Take this survey: I DOUBLE-DARE YOU

In a previous post I entitled Heart disease reversal a big "No No", I posed a challenge--a dare--to readers to ask their doctors if coronary heart could be reversed.

Here's what I said:

I dare you: Ask your doctor whether coronary heart disease can be reversed.

My prediction is that the answer will be a flat "NO." Or, something like "rarely, in extraordinary cases," kind of like spontaneous cure of cancer.

There are indeed discussions that have developed over the years in the conventional scientific and medical literature about reversal of heart disease, like Dean Ornish's Lifestyle Heart Trial, the REVERSAL Trial of atorvastatin (Lipitor) and the ASTEROID Trial of rosuvastatin (Crestor). Reversal of atherosclerotic plaque in these trials tends to be small in scale and sporadic.

The concept of reversal of heart disease has simply not gained a foothold in the lexicon nor in the thinking of practicing physicians. Heart disease is a relentlessly, unavoidably, and helplessly progressive disease in their way of thinking. Perhaps we can reduce the likelihood of cardiovascular events like heart attack and death with statin drugs and beta blockers. But reverse heart disease? In your dreams!

We need to change this mentality. Heart disease is a reversible phenomenon. Atherosclerosis in other territories like the carotid arteries is also a reversible pheneomenon. Rather than throwing medicines and (ineffective) diets at you (like the ridiculous American Heart Association program), what if your doctor set out from the start not just to reduce events, but to purposefully reduce your heart's plaque? While it might not succeed in everyone, it would certainly change the focus dramatically.

After all, isn't this the theme followed in cancer treatment? If you had a tumor, isn't cure the goal? Would we accept an oncologist's advice to simply reduce the likelihood of death from cancer but ignore the idea of ridding yourself completely of the disease? I don't think so.

Then why accept "event reduction" as a goal in heart disease? We shouldn't have to. Heart disease reversal--elimination--should be the goal.


I know of one person who actually followed through on this challenge and asked his cardiologist whether his heart disease could be reduced or reversed. As predicted, the answer was no. No explanation followed.

But allow me to reiterate: Heart disease is 1) detectable, 2) quantifiable, 3) controllable, and, in many cases 4) reversible.

What if there was a big payoff to your doctor if heart disease was reversed, say $100,000? That's enough to dwarf the payoff from procedures. Guess what? You'd have doctors fighting for your business, a chance to reverse your disease, ads to that effect, champions of reversal emerging. No new tools would be necessary. They could use the tools already available. Then why hasn't this happened? Is the technology unavailable? Are the treatments ineffective?

No, heart disease is a controllable and reversible process with tools that are available today. But there is, of course, no big payoff for doing it. So the financial incentive remains to do procedures, not to reverse the disease.

But I'd like to re-pose this challenge. Ask your doctor if heart disease can be reversed, or at least reduced. I've even posted a Survey at the top left for anyone who tries.

Again, my prediction: Nobody will try it and nobody will post survey results. Why? Despite my rantings (and those of a few others) about the concept of heart disease being a reversible process, in the public's consciousness it remains a death sentence and the only solution is hospital procedures. My colleagues continue to cultivate this attitude and it serves them well financially.

I'll be disappointed if I prove to be right. I hope that I am wrong. But I don't think that I am.



Copyright 2008 William Davis, MD

Comments (10) -

  • Anonymous

    1/14/2008 2:03:00 PM |

    I'm not planning to see my doctor again until I reverse my plaque growth.  My first round of talks with him was not encouraging as he only believes statin drugs can be of help.  Ironically my doctor's age is similar to mine and he also told me he has a similar amount of plaque.  My plan is simply to see him again once I control or reverse my plaque growth and tell him there no reason why he couldn't do the same thing too.

  • Anonymous

    1/14/2008 2:30:00 PM |

    Interesting.  Recently, my primary care physician and I had a long talk about causing regression of heart disease.  (Imagine that - my doctor actually spent more than 30 minutes talking to me about medicine.)  He took the time to pull out various articles and texts about heart disease and explain the underlying causes.  He noted that his goal for his patients was to move their heart scan score backwards.  His primary tools for doing so are (1) EBT; (2) blood tests using VAP; and (3) medication (primarily statins mixed with niacin); and (4) repeat EBT.  He noted that very few of his patients had regression of their calcium scores but that many of his patients had calcium score increases in the 0 to 10% annual range.  Most interesting to me is that my doctor also has coronary calcification and is a diabetic.  He mentioned that his own calcium score had decreased in the past year by about 3%.  So obviously he must be doing something right, at least for himself.  

