Carotid plaque can be shrunk

28. May 2006 William Davis (1)
Rose, a 64-year old woman, just had a 70% carotid blockage identified by a screening ultrasound. When the result was given to her doctor, he prescribed Lipitor and told Rose that an ultrasound would be required every year. She would need carotid surgery, an "endarterectomy", if the blockage worsened.

"Can't I reduce the amount of blockage I have?" asked Rose.

"No. Once you've got it, it doesn't get any better."


Is this true? Once you've got carotid plaque, you can only expect it to get worse and it can't be reduced?

This is absolutely not true. In fact, compared to coronary plaque, carotid plaque is easier to reduce!

Of course, the Track Your Plaque program is designed to help you control or reduce coronary plaque. But, in our experience, people who have both coronary and carotid plaque will show far greater and faster reduction of carotid plaque. Dramatic reductions are sometimes seen. I've personally seen 50-70% blockages reduced to <30% on many occasions.

The requirements to achieve reduction of carotid plaque are very similar to the approach we use to reduce coronary plaque. One difference is that hypertension may play a more important role with carotid plaque and needs to be reduced confidently to the normal range before carotid plaque is controlled.

I find it shocking that the attitude like the one provided by this physician continue to prevail. Unlike coronary plaque, which has a relatively small body of scientific literature documenting how it can be reduced, carotid plaque actually enjoys a substantial clinical literature. Part of the reason is that the carotids are more easily imaged using ultrasound. (Heart structures can be seen with ultrasound, but not the coronary arteries.)

Numerous agents have been shown to contribute to reduction of carotid plaque: statin drugs, niacin, fish oil, the anti-diabetic "TZD" drugs (Actos, Avandia), several anti-hypertensive drugs, vitamin E, pomegranate juice, and several others.

It outrages me to hear stories like this. Rose is not the only one.

Don't accept the flip dismissals or the over-enthusiastic referral for carotid procedures. Insist on a conversation about plaque regression.


Note: Although I am a vigorous advocate of atherosclerotic plaque regression, this does not mean that if you have a severe (70% blockage or greater), or if there are symptoms from your carotid disease, that you should engage in a program of reversal. You must always take the advice of your doctor if your safety is in question.
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Comments (1) -

  • buy jeans

    11/3/2010 7:35:40 PM |

    The requirements to achieve reduction of carotid plaque are very similar to the approach we use to reduce coronary plaque. One difference is that hypertension may play a more important role with carotid plaque and needs to be reduced confidently to the normal range before carotid plaque is controlled.

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What's important, what's not in your plaque-control program

What's important, what's not in your plaque-control program

6. July 2006 William Davis (0)
Sometimes it's hard to know what is really important in your plaque-control or plaque-reducing efforts.

There are, indeed, crucial make-it-or-break-it factors that are necessary to gain control over plaque. If you hope to stack the odds of reducing your heart scan score as much as possible in your favor, then fish oil, vitamin D, 60-60-60 in the way of standard lipids, elimination of small LDL, etc. -- all the elements of the Track Your Plaque program--are necessary.

But there's lots of things that sidetrack people. I spend much of my day fielding questions from patients about all the things that either provide very little benefit for plaque control, or provide none at all.

Among the things that we have found to be too weak or useless for plaque control, or are "non-issues", include:

--Caffeine--Go ahead and enjoy a couple cups a day (though not a pot). The effect is too trivial to make much difference.

--Hawthorne--Yes, it may dilate coronary arteries modestly, but not enough to make any difference.

--Garlic--with the possible exception of a specific preparation called Aged Garlic Extract (an acqueous, non-oil-based, extract from Kyolic), garlic's effects are too tiny to help, e.g., drop in blood pressure 1-2 points. Use it, but don't expect much. Aged Garlic Extract may be an exception, in that a single study from UCLA suggested specific effects on slowing coronary plaque growth. We await more info on this.

