Dr. Davis Primer

Whenever I implicate carbs instead of fat as a major risk factor for obesity and heart disease, I am met with rolling eyes and eventually that look that says “you’re insane.”

In an ongoing effort to convince my audience that I am NOT nuts, I encourage them to read the advice of someone with better qualifications on the subject: a cardiologist.

Not just any cardiologist mind you, but a rare breed actually concerned with prevention:
Dr. William Davis.

Dr. Davis’ Heart Scan Blog is full of great info but there is a LOT to wade through.

   
To make your first encounter with Dr. D easier, let me start you off with a few recommendations:
 

1. Know your risk factors for heart disease

• What your doctor doesn’t know about heart disease
• Cholesterol Score vs. Heart Scan
• Cholesterol effects of carbohydrates
• The myth of mild coronary disease
  hint: there’s no such thing as mild blockages
   

2. Understanding cholesterol Values
The LDL/HDL/Total cholesterol numbers are NOT a good indication of your risk of heart disease. These number can mislead by underestimating or overestimating risk. Learn what Lipoprotein analysis (NMR) is and understand what small LDL particles are.

• Why average cholesterol values can be so bad
• Tale of Two LDLs
• When LDL is more than meets the eye
     

3. Reducing your risks and reversing heart disease
There is no one post that pulls this all together* but his advice is consistent:

• Eliminate sugars, wheat and cornstarch
  Eliminate–not reduce, but eliminate wheat products from your diet, whether or not the fancy label on the package says it’s healthy, high in fiber, a "healthy low-fat snack", etc. This means no bread, pasta, crackers, cookies, breads, chips, pancakes, waffles, breading on chicken, rolls, bagels, cakes, breakfast cereal. This includes…
   
• Eliminate junk foods
  such as candies, cookies, pretzels, rice cakes, potato chips, etc.
   
• Take Omega 3
  It must be from fish oil There is no need for expensive brands like Lovaza (aka Omacor). Dosing frequently (eg 2-3 times per day) seems to enhance the effect. Take a minimum EPA + DHA of 1200 mg per day (ie 4000mg standard fish oil) or more.
   
• Take Vitamin D3
  This should be oil based (ie gel not tablet). Dr. D has on occasion recommended Carlson’s and Vitamin Shoppe brands.
  "Though needs vary widely, the majority of men require 6000 units per day, women 5000 units per day. Only then do most men and women achieve what I’d define as desirable: 60-70 ng/ml 25-hydroxy vitamin D blood level." ref
   

Dr. D has also mentioned that exercise may enhance the benefits of these changes but he does not discuss exercise much.

Likewise he has stated that one should not allow saturated fats to dominate but again his blog does spend a lot of time on this recommendation. In this respect he is more conservative than much of the low-carb community particularly given that he remains anti-egg yolk: "One yolk per day is clearly too much."

More info:

• Blast Small LDL to oblivion
• Wheat Free and weight loss
• C-Reactive Protein can be reduced
• "High-dose" Vitamin D
• Omega-3 acids: Frequency vs. quantity
• You probably don’t take enough fish oil
• Some basic vitamin D issues  

* Note that this list is my own compilation from various posts and may not accurately reflect Dr. Davis’ protocol due to errors of omission or emphasis.

Dumbest Headline Today

Science Daily
Too Much Protein, Eaten Along With Fat, May Lead To Insulin Resistance

I’d love to know who funds this stuff. Turns out that while you thought the insulin response was a reaction to carbohydrates, the real culprits are fat & protein.

Ideology trumps evidence

Fantastic opinion piece in the NYT:
Believing in Treatments That Don’t Work

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

The critical question that looms for health care reform is whether patients, doctors and experts are prepared to set aside ideology in the face of data. Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?

And when we insist on evidenced based healthcare, will our doctors accept it?

High Cholesterol – Low Triglycerides

I recently got my lipids tested. Unfortunately I do not have access to detailed subfraction tests so I was only able to get the high level numbers.

I’ve been low-carbing for quite a while now. I’ve generally had good cholesterol figures so this would be telling for the increased consumption of fat in my diet.

The results, however, were a bit confusing:

Total cholesterol LDL HDL Triglycerides

229 – high 154 64 54 – low

 

My total cholesterol number has climbed significantly over the past 2 years (it was ~170 before) which is a concern. However the low triglycerides with the high cholesterol figure gives contradictory risk indications for heart disease.

Now I’m aware that not all LDL are created equal but I wanted some definitive advice on this point (it wasn’t coming from my doctor who didn’t even remark on the triglyceride number).

