Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
The myth of “optimal medical therapy”
Over 30 years ago, I help set up the first CT heart scan device in Wisconsin, one of the first in the entire midwest. This was so long ago that it was really an electron beam tomogrraphy, or EBT, device that predated the more recently developed CT devices. The point is that these devices acquired images quickly, about 1/10th of a second. This is important because the heart is perpetually in motion through various cycles of its beating rhythm, with motion also provided by breathing. But these devices allowed us to precisely quantify calcium in the coronary arteries of the heart, the arteries that close and cause heart attacks. My friend, Dr. John Rumberger while at the Mayo Clinic, performed studies demonstrating that calcium consistently occupies 20% of total atherosclerotic plaque volume in the coronary arteries. In other words, quantifying calcium in the coronary arteries served as a gauge or dipstick for total atherosclerotic plaque in the heart’s arteries.
Some years later, cardiologist Dr. Arthur Agatston, whose name you may recognize from his popular South Beach Diet books, developed a scoring system for coronary calcium, yielding something that came to be called an “Agatston score”: the higher the Agatston or calcium score, the more atherosclerotic plaque was present in the coronary arteries. Subsequent research has shown that the Agatston or calcium score is, by a long stretch, the best predictor of future cardiovascular events, far better than crude measures like cholesterol and these scores, in the 30+ years since my team and I started doing these scans, have become well-established as predictors of cardiovascular events like heart attack.
But what to do with the score—can it be stopped? Can it be reduced? That is the topic for this episode of the Defiant Health podcast, highlighting what my colleagues call, even to this day, “optimal medical therapy” that has repeatedly been shown to NOT work and the answers lie elsewhere, answers that I shall discuss.
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Over 30 years ago I helped set up the first CT heart scan device in Wisconsin, one of the first in the entire Midwest. This was so long ago that it was really an electron beam tomography or EBT device that predated the more recently developed CT devices. The point is that these devices acquired images quickly about a tenth of a second. This is important because the heart is perpetually in motion through various cycles of its beating rhythm, with motion also provided by breathing. But these devices allowed us to precisely quantify calcium in the coronary arteries of the heart, the arteries that close and cause heart attacks. My friend, dr John Rumberger, while at the Mayo Clinic, performed studies demonstrating that calcium consistently occupies 20% of total atherosclerotic plaque volume in the coronary arteries. In other words, quantifying calcium in the coronary arteries served as a gauge or dipstick for total atherosclerotic plaque volume in the heart's arteries. Some years later, cardiologist Dr Arthur Agatston, whose name you may recognize from his popular South Beach diet books, developed a scoring system for coronary calcium, yielding something that came to be called an Agatston score. The higher the Agatston or calcium score, the more atherosclerotic plaque was present in the coronary arteries. Subsequent research has shown that the Agatston or calcium score is, by a long stretch, the best predictor of future cardiovascular events, far better than crude measures like cholesterol. And these scores, in the 30 years since my team and I started doing these scans, have become well-established as predictors of cardiovascular events like heart attack. But what to do with this score? Can it be stopped? Can it be reduced? That's the topic for this episode of the Defiant Health Podcast, highlighting what my colleagues call, even to this day, optimal medical therapy. That has repeatedly been shown to not work. And the answers lie elsewhere, answers that I shall discuss Later in the podcast. Let's talk about Defiant Health's sponsors Paleo Valley, our preferred provider for many excellent organic and grass-fed food products, and BioDequest, my number one choice for probiotics that are scientifically formulated, unlike most of the other commercial probiotic products available today. I'd like to also make you aware of a new source for our favorite microbe, lactobacillus roteri, and a skin formulation I designed that improves skin from the inside out. As I mentioned in the opening comments, about 30 some years ago I helped set up the first heart scan device in Wisconsin one of the first in the Midwest and we started scanning people. These are people without heart disease symptoms. They don't have chest pain, they're not in an emergency room. They're not having heart attacks. They're going about their business, riding bikes, going for walks, etc. With no limiting symptoms. They'd come in because of some concern over having heart disease Perhaps their cholesterol was high or perhaps a family member had heart disease early in life, maybe in their 50s, and they'd come in to want to know were they headed in the same direction. They'd have a scan and they'd have a positive score. So a normal score is zero, meaning no calcium.
Speaker 1:Recall that calcium occupies 20% of total atherosclerotic plaque volume, so it serves as an indirect measuring stick or dipstick for how much total plaque you have. So, for instance, if someone had two cubic millimeters of calcium, they'd have 10 cubic millimeters of total atherosclerotic plaque. And the more plaque you have, the greater the volume of plaque, the more likely it is to rupture. That's what a heart attack is. People often wrongly think that a heart attack is when an artery progressively narrows, and that does happen. But it's much more common for a minor plaque, maybe blocking only 30% of the diameter of the artery, to rupture like a little volcano. And when that happens, some of the internal components of that plaque are exposed to flowing blood and that is a trigger for blood clot formation. So that's why it's very difficult to predict heart attack, because if you looked at blockages only you'd see a bunch of 10%, 20%, 30%, 40% blockages and you can't tell which one's going to rupture. That's why it's so difficult to manage this disease with procedures. So instead we're measuring calcium as an indirect way to quantify the total atherosclerotic plaque volume lining all three coronary arteries.