--Anti-oxidants--There is no shortage of extravagant claims about the benefits of anti-oxidants. Unfortunately, there's very little human exerience with pine bark extract, pycnogenol, grapeseed extract, and so on. Is the purported benefit from anti-oxidation or through some other means, e.g., enhancement of nitric oxide synthase? No data.

--Policosanol--If you've followed the Track Your Plaque Special Reports, you already know what a disappointment this agent has been, despite the too-good-to-be-true clinical data. It doesn't work.

--"No-flush niacin"--Unfortunately, no flush, no effect. This high-priced supplement is still sold widely in the U.S. despite its complete lack of efficacy. It does not work in humans. (It works great in rats!)

Track Your Plaque continues to try to be the arbiter of truth in what works, what doesn't in truly stopping or reversing your coronary plaque. The proof positive? Stopping or dropping your heart scan score.
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A dirty little secret

A dirty little secret

21. April 2007 William Davis (0)
Here's a dirty little secret many people don't know about.

If I implant a stent, I might get paid somewhere around $2000 for the heart catheterization, stent implantation, femoral artery closure device, hospitalization charges. That's not too bad.

But what if I'd like more? What if I'd like to squeeze this unsuspecting patient for more, or actually his/her insurance company?

Easy: Add on complex procedures to the basic procedure that yield more professional charges. For instance, I could perform laser angioplasty, a procedure that adds another couple thousand dollars. I might pull out the old rotational atherectomy device, a high-speed diamond tipped drill that also adds substantial professional charges. I might also use the intracoronary ultrasound device, an otherwise helpful device, but I might pull it out to use on everybody.

With the exception of ultrasound, all the "add-on" procedures were more popular in the early and mid-1990s--before they were shown in clinical studies to provide no advantage, perhaps even add to procedural risks.

Thus, a patient might undergo a heart catheterization, balloon angioplasty with stent implantation into the proximal left anterior descending coronary artery (LAD), followed by laser angioplasty of the mid-LAD, followed by intracoronary ultrasound of the vessel. Next, rotational atherectomy of the circumflex, followed by stent and ultrasound. Total charges for this 2-3 hour procedure? Somewhere around $8000 to the cardiologist. Of course, hospital charges are far more.

Ironically, patients are invariably impressed. Hearing that they went through all sort of high-tech procedures makes them grateful for receiving the benefits of the skills of their cardiologist. Of course, they would like have done as well with a far simpler procedure. Perhaps they didn't need the procedure at all.

If the excessive use of procedures and devices fails to benefit patients, why don't hospitals discourage it? Two reasons: 1) It's difficult to legislate or regulate decisions made on judgement, which can be a tough issue with many fuzzy edges, and 2) hospitals made oodles more money from the practice.

If you have a salesman in your new car lot and he outsells all his colleagues by 30-50% and makes you a couple hundred thousand a month more in sales. You've watched him at work and he's clearly good at it. But you suspect that he pushes the envelope of propriety frequently--badgering customers, add rustproofing to a little grandmother's car that will be driven 3000 miles a year, selling cars for prices far above what they would have sold for had the customer bargained more vigorously.
do you put a stop to it at the risk of pushing your star salesman away? Few would.

Only a minority of my colleagues are guilty of this despicable practice. I only know of a few who openly do it. Hopefully, you're not among their patients.
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Metabolic syndrome--cured

Metabolic syndrome--cured

27. February 2007 William Davis (0)
Peter started out at age 59 at 248 lbs, standing 6 ft tall (BMI = 33.6!).

Along with his weight, Peter had the entire panel of phenemena of the so-called "metabolic syndrome", or pre-diabetes:

--Triglycerides 238 mg/dl and associated with extremes of excess VLDL and IDL
--High blood pressure
--Blood sugar 115 mg/dl
--High c-reactive protein
--Small LDL particles 99% of total LDL

Interestingly, Peter's HDL was a surprisingly favorable 58 mg/dl (HDL is usually low in this syndrome). However, when broken down by size, he had nearly zero large, healthy HDL (sometimes called HDL2b). Though total HDL was favorable, most of it was simply ineffective.

