Don't get smug!

31. May 2006 William Davis (2)
It may sound silly, but after someone succeeds in stopping their heart scan score from increasing or reduces their score, I warn them to not get smug. Let me explain.

I'll tell you about Jack. I met Jack a few years ago after he had a heart scan at age 39. His score: 1441! A score this high at his age obviously puts him in the 99th percentile. Also recall that a score >1000 carries a 25% annual risk for heart attack.

This captured Jack's attention. At the start, his lipoproteins were disastrous with numerous abnormal patterns. Jack committed to the program. After one year, his lipoproteins were around 80-90% corrected towards perfection. He'd lost 27 lbs, was exercising six days a week, and felt great.

Jack's repeat score one year later: 1107--over a 300 point drop! A huge success. He was ecstatic.

Unfortunately, work and life in general distracted him. Jack allowed himself to drift back to old habits, indulging in fast food 2 or 3 times a week, slacking on exercise such that it became sporadic, half-hearted efforts, and regained 15 lbs. He even failed to show up for appointments and we lost contact for two years.

One day, Jack simply decided to see where he stood, so he got himself another heart scan. The score: 2473--over a doubling from his reduced score.

The message: Long-term consistency is key, even after you've achieved control over your score. Stick with your program--and don't get smug!
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Comments (2) -

  • Anonymous

    7/3/2006 4:40:00 PM |

    Great site lots of usefull infomation here.
    »

  • Physical Therapy Supplies

    6/17/2011 6:34:52 AM |

    I just like your site very much. Good to have all this kind of information. Just want to convey message to keep your body fit and don’t get indulge in bad things. It will make your body misbalance and make you unfit. So be careful.
    Physical Therapy Supplies

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Self-directed thyroid management

Self-directed thyroid management

2. April 2009 William Davis (9)
Is there an at-home test you can do to gauge thyroid status?

Yes. Measure your temperature.

Unlike a snake or alligator that relies on the sun or its surroundings to regulate body temperature, you and I can internally regulate temperature. The hypothalamus-pituitary-thyroid glands are the organs involved in thermoregulation, body temperature regulation. While the system can break down anywhere in the sequence, as well as in other organs (e.g., adrenal), the thyroid is the weak link in the chain.

Thus, temperature assessment can serve as a useful gauge of thyroid adequacy. Unfortunately, temperature measurement as a reflection of thyroid function has not been well explored in clinical studies. It has also been subject to a good deal of unscientific discussions.

How should temperature be measured? The temperature you really desire is between 3 am and 6 am, while still asleep. However, this is difficult to do, since it would require your bed partner to surreptitiously insert a thermometer into some body orifice without disturbing you. A practical solution is to measure temperature first upon arising in the morning, before drinking water, coffee, making the bed, etc.--immediately.

While traditionalists (followers of Dr. Broda Barnes, who first suggested that temperature reflects thyroid function) still advocate axillary (armpit) temperatures, in 2009 it is clear that axillary temperatures are unreliable. Axillary temperatures are inconsistent, vary substantially with the clothing you wear, vary from right to left armpit, ambient temperature, sweat or lack of sweat, and other factors. It also can commonly be 2-3 degrees Fahrenheit below internal ("core") temperature and does not track with internal temperatures through the circadian rhythms of the day (high temperature early evening, lowest temperature 3-6 am).

Rectal, urine, esophageal, tympanic membrane (ear), and forehead are other means to measure body temperature, but are either inconvenient (rectal) or require correction factors to track internal temperature (e.g., forehead and ear). For these reasons, we use oral temperatures. Oral temperatures (on either side of the underside of the tongue) are convenient, track reasonably well with internal temperatures, and are familiar to most people.

Though there are scant data on the distribution of oral temperatures correlated to thyroid function, we find that the often-suggested cutoff of 97.6 degrees Fahrenheit, or 36.4 C, seems to track well with symptoms and thyroid laboratory evaluation (TSH, free T3, and free T4). In other words, oral temp <97.6 F correlates well with symptoms of fatigue, cold hands and feet, mental fogginess, along with high LDL cholesterol, all corrected or improved with thyroid replacement and return of temperature to 97.6 F.

But be careful: There are many factors that can influence oral temperature, including clothing, season, level of fitness, "morningness" (morning people) vs. "nightness" (night owls), relation to menstrual cycle, concurrent medical conditions.

