"How I voted": After diet, exercise,Lowest Lipitor(1/2 a 10)and 1500 Niacin(high LP a)....my Cardio told me I was the only one of his patients able get to counts so low. And at that level he felt I would have "some chance for a little reversal". HDL70/LDL34/TR32/LPa30. I gave him a "2" because his tone of voice sounded forced to say "some chance" like he wasn't really convinced. Love your blog info....many thanks!

Dr. Davis,

I don't think there is a lot of inconsistency. I first got a scan because my Dr. was frustrated with me for not wanting to do the statin and niacin and lisinopril that he thought were needed. So he challenged me to get a heartscan. I'd never heard anything about them before. Once I came back motivated he was delighted. So, the only reason I got a scan was that I had a Dr. who already thought that heart disease was reversible, though to a more limited degree than you have documented.

Before I got the scan I found your book and site and took your advice on EBT.

When I talked to the cardiologists in the HMO, the first and supposedly the most flexible one told me that it was not reversible. The others were downhill from there. The primary care Dr's of 4 close friends that I keep bugging on this issue all either deny the usefulness of scans and/or maintain that niacin is useless if you are on a statin. (I guess they don't even read the NYtimes.)

So, I think you got the responses you did because one way people come to this program is through Drs. that already know a bit more than the average Dr. about these issues. I find it very hard to motivate friends on these issues if their docs are not supportive, even if they have terrible scan scores.

Best,
Jim

May be the result is not such a surprise because the question is not answered by a random group.

Most of the people who read this blog are already aware that heart disease is reversible. Majority with heart problems are not aware and are not told by their doctors that such a possiblity exists.

It would be interseting to find out what course the "reversible" doctors take to achieve reversal: is it drugs to lower LDL and raise HDL or low fat diet or TYP.

Hello Dr.Davis
I responded heart disease is reversible because of data that I have read and personal experience on body's ability to heal.

Also just a thought that your survey results might be weighted because people reading this blog would tend to be better informed. They also must think there are positive results in proactive (and preventive) health management to invest time in reading this blog, etc..

One other thought - it seems that doctors do prescribe activities that they think reverses ( or at least halts) heart disease - such as quit smoking, lose weight, exercise, etc..
But they aren't paid to educate - they are paid to treat disease (as you have pointed out so many times; there is no money in prevention).
It seems like we need a new mandatory addition to the public education system.

I am subscribed to the newsfeed of this blog, and try not to skip over anything you post. But perhaps I missed something, because you bashed nattokinase in a few of your recent posts.

Isn't nattokinase also called natto, which is high in K2? Didn't you post about how it could be promising here:
http://heartscanblog.blogspot.com/2007/12/food-sources-of-vitamin-k2.html

Maybe I didn't understand the December post, or maybe you've changed your views on it.

Well back to this posts theme: my parents dropped in from their motorhome-gypsy trip, and my father told me about his GP, who's a DO, that has him taking the supplements you recommend, as well as on a low-glycemic diet to control his newly diagnosed diabetes.

His fasting sugars now range between 110-120s without pills or insulin, but he didn't know his cholesterol profile. I'll have to follow up with him via snail mail to ask him about that, now that I have their national forwarding address (it's difficult to finish a conversation with him with interruptions from my mother -- I asked my father his DO/GP's name, but instead I got my mother's doctor's name for her condition, sigh).

I mentioned K2 to him, so now I'm wondering if I should tell him to forget it.

Hi Doc:
My cardiologist says that heart disease can be reversed by driving down LDL, pure and simple.  He has no interest in any other numbers.  To accomplish this he prescribes statins, and has not counseled me about any other lifestyle changes.

I agree with what others have said.  The people who would take time to read your blog are better informed and probably seeking out better than average medical advice.  My doctor is very proactive on many things and not just a pill pusher.  In fact I would not continue to visit a doctor that is just pushing pills, surprisingly to me, there still seems to be a lot of people in the country that think that because their doctor has perscribed them something it is totally safe.

Now wait a minute: Where is the disconnect? Why are doctors saying that heart disease is reversible, yet not following this concept in practice? Contrary to the survey results, I have yet to meet a patient who said their doctor was trying to reverse their heart disease. Of course, this may be a skewed population, but I find it hard to believe that the prevailing view is that heart disease is reversible.

I appreciate the concern which is been rose.This is a wonderful opinion. The things mentioned are unanimous and needs to be appreciated by everyone.