Peter eliminated snacks and processed foods, particularly bread; increased his reliance on healthy oils and lean proteins; incorporated soy protein; increased vegetables. He added 30 minutes of a rapid walk on a treadmill every day. He added vitamin D to achieve a blood level of 50 ng/dml. He added a magnesium supplement.

Peter has lost 31 lbs. in the last year. Weight 207 lbs., BMI 28.1 (desirable <25). Blood sugar: 96 mg/dl; triglycerides: 56 mg/dl; HDL 71 mg/dl with 35% in the large fraction; small LDL 45% of total. Not perfect, but a damn site better.

Control of metabolic syndrome is an achievable goal for over 90% of people, just with these simple efforts. We haven't yet had a chance to assess the effect on the progression or regression of Peter's heart scan score, but he has, at the very least, spared himself a future of diabetes and all its complications.
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More catheterizations would make me happy!

More catheterizations would make me happy!

11. October 2006 William Davis (0)
I received this fax today from a cardiologist seeking a position:

"I would prefer to perform as many interventions [stents, angioplasties, etc.] as possible..."

That about sums it up, doesn't it? The goal of this young man, trained in major universities including Columbia University, Harvard, and Emory, is not to pursue an avenue of investigation or healthcare that yields real answers. His goal is to perform as many procedures as possible.

This attitude is deeply ingrained in cardiologists. It's also shared by all procedural medical specialties: the drive to do more and more procedures. It's not because it does more good for the public, but it fulfills a primitive impulse to spread your influence, enlarge your territory, and--of course--make more money.

Personally, I find this impulse repulsive. The fact that this young cardiologist looking for a position is willing to make this statement out in the open demonstrates how widely accepted this attitude is. Imagine your cancer surgeon, looking for a new job, said, "I'm looking to remove as many tumors as I can."

My colleagues have lost sight of the fact that we're trying to reduce or eliminate disease, not enrich our pockets or service some primitive impulse to beat others at our game.
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Do the math: 41.7 pounds per year

Do the math: 41.7 pounds per year

14. October 2011 William Davis (21)
Consumers of wheat take in, on average, 400 calories more per day. Conversely, people who eliminate wheat consume, on average, 400 calories less per day.

400 calories per day multiplied by 365 days per day equals 146,000 additional calories over the course of one year. 146,000 calories over a year equals 41.7 pounds gained per year. Over a decade, that's 417 pounds. Of course, few people actually gain this much weight over 10 years.

But this is the battle most people who follow conventional advice to "cut your fat and eat more healthy whole grains" are fighting, the constant struggle to subdue the appetite-increasing effects of the gliadin protein of wheat, pushing your appetite buttons to consume more . . . and more, and more, fighting to minimize the impact.

So, if you eat "healthy whole grains" and gain "only" 10 pounds this year, that's an incredible success, since it means that you have avoided gaining the additional 31.7 pounds that could have accumulated. It might mean having to skip meals despite your cravings, or exercising longer and harder, or sticking your finger down your throat.

400 additional calories per day times 365 days per year times 300,000,000 people in the U.S. alone . . . that's a lot of dough. Is this entire scenario an accident?

Or, of course, you could avoid the entire situation and kiss wheat goodbye . . . and lose 20, 30, or 130 pounds this year.
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Comments (21) -

  • Keenan

    10/14/2011 3:56:07 AM |

    On Sept. 10 I stopped my consumption of wheat containing foods and multi-grain rice crackers. Two weeks later I began having aching elbows which have not bothered me for years. I'm a 65 yr old male, thin with a bit of a 'wheat belly'  which is shrinking but my muscle mass is also shrinking. Have you heard of anyone experiencing changes in joints after stopping wheat and grains?

  • David Klatte

    10/14/2011 10:58:16 AM |

    That math isn't right and it is pretty misleading because a person who ate 400 more calories per day would gain weight up until they reached an equilibrium. It would be better to use something like the Harris Benedict equation to get a sense of how bad that is.