Also, be sure that your thermometer can detect low temperatures. Just because it shows low temperatures of, say 94.0 degrees F, doesn't mean that it can really measure that low. If in doubt, dip your thermometer in cold water for one minute. If an improbable temperature is registered, say, 97.0 F, then you know that your device is incapable of detecting low temps.

A full in-depth Special Report on thermoregulation will be coming soon on the Track Your Plaque website.
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Comments (9) -

  • Dan

    4/2/2009 6:11:00 PM |

    Dr. Davis.

    What do you think of brachial artery reactivity testing (BART).  There's another study (here: http://www.adajournal.org/article/S0002-8223(08)02336-5/abstract) linking high-fat diets to decreases in flow-mediated vasodilation.  I was wondering your thoughts on the likelihood that BART is measuring a significant risk factor for CVD.  

    This is definitely off-topic so apologies.

  • Anna

    4/2/2009 6:14:00 PM |

    As you say, most common thermometers are calibrated to measure fever or elevated temps.

    Look for basal thermometers, often sold for detecting ovulation, so they'll be with fertility and
    "women's products" aisles, but may be used by anyone. Basal thermometers are calibrated low enough to detect the low temperatures of hypothyroidism.

    When I was experiencing infertility 15 years ago, I handed over many months of early morning temperature charts to the specialists, with all my menstrual cycle details.  Routinely, I had temperatures in the 96°F range, unless I was sick or ovulating (98.6F was a fever for me back then).  A spike to 97 indicated ovulation.  No one ever questioned the low temps in terms of my lack of fertility, of course, but the nurses joked about how cold I was.  If I only knew then...

  • Anonymous

    4/2/2009 8:08:00 PM |

    Dr.Davis

    This is very informative.
    What is the best base level of Iodine daily to promote thyroid health?

    Thanks for you great blog!

    Aaron

  • Anonymous

    4/4/2009 4:33:00 AM |

    Using a thermometer to determine thyroid function may be worthwhile, but realistically... how useful is it really?

    By this I mean, say it registers low. Okay, so now you go to your doctor and try to get your thyroid levels measured. A GOOD doctor who knows what they doing (which is rare) will measure Free T3, Free T4, TSH and antibodies.

    Unless your TSH is in the >3 range, along with raised antibodies, the chances of getting treatment is close to nil, regardless of your temperature. And usually most doctors look for TSH >5.

    Perhaps you can find the rare doctor who will treat based on antibodies alone, or the doctor who will consider a TSH >2.5 significant, but prepare to see a lot of doctors in order to find one who will treat.

    And recommending iodine without checking antibodies first, probably is a bad idea. Iodine + Hashimoto's doesn't always work out so well.

  • Monica

    4/8/2009 3:12:00 AM |

    Thanks so much for this information.  I measured waking temps for around 6 months for fertility reasons.  Usually I was in the low to mid 97 range.  Just measuring, evening, it's only 97.9 -- as measured with two different BBT thermometers.  I've lost about 15 pounds on a wheat-free, sugar-free diet, but I have about 20 lbs. more to lose and often wonder why I can't seem to shake the extra weight.  This post has encouraged me to get my thryoid checked.  my mom, grandma, and great-grandma all have/had hypothyroidism.

  • Anna

    4/8/2009 2:59:00 PM |

    Monica,  based on my experience and of others I know, it might take some persistence on your part.  Learn as much as you can about thyroid function and various approaches to treatment; Mary Shomon's thyroid.about.com website and book are a good start.  Good thyroid function is critical for optimum fertility, healthy pregnancies, and healthy babies; several years after we gave up on trying, when hypothyroid symptoms became so pronounced, I read at least 5 books with different angles; if I hadn't I would have given up much too soon and settled for the wrong care.  Check with a few doctors (even out of network and out-of-pocket if you can) if you are told you are fine despite your symptoms or only need synthetic T4; it's worth it (esp if low thoyroid function might be affecting your fertility - I learned too late it probably was at least part of my infertility problem all along).  I got nowhere fast with my PCP of 10 years and the next physician I saw in my network and only a fraction better.  Even once I found better care out of network, it took a lot of tinkering with treatment and dose to finally feel and function closer to normal in the third year of treatment.  Don't get discouraged.