    We spoke about Vitamin D3.  He is a proponent of supplementing D3 when the levels are below 30 ng/mL.  He also tested for homocysteine levels and then emailed me to to take a B multi-supplement based on a high homocysteine score saying that it may have benefits both for heart disease and stroke prevention.

    He had not heard of TYP but I would bet that he would be quite open to this approach as he says his goal is "preventive cardiology."  What materials would you suggest I provide him for my next office visit?

    -Russ

  • Nancy M.

    1/14/2008 7:23:00 PM |

    We just had a woman reverse her heart disease through diet: congestive heart failure, hypertrophic cardiomyopathy.  Her doctor initially put her on a low fat, high carb diet and she got worse.  She ran into a cardiologist on a plane trip who advised low carb.  She went back onto a low carb diet (she'd been on one previously) and the results of her last echo cardiogram say the damage to her heart is negligible.  Her doctor was formerly skeptical of low carb diets but is now on one and has dropped 20 pounds herself.

    So yeah!  She's pretty convinced heart disease is reversible!

    And to confirm her results, the day after she found out a study came out about insulin resistance and cardiomyopathy.  Insulin-Resistant Cardiomyopathy, Clinical Evidence, Mechanisms, and Treatment Options.
    http://content.onlinejacc.org/cgi/content/abstract/51/2/93

    Sadly the study doesn't mention changing your diet to treat it....

  • Dr. Davis

    1/14/2008 8:20:00 PM |

    Interesting!

    Can you tell us who your doctor is? I'd like to contact him myself and congratulate him on trying to achieve regression/reversal. He is truly exceptional.

    In the meantime, just let him know that the Track Your Plaque program is all about trying to gain control over your heart scan score. We might be able to improve his results dramatically just by adding a few bits of wisdom.

  • Dr. Davis

    1/14/2008 8:32:00 PM |

    Thanks, Nancy.

  • Dr. Davis

    1/14/2008 8:40:00 PM |

    That's an interesting turnaround.

    Also, perhaps a curious reflection of how motivations can differ between doctor and patient nowadays. You want to save your life, your doctor often wants to save money (i.e., insurance money).

  • Anonymous

    1/14/2008 9:31:00 PM |

    Dr. Davis - I sent a message to your aol account with my doctor's details.  I would be very curious to learn of his reaction to the TYP program.  I suspect he'll be receptive to your approach.

    -Russ

  • Stan

    1/14/2008 11:01:00 PM |

    Of course it can be reversed!   I have done it myself although I cannot prove it now.   I used to experience some mild angina pain in my early fourties, and frequent episodes of rapid heart beat every few months.  It all went away about 6 months on a ketogenic diet, on which I have stayed permanently on, to this day. It never reoccured and my stamina has gone back up to roughly the same level I had in my twenties (I am 51).   It was 8 years ago.

    Best regards to all, this is really exceptional blog. Keep up your good work,

    Stan (Heretic)

  • moblogs

    1/15/2008 12:18:00 PM |

    I won't add to the survey as I haven't asked, but the mantra from the British Heart Foundation down to the doctor is prevention or management. Nowhere in their literature have I seen any mention of reversing heart disease.

  • Anonymous

    12/26/2009 4:30:22 PM |

    Cannot be

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Fish oil: What's the difference?

Fish oil: What's the difference?

Ultra-purified, pharmaceutical grade, molecularly distilled. Over-the-counter vs. prescription. Gelcap, liquid, emulsion.

There's a mind-boggling variety of choices in fish oil today. A visit to any health food store, or any "big box" store for that matter, will yield at least several, if not dozens, of choices, all with varying and often extravagant claims of purity and potency.

So what's the real story?

Given the analyses conducted over the years, along with my experience with dozens of different preparations, I believe that several conclusions can be reached about fish oil:

Fish oil is free of contamination with mercury, dioxin, PCBs, or furans. To my knowledge, only one fish oil preparation has been found to have a slight excess of PCBs. (This is different from cod liver oil that has been found by one source to have a slight excess of PCBs.)

Oxidative breakdown products differ among the various brands. Consumer Lab (http://www.consumerlab.org/), for instance, has found that several widely available brands of fish oil contained excessive oxidative breakdown products (TOTOX). You can perform you own simple test of oxidative breakdown products: Sniff it. Your fish oil should pass the "sniff test." High quality fish oil should smell non-fishy to lightly fishy. Rancid fish oil with excessive quantities of oxidative breakdown products will smell nasty fishy.