Well, it’s amazing. The miracle has been done. Hat’s off. Well done, as we know that “hard work always pays off”, after a long struggle with sincere effort it’s done.
--------
johndouglas

Cycle Covers Motorhome Facts

I'm probably way off here, but vitamin D derivatives are mainstays of topical therapy for chronic plaque psoriasis; I have to wonder if coronary plaque can form if vitamin D is deficient since vitamin D is involved with insulin regulation and insulin and hyperglycemia is also implicated in heart disease; often those with diabetes are found deficient in vitamin D, and they're a population most at risk for heart disease?  Makes you wonder, doesn't it?

You're absolutely right. There is solid evidence that vitamin D deficiency increases diabetic patterns, including higher blood sugar and insulin levels. Whether this is part of the reason why vitamin D might exert benefits on coronary plaque remains uncertain. I suspect that there are many reasons, this being a major one.

You may be interested in the following papers.
The case against ergocalciferol (vitamin D2) as a vitamin supplement.
http://www.ajcn.org/cgi/content/abstract/84/4/694
Risk assessment for vitamin D
http://www.ajcn.org/cgi/content/abstract/85/1/6
http://www.ajcn.org/cgi/content/full/77/1/204
Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol

Dr. Prendergast has posted today an astonishing story of benefit from D3. The patient was switched to D2 in an effort to move to generic alternatives and he went rapidly downhill toward death. The mistake was discovered, the patient was switched back to D3 and he immediately recovered.
Here's the link to the short video:
http://enews.endocrinemetabolic.com/2007/11/generic-wars.html

Thanks for the heads-up, Rich. It is truly an astonishing story.

Dr Davis!
   Sometime back I had posted a comment on your entry about wheat. And you had suggested that my Vitamin D3 levels might be low. Your diagnosis from 3000 miles away proved right! I had a 25-OH-D3 test and the value was less than 4ng/ml. I consulted my cardiologist and he brushed away the fact and asked me to drink more milk! I'm planning to switch doctors now.
   My copy of TYP reached me and I'm through cover to cover. The level of  details in the book is amazing and I've started correcting my lifestyle, food habits and medicines(of course, after discussing with the doctor).
   Many doctors here prefer a CT angiogram to a heart scan. My doctor was unable to give a good reason for why I should not have a heart scan but a CT angiogram. ("You are too young to have a heart scan"). So the situation here in India is no better.
  Many thanks!
-Neelesh

Then I suppose I am the imperfect carnivore-tendency towards high Lp(a) which is recently under control but also apoE3/4 which suggests limiting fat (or is it just saturated fat?).  Limit carbs...no, limit saturated fat.  OK, so that leaves lean meat, avocadoes, nuts and non-starchy veggies, right?

Not necessarily, Buckaroo.

The apo E4 introduces a trait of highly variable fat-sensitivity.

Perhaps this is something worth discussing in future.

I'll second a request for your opinions on what to do when you're ApoE ε3/ε4 or ε4/ε4! This is very interesting, but just the beginnings of personalized medicine.

Dr. Davis,
I have extremely elevated Lp(a) (190 mg/dL) that hasn't budged despite 2 g niacin  and  4 g  fish oil daily.  I am seem to fit several of your descriptors, i.e. thin, premature CHD at. 47, LDL that is resistant to lowering beyond 85 mg/dL despite statin and niacin therapy, borderline fasting glucose etc. Always been very physically active and that hasn't changed despite one stent.

However, I am not and don't want be to be a carnivore. Any other options?
Thank you.

Anand

What level of Lp(a) do we need to be concerned about?

I would welcome a more in-depth discussion of the role of fat sensitivity in apoE4.  I've not been able to find anything remotely like a consensus on PubMed, and The Perfect Gene Diet which addresses was a big disappointment.

Well, I just got my Lab Results back and I am the lucky carrier of Lp(a) as well as Apo E3/4 and probable FH or FDB. LDL-C Direct 205, HDL-C 95, Triglycerides 52, LDL-P1969, LP(a) Mass 64, LP(a) Cholesterol 13. I have been wheat free, sugar-free, low carb, high fat for about 3 years. Looks like I will have to make some changes, but feel uncertain because high fat is what has really helped me lose weight. Without the fat, I have cravings. Higher carbs are no good for me. Would coconut oil perhaps lead to better results?

Hmm, I've recently learned I have lipoprotein(a). I am definitely not an endurance athlete (I adore sports where I can go hard for a minute and then recover), but the rest of the sketched profile fits.

I'm not sure how I feel about your assertions wrt carb tolerance as it applies to me, though. If I eat by preference with no effort to restrict, I get on average 100g carb/day (a bit less if there are no social demands), but higher or lower levels of carbohydrate don't seem to make too much difference in my blood glucose readings (or mood or ability to lose weight). I have had some wild effects from medication, though: the Mirena IUD (levonorgestrel) in particular caused a crazy post-prandial rollercoaster and elevated fasting glucose for a couple of months until I pulled the plug.