    I did that for a six foot 180 pound male who is 30 years old who is lightly active. Such an individual would maintain their weight at about 2246 calories per day. If they instead consumed 2646 calories per day, you would expect their weight to top off at about 244.7 pounds after some period of time. About a 65 pound gain, so nothing to sneeze at.

  • Dr. William Davis

    10/14/2011 12:48:30 PM |

    Hi, Keenan--

    I've only seen relief from arthritis, not a triggering of arthritis. That's strange.

    Of course, we are all subject to conditions that fall outside of wheat. It will be interesting to see whether this persists.

  • Dr. William Davis

    10/14/2011 12:49:04 PM |

    Thanks, David.

    Yes, this was hardly a scientific analysis, just an argument to graphically illustrate what we are battling.

  • Philippa

    10/14/2011 12:51:54 PM |

    This would be actionable advice across the Atlantic in the UK, where the Health Minister landed himself in a controversy this week by annoucing the Brits need to cut 5 billion calories off their annual diet.
    http://www.dailymail.co.uk/health/article-2048738/Jamie-Oliver-blasts-Andrew-Lansleys-plan-tackle-obesity.html

  • Teresa

    10/14/2011 8:23:30 PM |

    I couldn't post this below about the drug companies.  

    While I agree that a person should not be made to take medications against their will, what am I to do for a patient with a blood pressure of 220/110, on several occasions?  I have had a few.  They refused meds, and also refused to make any diet or lifestyle changes that may have helped.  While I haven't discharged any patients because of this, I do make sure they know the potential consequences of severe hypertension, including death.  Or worse, complete paralysis on one side, requiring total care.  Sometimes it's a matter of lesser evils.

    More of my patients want the  pills, because they are unwilling to do anything else to help their condition, even though I encourage them, and offer referrals for further education.  I hear it's too complicated, or their insurance won't cover it and it's too expensive.  I doubt I could make a living in my community without a prescription pad.  I wish I could!  I'll keep trying.

  • Princess Dieter

    10/14/2011 9:29:06 PM |

    Just a heads up (although you may have already seen it) is that Gillian Riley, the UK expert on food addiction/breaking out of overeating, recommended WHEAT BELLY in her October newsletter. http://www.eatingless.com/archive-newsletters.html#

    I've often recommended Ms. Riley's books--EATING LESS ; BEATING OVEREATING; and WILLPOWER!--to fellow hyperconditioned overeaters.

    Not eating wheat/sugar  sure helps in the "not overeating" dept. Laughing And Gillian is on board with that.

  • Corey

    10/14/2011 9:42:55 PM |

    Love your site doctor, but this is a terribly naive and simplistic approach. Calorie numbers are irrelevant, it's the kind of calories. Yes, I understand that the 400 you mention would most likely be 400 calories of additional carbs, but calories in/calories out don't determine weight now, do they?

    Really shouldn't post anything reinforcing the outdated but still omnipresent "calorie equilibrium" theory (fairy tale is more like it) of weight gain.

    Otherwise, keep up the good work.

  • Rieland Rigg

    10/15/2011 1:30:51 AM |

    I guess that explains pretty clearly why I've been able to lose about 40 lbs so far in 9 months... Smile

  • Ted Hutchinson

    10/15/2011 9:14:49 AM |

    If you live in the Northerm hemisphere Vitamin D levels drop from September through to March unless effective strength supplementation is implemented.
    Also 65yrs old the natural production of the antinociceptive, anti-inflammatory, antibiotic, antioxidants melatonin and vitamin d will have declined (by age 75 only 25% of vit d capacity is possible if sufficient 7-dehydrocholesterol remains in skin) so everyone becomes far more sensitive to pain/inflammation (and infection).  You can replace the missing Vitamin D3, melatonin with at least 5000iu/D3/oil based gelcap and 3mg Time Release melatonin (Also pay strict attention to improving natural melatonin secretion by using Flux getting outdoors midday and total darkness while asleep. ) Search this site for good Vitamin D3 & Melatonin information.

  • Kris

    10/15/2011 12:11:25 PM |

    A few months ago I did an experiment and cut all wheat and sugar out of my diet.