FDA approval does not necessarily mean greater potency, purity, or effectiveness. It just means that somebody assembled the hundreds of millions of dollars to obtain FDA approval, followed by lots of marketing savvy to squash the competition.

This means that there are a number of excellent fish oil products available. My favorites are the liquid fish oils from Pharmax, Nordic Naturals, and Barleans. Capsules from Carlson, PharmaNutrients, and Fisol have also performed consistently. The "big box" capsules from Sam's Club and Costco have also performed well and are wonderfully affordable.

Comments (27) -

  • Bill Millan

    12/10/2010 3:01:47 PM |

    I have engaged in more discussion about fish oil than any other supplement. Just remember we could care less about the fish oil, what we are after is the EPA+DHA Omega 3 in the oil. The rule of thumb is, "the higher the price, the more Omega 3." You can save money and get the 30% in the Kirkland or Sam's Club brand or spend a lot more money and get the 50% to 70% brands.

  • Bill Millan

    12/10/2010 3:01:47 PM |

    I have engaged in more discussion about fish oil than any other supplement. Just remember we could care less about the fish oil, what we are after is the EPA+DHA Omega 3 in the oil. The rule of thumb is, "the higher the price, the more Omega 3." You can save money and get the 30% in the Kirkland or Sam's Club brand or spend a lot more money and get the 50% to 70% brands.

  • arnoud

    12/10/2010 3:11:11 PM |

    Often I have wondered about the benefits, if any, of krill oil versus regular fish oil.    
    It seems that the Phospholipids in the Krill oil play a role in HDL quality.

    I have not yet found a good paper explaining this, but Neptune Technologies is doing some research on this.  I prefer whole foods, rather than drugs, but the research on this topic looks interesting.

    From their website on a research on concentrated phospholipids form krill oil:
    Neptune Technologies & Bioressources Inc. Reports Completion of Acasti Pharma Comparative Benchmarking Program versus Lovaza®



    Laval, Québec, CANADA – November 25, 2010 – Neptune Technologies & Bioressources Inc. (“Neptune”) (NASDAQ: NEPT - TSX.V: NTB) subsidiary, Acasti Pharma Inc. (“Acasti”), reports the completion of its  preclinical program designed to compare the lipid management effects of Acasti’s drug candidate CaPreâ„¢ versus prescription drug Lovaza®.  Blood lipids were monitored in two animal models in order to assess and compare the efficacy of CaPreâ„¢ and Lovaza® over a 12-week treatment period.

        * A low daily human equivalent dose of 1g CaPreâ„¢ reduced LDL-C (bad cholesterol) levels by 40% and increased HDL-C (good cholesterol) by 180% in a normal rat model (“SD”) while 4gr of Lovaza® did not show any significant effect.
        * An even lower daily human equivalent dose of 0.5g CaPreâ„¢ was shown to be as efficient as 4g of Lovaza® in reducing triglycerides levels by 40-50% in obese rats with severe diabetes and high triglycerides (“ZDF”)


    “These results suggest that a low (0.5g to 1g) daily dosing of CaPreâ„¢ is more effective than 4g Lovaza® in elevating HDL-C and lowering LDL-C and triglycerides.  These effects become even more striking considering that a 1g daily dose of CaPreâ„¢ contains 8.9 times less EPA and 11.1 times less DHA than the recommended 4g daily dose of Lovaza®. It is also important to note that the triglycerides reduction was observed only after 4 weeks and was maintained throughout the study suggesting a significant metabolic impact of CaPreâ„¢,” said Dr. Bruno Battistini, Senior Director, Pharmaceutical R&D of Acasti.

  • Geoffrey Levens

    12/10/2010 4:38:02 PM |

    If one brand showed slight excess of PCB's, does that mean all the rest also contained PCB's only just the right amount?

    What are the benefits to cardiovascular health of taking plant/algae sourced DHA vs fish sourced EPA/DHA?

  • Anonymous

    12/10/2010 4:54:31 PM |

    What do you think of the conclusions in this blog post?
    http://thehealthyskeptic.org/when-it-comes-to-fish-oil-more-is-not-better

    For a "healthy" person are your recommendations the same- as in make sure to get a high quality fish oil?

    I really appreciate you taking the time to write on this blog.  Thank you!
    Char

  • Jack

    12/10/2010 5:00:58 PM |

    or you could just eat natural food sources of omega-3, like wild salmon, tuna, sardines, grass fed butter, eggs from pastured chickens, fermented cod liver oil. then you wont need supplements.

    cheers
    jack k

  • Eric

    12/10/2010 5:20:40 PM |

    What if you can't stand the taste of fish like salmon and sardines or fermented cod liver oil?