    I know there's a fine line between doctor-shopping to neurotically get what you think you need vs. being a tenacious advocate for your health (I was constantly aware of this).  Despite the dismissal of concerns and frustration I often experienced early on,  I wouldn't accept the constant push to take other meds offered to manage the symptoms just because the doc or lab held to an outdated TSH threshold or couldn't/wouldn't figure it out.  

    Good luck to you.

  • EMR

    2/10/2010 6:37:34 PM |

    Temperature assessment should be a great way to detect the disease.Thanks for the informative article.

  • College Term Papers

    3/4/2010 6:41:18 AM |

    This is a fantastic presentation which captures what technology is all about. Thanks you for sharing and may you have many thought provoking conversations!

  • Study in UK

    4/16/2011 10:58:33 AM |

    Very pleased to find this site.I wanted to thank you for this great read!!

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What to Eat: The diet is defined by small LDL

What to Eat: The diet is defined by small LDL

9. April 2010 William Davis (15)
I approach diet from the perspective of small LDL particles.

Small LDL particles have exploded in frequency and severity in Americans. It is not at all uncommon to see 70% or more small LDL particles (i.e., 70% of total LDL particle number or Apo B) on lipoprotein testing. (I saw two people today who began with over 95% small LDL.)

Small LDL particles are:
--More likely to persist in the bloodstream longer than large LDL particles.
--More likely to adhere to components of atherosclerotic plaque.
--More likely to gain entry to plaque.
--More likely to be taken up by inflammatory white blood cells which, in turn, become the mast cells that fill coronary plaque.
--More likely to be oxidized.
--More likely to be glycated (8-fold more likely than large)

To add insult to injury, foods that trigger small LDL formation--i.e., carbohydrates--also cause high postprandial blood sugars. High postprandial blood sugars, in turn, glycate small LDL. That combination of events accelerates 1) plaque growth, 2) plaque instability, and 3) aging.

So carbohydrates trigger this sequence, carbohydrates of all stripes and colors. Not just "white" carbohydrates, but ALL carbohydrates. It's all a matter of degree and quantity. So, yes, even quinoa, bulghur, and sorghum trigger this process. I've only recently appreciated just how bad oats and oatmeal are in this regard--really bad.

Foods that trigger small LDL also trigger higher blood sugars; foods that trigger higher blood sugars also trigger small LDL. Small LDL and blood sugar are two different things, but they track each other very closely.

So, in the Track Your Plaque approach to diet, we craft diet based on these simple principles:

1) Eliminate wheat, cornstarch, and sugars--These are the most flagrant triggers of small LDL, blood sugar, and, therefore, LDL glycation.
2) The inclusion of other carbohydrates, such as oatmeal, quinoa, rye, etc. depends on individual sensitivity. Individual sensitivity is best gauged by assessing one-hour postprandial glucose.

Stay tuned for more in this series. Also, Track Your Plaque Members: We will be having an in-depth webinar detailing more on thees principles in the next couple of weeks.
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Comments (15) -

  • Anonymous

    4/9/2010 8:44:03 PM |

    How ia ApoB test used to know small LDL? Particle count exams aren't available in my area but ApoB is. So I'd like to know how to read this test.

    thankyou

  • Dana Law

    4/10/2010 12:45:03 AM |

    Dr. Davis,
    Please give us an eating plan.  You rant about people making lousy decisions with food.  We need some direction.  What are you eating?  Please tell us.  I find this part the most difficult.  I know I've improved in my quality of food.  Three times a day I need to make the best choices.  It's like being married to a nymphomaniac. You have to have to satisfy the healthy needs of your body, everyday!
    I believe you know what you are talking about.  You've improved our lives but tell us, please, what you are doing personally, day by day, to make those LDL particles small.  
    Sincerely,
    Dana Law
    San Diego, Ca
    P.S. This is a rant.  We need your help.

  • Taylor

    4/10/2010 5:48:55 AM |

    Love your blog, sir. I've been reading up over the last couple weeks--one question I couldn't find answered, though, was which glucose monitor you'd personally recommend? There are a lot of them out there on the market and I'm completely at a loss for how to tell them apart!

    Thanks for all the important work you do.

    --T.