In my searching, I found this interesting and succinct comment on the subject here which I am reprinting as it addresses my question directly:

LDL cholesterol can be broken down into two kinds, pattern A and pattern B. LDL pattern A is large fluffy particles that are less dense than pattern B and not easily oxidized. LDL pattern A is essentially benign with respect to heart disease. LDL pattern B on the other hand is small dense particles that are easily oxidized and more closely associated with heart disease. It has been theorized that the harm to the arteries is associated with oxidized cholesterol. Ok, enough about that. To summarize, LDL pattern B (think small dense BBs) is bad, LDL pattern A (light and fluffy) is not a problem.

Now you would think that the lab actually measured your LDL, but they likely didn’t. Most labs just calculate LDL from the following equation:

LDL = Total Cholesterol – HDL – triglycerides/5

So from this, you don’t know if you are predominately LDL pattern A (no big deal) or predominately LDL pattern B (much more risk). Some labs do have the capability to measure the LDL gradient and can determine your predominate LDL pattern type. However, there is another way. Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (the non risky kind), and conversely, a high triglyceride/low HDL level is strongly associated with LDL pattern B (the harmful kind). This is one reason that high triglycerides alone are an independent risk factor for heart diease.

Ok, where am I going with this with respect to your situation. Other studies have shown that a high triglyceride/HDL ratio is the best indicator for heart disease risk (approximately 8x better at predicting heart disease risk than high total cholesterol alone). A triglyeride/HDL ratio of 5.0 is moderate risk and the higher the number, the higher the risk, while a ratio of <2.0 is very low risk.

From what I have just described, you can see that with your very low triglyceride level (<100) and moderately high HDL level (>50) you are at very low risk of heart disease. Also, your very low triglyceride level indicates that your LDL is predominately pattern A, the harmless kind. If you are still concerned, you can have your LDL gradient measured to determine your LDL pattern type.

I wouldn’t even remotely consider cholesterol lowering medications without knowing your LDL pattern type to see if there is any risk associated with your lipid levels because there are potential significant side effects (muscle damage, neurological damage, liver damage, even death – i.e. the Baycol recall) associated with many cholesterol lowering medications (statins in particular).

Oh, and I think that your low sugar, lower carbohydrate diet is the way to go to lower your risk of heart disease because of the positive effects it has on triglycerides and HDL.

Alan

Unfortunately the mystery man Alan does not provide any references however this is broadly in line with what I have read elsewhere. My triglyerides/HDL = 1.18 which suggests, according to Alan, that I am very low risk for heart disease.

I will, however, get my LDL gradient tested at the first opportunity.

Related:

• What Your Cholesterol Levels Mean
• Triglycerides: What is normal?
• Triglycerides: Mother of Meddlesome Particles

 

Vitamin D Home Test

As a follower of  Dr. William Davis’ Heart Scan blog, I am a convert to the Vitamin D message.

For eight months now I’ve been supplementing with  6000-8000 IU of D3 on a daily basis. In the absence of any initial test of blood levels, my self-prescription was a complete shot in the dark based loosely on posts I’d read on his and others’ blogs.

 
A Trip to the GP

Finally, a few weeks back, I decided it was time to find out how the supplementation was going. So I asked my GP if he could do the Vitamin D (25-OH) blood test. His immediate response was, “Why do you need that? Just go outside in the sun.” I explained that, being over 40, I was concerned my ability to make my own Vit D was impaired hence the supplements and follow up test. This irritated him even more at which point I was told he was “too busy to discuss this now” and “go talk to the receptionist.”

To make a long story short, the lab they work with does not do this test. I suppose this story is irrelevant other than to warn you that your “weird” views on Vitamin D may be met with derision.

 

Saved again by the internets!

Fortunately, I had already learned that I could order a home test over the net. They even do the tests internationally! The cost for those outside the US is US$90 including shipping.

So I placed the order and it arrived promptly by courier a few days later.

Basically you need to prick your finger and put a few drops of blood on a paper tablet then return it through the post to the lab.

It’s almost a no-brainer however I would definitely recommend that before you prick your finger, you should swing your arm around a few times to ensure that you get enough flow to fill the card. Swinging your arm after you prick your finger results in a scene out of CSI.

I suppose the swinging bit may not be necessary in all cases but my initial pricking effort produced only one drop of blood. But I digress…
 

With the test complete including only minor spillage on the test card (excluding aforementioned spatter on walls, ceiling and floor), I sent it back through the regular post… And about two weeks later my results arrived by mail.