    I'm hoping Carlsson's is good, that's what I've been taking for the past few months and I love how it tastes like lemon oil, not fishy at all.

  • Dr. William Davis

    12/10/2010 7:48:29 PM |

    While there is debate on the reduction in cardiovascular events with omega-3 fatty acids, I use them to achieve correction of a number of physiologic parameters:

    1) Reduction of triglycerides
    2) Acceleration of clearance of postprandial lipoproteins, such as chylomicrons, chylomicron remnants, and VLDL
    3) Reduction of lipoprotein(a)

    The data on the likelihood of cardiovascular mortality correlates inversely with RBC omega-3 EPA + DHA; the relationship is quite strong. While we lack prospective trials outside of GISSI Prevenzione on the reduction of cardiovascular death with higher levels, given the overall improved surrogate measures of risk, I believe that the data overall are sufficiently compelling.

  • Anonymous

    12/10/2010 8:49:01 PM |

    Funny, I've been reading up about this lately. I like the fact that if we can - there is the possibility of actualy getting the appropriate amount of EPA+DHA Omega 3's by eating fish. I recently started buying sardines just for this purpose and I'm going to try real hard to incorporate oily fishes. I like it when people help others minimize the amounts of supplements they use.

  • Anonymous

    12/10/2010 10:03:22 PM |

    dr. davis

    i can't smell anything rancid in my distilled fish oil with orange flavour but its so weird its too heavy barely digests and stays as if stuck in the chest. feels horrible.

    not sure what to make of it.

  • Pater_Fortunatos

    12/10/2010 10:07:40 PM |

    There are a few benefits of a plant based diet: avoiding acid load, toxin accumulation in the food chain, and another one, high lipid peroxidation level of the longer chain EFA.
    So I just heard that "Reduction of triglycerides" using fish oil, is an effect of liver damage.

    Just search for this book:
    "Fatty acids in foods and their health implications" - Ching Kuang Chow
    I just quote from the chapter V. MEMBRANE UNSATURATION AND LONGEVITY
    _______________________________
    In summary, the above mentioned studies provide a correlation between the maximum longevity of animals and the degree of unsaturation of membrane fatty acids. That correlation joins the previously stated one between the rate of mitochondrial oxygen radical generation and the maximum
    longevity of animals. In long-lived homeothermic vertebrates, both free-radical production and the
    membrane fatty acid unsaturation are lower, offering an explanation for some of the main causes of
    the low aging rate peculiar to these animals. No studies have been carried out on these aspects in
    relation to dietary fat and, as it will be stated below, this is another notable aspect of fatty acids and
    aging.
    _______________________________

  • John

    12/11/2010 2:35:55 AM |

    Is there an over-the-counter brand of fish oil that closely matches prescription Lovaza?

  • Jack M.

    12/11/2010 3:37:59 AM |

    westonaprice.org has very informative articles on this. Type "cod liver oil" in the search box to find their articles.  There is great info on how the better brands are manufactured.

  • William Trumbower

    12/11/2010 3:24:04 PM |

    A product similar in principal to krill oil is Vectomega.  It is a phospholipid bound salmon oil made from salmon heads.  The heads used to be discarded and this is a resource that doesn't deplete the food of whales etc.  According to the companies data, one tablet is the equivalent of eight standard capsules (probably 2.4gm of EPA+DHA).  It is a little pricey, but you will never burp it and it is very portable when you travel.  I suggest to my patients that if they regularly take much more than 2.5gm, that they get AA/EPA ratio available thru many labs.  yourfuturehealth.com,    LEF.org

  • Geoffrey Levens

    12/11/2010 4:57:33 PM |

    Supposedly DHA converts in the body to EPA pretty easily.  Anyone know any data about taking DHA alone vs with EPA?

  • Vlado

    12/11/2010 5:36:56 PM |

    to come from other side, I have started to read Ray Peat's articles and he is big on the dangers and overhype of non saturated fatty acids , in particular omega 3. It makes sense that humans having developed in hot climate require primarily saturated fat to protect from heat, light and oxygen. There is a reason why fish oils smell and why vegetable oils must be deodorized, it's basically our body telling us that non saturated oils are bad for us. Ray Peat says these oils make our membranes "floppy" and our skin prone to photo dammage by the sun. Basically we need all the saturated fat we can get primarily from coconut oil and butter but polyunsaturated fats should be minimum and certainly no supplement. Read up here
    http://raypeat.com/articles/articles/fishoil.shtml
    http://raypeat.com/articles/articles/membranes.shtml
    http://raypeat.com/articles/articles/unsaturatedfats.shtml

  • Anonymous

    12/11/2010 6:57:14 PM |

    I take at least 900 EPA + 600 DHA fish oil daily. I usually take 1-2 softgels with each meal. I continue to experiment with higher doses, but so far, I can't tell the difference between 5 softgels daily vs 10 softgels daily except 10 softgels means 50 extra calories. Sometimes I actually need extra calories, so I've taken as much as 40 softgels in one day.