  • ET

    4/10/2010 11:04:36 AM |

    For me, reducing carbs to <90g/day did little to improve my small, dense LDL.  My LDL particle number was over 2,000 and my small, dense LDL >1,600.  Increasing my saturated fat intake and niacin dropped my small, dense LDL to <120 in less than a year.

  • JC

    4/10/2010 11:26:38 AM |

    Many of those who live in the "green zones" have a high carb diet and yet live long healthy lives.Maybe the type of carb really is important.

  • Peter

    4/10/2010 11:47:32 AM |

    Re: the cultures that eat high carb but have low rates of diabetes (Japan) do they have low post-prandial scores and low small LDL particles despite lots of rice or corn and beans?

    I'm wondering why some very high carb cultures have so little obesity, heart disease, and diabetes.

  • Lou

    4/10/2010 2:09:54 PM |

    For people who are confused of what to eat, etc - check out Whole Health Source website. Very helpful.  Check out diabetes and diet under LABELS on the right side that Stephan explains in more details why, how, what, etc works.

    If there's a diet book that you can buy from a bookstore, Paleo Diet would probably be the best but it's not perfect. It says to avoid but it's perfectly fine and even the author changed his mind and it's fine to consume them.

    Free The Animal website has helpful information on how to make dinners.

    Dana Law, there's not need to eat 3 times a day. It's not really required. You can have two very nutritional meal with high amount of fat and feel satisfied for a long time, preferably break fast and dinner with maybe handful of snack like pecan, almond, walnut. That's pretty much how I eat. We're not programmed to eat that often anyway. That's how blood sugar stays low.

    JC and Peter, you need to be more specific... are we talking about percentage of meal high in carbs or total amount of carbs? Two entirely different things. We eat way more carbs than those people, I bet. I'd have to travel to those places to see that myself because I don't believe anything media tells us.

  • Paula

    4/11/2010 12:25:10 AM |

    Dana,
    Dr. Davis's "eating plan" is available to Track Your Plaque members.  I've been a member for over a year, and I can't tell you how much I've learned.  Check out the website at trackyourplaque.com and sign up!

  • Anonymous

    4/11/2010 7:35:20 AM |

    Dana, stop your ranting.  Your air of entitlement is annoying.  The fact that Dr. Davis graciously gives of his time to post some of his insights and advice does not make him a servant at your beck and call.

  • Anonymous

    4/11/2010 1:30:51 PM |

    ET, thanks for your post.  Some folks get carried away with Paleolithic diet or nothing. For those of us who prefer to limit our meat consumption, 2-3grms/day Niacin is a must.

    Dr D is always solid about whether his information is anecdotal or based on clinical trials.  If you would like additional supporting evidence for Niacin and its effects on LDL particle size, check out lipdsonline.org and search "niacin"

    " As in previous studies, niacin therapy had no significant effect on LDL cholesterol concentrations; however, after 3 months of treatment the number of small and medium sized LDL cholesterol particles was significantly decreased in those given niacin compared with those given placebo"

    Trevor

  • Tom

    4/11/2010 2:35:58 PM |

    I agree that I find it pathetic that someone would rant on a free website and some of the very best information available anywhere.  Please stop it now.

    Other posters who are asking about meters, etc:  please review the prior blogs that are listed alphabetically on the left.  Jeez folks, make some effort will you?

    Tom C.

  • Gina

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

    Yeah! So good to hear you speak out re the quinoa, oats and other carbs. Seems I can get clients to consider letting go of wheat (surprising) but  they now think quinoa is the nectar of the gods. 15 years ago I had a hard time selling even a handful of quinoa and now it is the sweetheart of grains. go figure...oh yet  again it is about who is pushing the stuff. You suppose Ornish is involved ;)
    Great post yet again Doc!

  • Anonymous

    4/12/2010 6:45:36 PM |

    I don't see what is wrong with Dana's post..... maybe we are just a tad more relaxed, those of us who don't eat too much meat Smile
    Trevor

  • April

    4/13/2010 4:42:17 AM |

    yes,I agree that a diet high on carbohydrates and sugar makes people obese and increases the risk for them to be diabetic.

  • Anonymous

    6/26/2010 6:36:17 PM |

    Do any of the home cholesterol meters (Cholesetch , Cardiochek, etc.) measure LDL particle number (i.e. small dense vs. the large not-so-dangerous kind)?

    Would be nice to conveniently measure real ldl once a day!

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