 

Success!

Verdict? My 25-OH score was 73 ng/ml – pretty good. This is very close to optimum (the ranges doctors work to vary but for the proponents of Vitamin D it’s typically in the 50-70ng/ml range).

However, my results came with this warning:

Your blood vitamin D level is with the reference range (32-100ng/ml), but slightly above the range most experts consider as optimal for health (50-70 ng/ml). Excessive levels of Vitamin D over a prolonged period of time can be unhealthy.

I suppose they have to say that to cover themselves but frankly I was hoping they were going to tell me what a star I am.

It’s also worth noting that the quote, repeated verbatim, shows some wavering over whether or not to capitalize “Vitamin D.” As I was looking for guidance on that point I’m still lost.

 

The Test Kit Contents

Instructions

My Bloody Results

 

PS: I’m going to drop my daily dose of D3 to 2000IU.

Ethical Quandary – Industry Money in Med Schools

Give your doctor a break, he doesn’t know he has been brainwashed:

In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

“I felt really violated,” Mr. Zerden, now a fourth-year student, recently recalled. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”

More – New York Times

In the end, Only Calories Count: Wrong

I’ve been seeing this headline a lot lately:

Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content

Well yes that’s true. But quite frankly, it misses the point.

A person who is overweight does not have a weight problem. She has a weight symptom. Her problem is hunger.

There is no point trying to manage weight if you do not manage hunger. There is only so long you can fight your body’s desire to reach and maintain its target weight. And by target I don’t mean the one you have for yourself that makes you look good in a bathing suit. It’s the one your body feels is necessary given your diet composition, your level of activity and your genetic propensity for fat and sugar regulation.
 

Most people don’t know why they are overweight.

They think they know why but they don’t.

The standard answer from patient and doctor alike is “over-eating” which tells you absolutely nothing. I’m here to tell you that there is no such thing as over-eating short of the kind that leaves you feeling unwell because you’ve surpassed the volume comfortable for your stomach.

Over-eating, in the most common sense, refers to any food consumption that precedes weight gain. It’s a tautology. All things being equal, if two people follow the exact same diet and one gains weight, he is said to have “over-eaten” while the other “ate in moderation.” It’s like saying the tree was green because it was green.

The goal of any weight-loss diet should not simply be to create a caloric deficit, but to adopt sustainable lifelong eating habits which make it easy to reach and maintain an ideal weight. That is not to suggest it will ever be easy to drop detrimental eating habits which have been acquired over a lifetime and are probably central to one’s eating culture. But the changes must be sustainable physiologically.

Skinny people may admonish fat ones for failing to show self control, but the fact is that a modern diet makes some people constantly hungry. Fighting that kind of psychological torture day-in day-out is not possible. Gross caloric deficits can be sustained for short periods of time but falling off the wagon is inevitable unless hunger is addressed.

So it is true that the macro-nutrient composition of a diet is irrelevant if you are simply trying to achieve a caloric deficit.

However it is completely relevant if you are trying to control hunger in order to achieve a sustained depletion of fat stores.

Genes remember sugar hit

Just because your blood sugar normalises 8 hours later, it doesn’t mean that cupcake is done with you:

Human genes remember a sugar hit for two weeks, with prolonged poor eating habits capable of permanently altering DNA, Australian research has found.

A team studying the impact of diet on human heart tissue and mice found that cells showed the effects of a one-off sugar hit for a fortnight, by switching off genetic controls designed to protect the body against diabetes and heart disease.

"We now know that chocolate bar you had this morning can have very acute effects, and those effects can continue for up to two weeks," said lead researcher Sam El-Osta, from the Baker IDI Heart and Diabetes Institute.

"These changes continue beyond the meal itself and have the ability to alter natural metabolic responses to diet," he told Australian Associated Press Friday.

Regular poor eating would amplify the effect, said El-Osta, with genetic damage lasting months or years, and potentially passing through bloodlines.

The study’s findings were reported in the Journal of Experimental Medicine.

Source: Yahoo Australia

Mayonnaise Is Second Most Popular ‘Treat’ For American Dieters

Whoa – two posts in two days after 9 months incommunicado.
But where else can I share these WTF factoids???

Source

This graph reminds me what a freak I am given what the average world view is.

Mayo a treat?! What? Try staple.
Margarine a treat?? My god have you heard of butter?

Seriously, do people still eat margarine? I feel so clued out.

David Smith’s Journey to Himself

A must read:
David Smith’s Story

How he went from this:

To this:

More Photos