  • rhc

    12/12/2010 2:30:31 AM |

    I guess I'm the only one who actually LIKES chewing my fishoil capsules. To me they are like a treat! This has the added advantage of knowing for sure if they are rancid. I've been getting Sundown Naturals for over a year - never had a bad one yet. The taste is very mild and I they never make me burp.

  • Anonymous

    12/12/2010 2:53:27 PM |

    dr. davis i d like to know your take on this

    http://raypeat.com/articles/articles/fishoil.shtml

  • Travis Culp

    12/12/2010 7:27:04 PM |

    I've found that Barlean's cod liver oil is least offensive taste-wise, followed by Spectrum. Both are molecularly distilled. I have trouble finding Barlean's, however.

  • Anonymous

    12/12/2010 9:45:55 PM |

    In declaring EPA and DHA to be safe, the FDA neglected to evaluate their antithyroid, immunosuppressive, lipid peroxidative (Song et al., 2000), light sensitizing, and antimitochondrial effects, their depression of glucose oxidation (Delarue et al., 2003), and their contribution to metastatic cancer (Klieveri, et al., 2000), lipofuscinosis and liver damage, among other problems.

  • Anonymous

    12/13/2010 4:56:56 PM |

    Dr. Davis,

    Should Vitamin D gelcaps have an odor? I've been taking a generic drugstore brand and they always have an unpleasant smell, but I assumed they were supposed to.

    Thanks!

  • Vin

    12/13/2010 7:29:14 PM |

    @arnoud - phospholipid-bound Omega-3 appear to get incorporated into membranes 1.5 to 2X more than triglyceride or ethyl ester Omega-3. But Neptune researchers have not explained why krill oil reduces LDL more than Lovaza.

    @Geoffrey Levens - just about every food product has small amounts of PCBs. Yes, fish oil too. Cod and Shark liver oils typically have much higher levels. More on fish oil and PCBs here.

    Retroconversion of DHA to EPA is not very efficient. Roughly 10% of DHA gets converted to EPA. EPA to DHA far less efficient. Several metabolic factors affect these conversions. Bruce Holub at Univ Guelph has done great work on this. Check out PMID: 9507234 and 9076673.

    @John - Several brands have 700 - 900 mg Omega-3 per pill, like Lovaza.

    A few have 20-30% more Omega-3 than Lovaza:
    Minami Nutrition CardiO3
    OmegaVia
    Ocean Blue Professional
    RenewLife come to mind.

    These all have over 1000 mg Omega-3 per pill.

    Next-gen fish oil (pipeline) drugs like Epanova and AMR101 are mostly EPA - so worth looking into high EPA OTC formulas for a fraction of the price.

  • Kevin

    12/14/2010 12:05:36 AM |

    $2000 per month doesn't seem so bad.  For the three of us, two adults and one 18yr old, we pay $2600 per month.  But my wife had cancer twice:  Hodgkins Lymphoma 24 years ago and breast cancer six years ago.  Before doing anything that might be dangerous, I remind myself of the $1500 deductable.  

    kevin

  • Anonymous

    12/15/2010 8:27:27 AM |

    dr. davis

    i did some research and to answer my own question on fish oil...
    for those without heart disease (like me) 1 gram of fish oil is sufficient and should be taken with 4 grams of saturated fat otherwise fish oil slips through the intestines undigested. 4 grams of saturated fat is used for making the liver start bile production.


    -----------------------------------
    original question

    dr. davis

    i can't smell anything rancid in my distilled fish oil with orange flavour but its so weird its too heavy barely digests and stays as if stuck in the chest. feels horrible.

    not sure what to make of it.

  • Buy Resveratrol

    1/13/2011 9:41:21 AM |

    It is good; however the oil came from the liver. It can contain too much Vitamin A and it could be dangerous if u overdose. I suggest sticking with eating a variety of fish.

  • Anonymous

    2/12/2011 10:33:52 PM |

    ah great info.......i live in the UK and I usually take different supplements, plz cud u tell me what should i look for while buying the fish oil....tnx in advance Smile

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