    That is, if it would contain even a trace amount I would not touch it. I managed to follow this approach for two months, I didn't measure my food intake but my body fat dropped quite a lot and I could see much more muscle definition, especially in my abdominal area.

    Personally I think sugar and wheat are the two main contributors to obesity, and I think the "minimum effective dose" for optimal health would be to remove those two ingredients completely. And of course that doesn't allow any room for "cheat meals" like some people think.

  • Dr. William Davis

    10/15/2011 1:25:26 PM |

    Well said, Chris.

    I agree. In particular, I find that no wheat is far better than less wheat. I believe this is mostly due to the appetite-triggering effect of wheat gliadin.

  • Linda

    10/15/2011 1:27:22 PM |

    @Ted
    I am also living in the Northern Hemisphere [Iowa] and do not get nearly as much sunshine as I should.I tend to be a hermit and spend most of my day inside.  Also over 65. I am taking 5000 IU a day of Vit D, gelcaps.
    Without a lot of testing, is there a way to determine if I should take more and, if so, how much. My biggest concern is tightness in the hip area every morning.

  • Dr. William Davis

    10/15/2011 1:28:17 PM |

    Well, Corey, allow me to elaborate on my "terribly naive and simplistic approach."

    This is clearly not a scientific analysis, but a simple effort to illustrate what happens with simple math what could theoretically happen with an additional 400 calories per day intake but ignoring all other factors, such as proportion fat vs. carbohydrates.

    So of course this is simplistic. It just makes the point that the increased calorie consumption triggered by wheat gliadin has potentially huge effects.

  • Dr. William Davis

    10/15/2011 1:44:40 PM |

    Good to have friends in this battle, Princess!

    We are up against the incredible financial and lobbying might of vertically-integrated Agribusiness and Big Food, who have billions of dollars to allocate on lobbying, marketing, and pushing their agenda. We have social media, the internet, and our wits.

  • Dr. William Davis

    10/15/2011 1:46:00 PM |

    Hi, Dr. Teresa--

    That's all you can do: Keep on trying.

    I'm impressed that you DO try, since most of our colleagues pay no mind whatsoever to even considering genuinely effective dietary changes.

  • Dr. William Davis

    10/15/2011 2:16:54 PM |

    Hi, Philippa--

    Let's see: England, population 51 million times 400 calories per day, times 365 days per day, equals 7.446 x 10,000,000,000,000 calories, or several thousand times more than the Health Minister proposes.

    5 billion calories would be child's play.

  • Ted Hutchinson

    10/16/2011 8:41:41 AM |

    I don't think there is any way anyone can accurately predict their 25(OH)D level either from uvb exposure or daily supplement usage. It depends on individual response. The banner graph at GRASSROOTSHEALTH.ORG shows for any regular daily intake the 25(OH)D achieved varies up to 100ng/ml. Taking 5000iu daily D3 only increases your chances of staying around 50ng/ml  but you could be anywhere between 20ng/ml and 120ng/ml without testing you can't know. After you've had a few tests you get to the point where you can predict the result but it's still worth retesting annualy to make sure nothing's changed. You should be able to find a 25(OH)D test for $60.

  • Fat Guy Weight Loss

    10/16/2011 3:11:20 PM |

    I eliminated sugar and wheat from my diet just from the observation that the food did not keep me full as long compared to other foods of same number of calories.  Not only led to weight loss but also eliminated my ocassional GERD as well as frequent stomach discomfort.  Now I have even more reasons to stay off the stuff and now being 95% wheat free (indulge in ocassional small portion of dessert) I no longer crave these foods and feel great.

  • Dr. William Davis

    10/18/2011 12:52:08 AM |

    How about "Skinny Guy Weight Loss"? (I didn't feel right calling you "Fat Guy . . .")

    It's such a simple formula for returning to health. I, personally, experienced relief from the same gastrointestinal effects. With any small indulgence, I am provided a graphic reminder of how it used to be.

    Stay strong. Your body will be grateful!

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