these natural social instincts are increasingly an obstacle to our health and many of us know it.

    Yet it still takes a strong, independent personality to ignore these impulses.  While I have been able to make a number of changes in my life based on your recommendations, it has still been difficult to consistently follow through.  

    Just a few days ago I was invited over to someone''s house to celebrate a birthday.  So what was on the menu?  Several wheat pizza''s, of course.  So did I tell the host that because of my heart problems I no longer eat wheat?  Sorry Doctor, I didn''t.  Instead I shut up, ate the pizza and  proceeded to raise my small LDL particle level for the next week (http://www.trackyourplaque.com/blog/2011/11/friday-is-my-bad-day.html).

  • Robert

    3/5/2012 7:42:48 PM |

    Since adopting a paleo/low carb diet in the last year, I am looking into getting an NMR lipoprofile test to get a baseline of how my particle count looks.  Under the section of treatment options on this particular site, the first line of start with eating right reads "Eat more whole grains, fruits and vegetables."  The very first thing listed is whole grains.  This is so frustrating to see on a site promoting a very useful tool in CVD risk evaluation.  I have read "wheat belly" and "track your plaque", both very good books.  I am also reading primal body, primal mind.  Heart disease runs heavily in my family and I''m pretty much going against what most people in my famliy do by following low carb/paleo eating habits.  I just dont understand why these larger blood test companies, even with all the evidence continuing to pile up, still suggest foods that will worsen the problem the tests are evaluating in the first place.  I guess you have to have confidence in the test they provide (NMR), but just ignore what they say are the best options for treating abnormalities of that test?

  • Dr. William Davis

    3/6/2012 3:47:32 AM |

    It is unbelievable, isn''t it, with all their insights?

    Give them time and they''ll catch on. In the meantime, ignore this nonsense, Robert.

  • Julie

    3/6/2012 6:40:58 AM |

    Dr. Davis,
    What would you recommend for someone who had recently one stent put in and is currently on a statin and plavix post -op?
    Is it necessary to take statins in this case? Any additional supplements etc.?

    Thank you in advance for your help!
    P.S. Loved your book!

  • Catherine

    3/7/2012 12:41:32 AM |

    Dr. Davis,
    Could you please consider changing your "categories" back to the old way you had them organized--single file, alphabetical and one type size? Although it may give a more creative look to the website, it is harder to find the material being sought. I send many new people to your site and they often complain about it.

  • Dr. William Davis

    3/10/2012 3:51:20 PM |

    Hi, Julie--

    This is precisely what the Track Your Plaque program is about.

    In a nutshell:

    1) Identify the causes specific to you, including lipoprotein abnormalties/lipoprotein(a)
    2) Supplement and normalize vitamin D and iodine/thyroid status
    3) Supplement omega-3 fatty acids
    4) Do the diet

  • The Worst Habits for Your Heart - Christian Forums

    5/30/2012 7:50:36 PM |

    [...] patients so that they avoid having a cardiac.   "Why are heart attacks still happening?"  Why are heart attacks still happening? | Track Your Plaque Blog     I’m a cardiologist. I see patients with heart disease in the form of coronary artery [...]

  • margaret

    5/25/2013 6:05:53 AM |

    Dr Davis
    Just found your interesting website.  I am trying to get my partner to cut out wheat (overweight, high chol and high BP).  Unfortunately, I can't find a doctor who conducts the tests you recommend.  Do you know of such in Australia (particularly Western Australia)?  

    Many thanks and I'll continue reading till we catch up down here!!

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Useless low-fat diets

Useless low-fat diets

24. August 2007 William Davis (1)
If you would like to read an ironic testimonial to the futility of conventional low-fat diets, read:

Cutting Cholesterol, an Uphill Battle on the New York Times website at http://www.nytimes.com/2007/08/21/health/21brod.html?_r=2&adxnnl=1&oref=slogin&ref=health&adxnnlx=1187928650-f0mfyzGTFdsLmtInHcGPUw

In this story, author and columnist Jane Brody recounts her struggles with her cholesterol levels. She describes how she followed an increasingly strict low-saturated fat diet, hoping to reduce LDL cholesterol. But she saw the opposite occur: LDL climbed from an initial 134 to 171, a level that caused her doctor to prescribe a statin drug.

Yet she states that "About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood."

Had Ms. Brody and her doctor been just a bit better informed and performed lipoprotein analysis instead, they would have seen some obvious phenomena:

--All the increase in LDL was in the fraction of small particles, the sort highly likely to cause heart attack.

--The conventional LDL that she quotes is a calculated value that miserably misrepresents the real LDL when actually measured. Her calculated LDL of 171 mg/dl, in fact, was probably more like 220 to 250 mg/dl--much higher than they think.


Of course, Ms. Brody turns to her conventionally-thinking physician who then predictably prescribes a statin drug.

Ms. Brody's well-articulated story achieves the ironic, unintended result of proving the idiocy of the conventional low-fat diet. The low-fat diet, as currently practiced by most people, raises LDL cholesterol and escalates risk for heart disease. In fact, Ms. Brody probably increased her risk far more than suggested by a 30 mg increase in LDL.

One of my favorite blogs, the Fanatic Cook, has a tremendously insightful post on Ms. Brody's misadventures.

If all she did was eliminate all wheat flour containing products and reduce the overall glycemic index of her diet, she would witness an enormous drop in LDL cholesterol, both calculated and measured.

I hope that Ms. Brody survives her diet mistakes and her doctor's ignorance.
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Comments (1) -

  • Tracy

    8/27/2007 10:28:00 PM |

    Evidently the only nutrition/health reading she does is her own copy.

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The LDL-Fructose Disconnect

The LDL-Fructose Disconnect

26. February 2010 William Davis (8)
I believe that we can all agree that the commonly obtained Friedewald LDL cholesterol (what I call "fictitious" LDL cholesterol) is wildly inaccurate. 100%--yes, 100% inaccuracy--is not at all uncommon.

This flagrant inaccuracy, unacceptable in virtually every other discipline (imagine your airplane flight to New York lands in Pittsburgh--close enough, isn't it?), is highlighted in the University of California study by Stanhope et al I discussed previously.

32 participants consumed either a diet enriched with either fructose or glucose. Compared to the effect of glucose, after 10 weeks fructose:

Increased LDL cholesterol (calculated) by 7.6%

Increased Apoprotein B (a measure of the number of LDL particles) by 24%

Increased small dense LDL by 41%

Increased oxidized LDL by 12.6%


In other words, conventional calculated LDL substantially underestimates the undesirable effects of fructose. The divergence between calculated LDL and small LDL is especially dramatic. (By the way, this same divergence applies to the studies suggesting that calculated LDL cholesterol is reduced by low fat diets--While calculated LDL may indeed be reduced, small LDL goes way up, a striking divergence.)

This is yet another reason to not rely on this "fictitious" LDL cholesterol value that, inaccuracies notwithstanding, serves as the foundation for a $27 billion per year industry.
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Comments (8) -

  • Peter

    2/26/2010 5:29:27 PM |

    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.

  • sdkidsbooks

    2/26/2010 7:51:04 PM |

    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

  • shel

    2/27/2010 12:00:23 AM |

    ~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.

  • Dr. William Davis

    2/27/2010 2:35:53 AM |

    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.

  • shel

    2/27/2010 4:01:09 AM |

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

  • Rick

    2/27/2010 4:54:42 AM |

    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.

  • L

    2/27/2010 11:56:05 AM |

    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.

  • Neonomide

    3/4/2010 9:22:42 AM |

    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.

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