I am ApoE 3/4, and I have followed this issue closely. You may find some useful advice on Dr. Kruse's Optimal Living site, especially in his EpiPaleo diet - http://jackkruse.com/brain-gut-6-epi-paleo-rx/.

Hi Susan,

Instead of coconut oil i would rather suggest to have some high calorie food, because oil makes you increase of cholesterol not fat , having high calorie food like cereals will also help in have some energy in the body

Dr. Davis,

I am working on bringing my husband's Lp(a) 14 and apoB 109 down.  His current pattern is A/B smack in the middle.  What confuses me is saturated fat. How is this good for bringing down your numbers (assuming your not apoe4) when it is also highly inflammatory.  Perhaps this is in the book but it hasn't arrived yet.
Thanks.

Celeste

Look at this article on kidney failure in sugar cane workers...horribly fascinating.

http://openchannel.nbcnews.com/_news/2012/10/16/13866856-mystery-kidney-disease-decimates-central-america-sugarcane-workers?lite

It is hard to believe that regular readers of this blog will consider cereal in their diets.

I just got my first VAP test results back and my Lp(a) is 12 mg/dL.  I probably fit your description pretty well, except I have no idea if I get diabetic if I eat lots of grains.  I used to be semi-vegan but I was a marathoner at the time.  I do know that back then I would get very hungry every 2 hours and I would gain weight pretty easily if I stopped doing so much cardio.  My LDL has gone up (116 now, pattern A, was 94 a year ago) since going paleo 1.5 years ago, but my HDL is also up (95, was 85) and my trigs are down (55 now, was 65).

Thanks for the info!  I'll keep my carbs low as I can while keeping my energy up.  I know if I don't eat some starches I start to feel pretty awful, especially during certain times of the month.  I guess I should start using a glucometer!

Dr. Davis,

My VAP test showed that I have an Lp(a) of 12 on a normal scale of 1-10.  A specific Lp(a) blood test showed that I have an Lp(a) of 250 mg/dL.  Do you see such discrepancies often?  How can both tests possibly be right?

Thanks.

Kinda disliked that the text encourages confirmation bias, but had a private test for lp(a) anyway ($50, pretty cheap info).  It was predictably, very high, which matched up to the NMRLipo derived suspicions I had, big numbers were all awesome, with a bajillion ldl-p and very near diabetic a1c & insulin resistant! lol.

Needless to say, sugar and refined grains are now mostly deleted.    Keeping a <10% cap on carbs for now; not sure I can manage a smaller cap, but we'll know if that change was sufficient in a couple more months.

If someone needs a reason why lp(a) and associates would be evolutionarily advantageous?   On a distance hunt, away from village support, quick repair is better than good repair; and a downed hunter may not have much meat, but will have some body fat, and will have dried fruit.   Sugar+injury+gobs of sticky things in the blood, good nuff to be back in the game quickly (if painfully).    No one cares if their hunters die at 55 instead of 75.

nb... objectively measured, I fit your stated tendency characteristics exactly.   I'd kinda like to live past 55 though.

Hi Dr. Davis,
My husband has very high Lp(a) at 30 years old. We are trying to get on the right diet to help him so he can live a long life and not die of a heart attack at a young age like his mother, uncle and both grandfathers. You seem to be very knowledgeable in regards to Lp(a) levels in cardiac patients. His doctor is not and we are currently doing the Caldwell Esselstyn diet (plant-based, low-fat) to reverse plaque build-up. Reading your blog suggests to me that we are on the wrong track. Can you please point me to the research papers from which you derive your specific conclusion that high Lp(a) carriers should be carnivorous?
I would greatly appreciate any help!
Thank you so much,
Mar

How about eggs, dairy and fish?

And be sure to take low-dose aspirin, which has been shown to "abolish" the incremental risk of having Lp(a).

Dr. Davis,

I've had high Lp(a) readings in the past.  I've lost 35 pounds and dropped 4 meds, by eating low-carb, high-fat.  It's a now a lifestyle for me, not a temporary diet.  And I get plenty of fish oil, so I'll see what your recommendations do for my Lp(a).

I'm curious what you think of this study:  http://www.atherosclerosis-journal.com/article/S0021-9150(08)00522-4/abstract .  For the women in this study, the incremental Lp(a) risk was from having a minor allele in the LPA genotype, and for those women in this large study, low-dose aspirin eliminated that incremental risk.

I've been taking daily aspirin too, but now I think I know how it helps.

Thanks for all you do!