Speaker 1:So a score of zero is normal and the more plaque you have, the higher the score. And your score is compared to other people of your same sex and age. So, for instance, a score of 300 in a 55-year-old woman would be a very bad, very high score. A score of 300 in a 75-year-old male would be only a moderate score. So they should tell you how you compare to other people and it gives you a kind of sense how bad it is.
Speaker 1:But know that when you get to a score of about a thousand, the risk for dying, having a heart attack, sudden cardiac death or a need for a procedure like stent implantation or bypass surgery is about 15% per year, meaning that those things are inevitable in about six to seven years. In other words, you're given kind of a crystal ball for the future of whether you're going to have heart problems with your heart or not. So what happens if you do nothing? Let's say you have a score of 400 at age let's just say 60. If you do nothing, that score and this is well worked out, we helped contribute some of these data that score will increase 25% per year. So a year later it would be 500. Another year later, 625 and so on, and with each increase in score you're a step closer to heart attack and other events.
Speaker 1:Well, this goes back now 30-some years. What do you do about this? Well, back then all we had was baby aspirin, a high dose of a statin cholesterol drug, a low-fat, low-saturated fat, low-cholesterol diet and an exercise program what my colleagues back then called optimal medical therapy, and to this day they still call it that. Well, we help publish these data. If you do that optimal medical therapy baby aspirin, statin cholesterol drug, low-fat diet, exercise how fast does that coronary calcium score and thereby coronary atherosclerotic plaque grow? 25% per year, maybe more so. Several studies even showed that it accelerates, that optimal medical therapy accelerates the increase in score to 27% or so per year.
Speaker 1:It became clear that what my colleagues were calling optimal medical theory was useless medical therapy. It did virtually nothing. That program may reduce some of the soft elements of plaque, but it does not put a stop to the disease, not even close. So you can imagine. I had many panicked people coming in who saw their scores going up. Unfortunately, when they consulted with my colleagues, all too often they were told that even though they had no symptoms, they were told to undergo what my colleagues called the real test, a heart catheterization, to see if they needed a preventive stent implant or bypass operation. Well, it's well established that doing such procedures on people with no symptoms, that is, no chest pain, no breathlessness etc. Provides no benefit Because you can't bypass or stent everything and you don't know which plaque is going to rupture and cause a heart attack. So it's been clear preventive procedures we call them revascularization procedures do not benefit people without symptoms, do not benefit people without symptoms.
Speaker 1:So what do you do if the best they have in conventional healthcare, so-called optimal medical therapy, does virtually nothing for the progression of coronary atherosclerosis? What can you do? Well, it took some years, some trial and error and logic and consulting science. We had to come up with a program. It led to insights like adding vitamin D and achieving a 25-hydroxyvitamin D blood level of 60 to 70 nanograms per milliliter was a major factor in achieving regression Not a slowing but a regression of carnic calcium progression. In other words, we went from 25% per year progression to drops of a score, say from 400 to 240, something like that. Now, when you do that, when you stop the progression let's say 0% change your risk for a cardiac event like heart attack is virtually zero. If you reduce the score, your risk for a heart attack or other events is also zero and you don't have to get back to a heart scan score of zero to be safe. In other words, if you did reduce your score from 400, say, to 290, 290 sounds like a bad score but because it was achieved via reversal of plaque, your risk for heart attack, provided you stay in the program, is virtually zero. It's highly unusual to have any kind of heart event when you've had regression of carotid plaque. So by having this means of tracking the growth or regression of carotid atherosclerotic plaque, it taught us that vitamin D, as I mentioned, was very important. It was the first time we saw actual drops in calcium scores.
Speaker 1:Omega-3 fatty acids very important Iodine, because people have forgotten that iodine deficiency was a major public health problem up until 1924, when the FDA advised salt manufacturers to add iodine and then urged everybody to use lots of salt to prevent goiters. Well, you know what happened since then? Right, the use of salt and the other advice to cut fat and increase consumption of grains led to insulin resistance, which in turn leads to sodium retention. The problem was not the salt, the problem was the insulin resistance from diet. So the FDA wrongly advised Americans to cut back on salt and what do you think is coming back? Thyroid dysfunction and goiters. And so we add back iodine and of course we take steps in the program to reverse insulin resistance so that you do not retain sodium. We also add magnesium because we drink filtered water, we have to. Water in streams and rivers has sewage and farm runoff and other things, and so we filter our water by necessity, and water filtration removes all magnesium, so we have to supplement magnesium.
Speaker 1:Then we take steps to address the modern disrupted gastrointestinal microbiome, because all of us have been exposed to antibiotics off in many courses over a lifetime, to glyphosate and other herbicides in food preservatives that are antimicrobial in your food but also in our GI tracts, other food additives like emulsifying agents like polysorbate 80, carboxymethylcellulose and carrageenan that disrupt the intestinal mucus barrier and change the microbiome composition and many other factors. So we address that. We do so by making sure we add back fermented foods, lots of fermented foods like kimchi, kefir, sauerkraut, fermented vegetables. We re-implant keystone microbial species that colonize the small intestine, like Lactobacillus roteri and Lactobacillus gasseri, and we do so by fermenting them in something that looks and smells like yogurt. It's not yogurt, don't be fooled by that. It's nothing like the stuff you buy in a store which will not accomplish this. But we make the yogurts or other fermented foods with those microbes and re-implant them at very high numbers and that starts the process of reacquiring beneficial species. We also include lots of fibers, prebiotic fibers from foods like asparagus, brussels sprouts, legumes like black beans, white beans, chickpeas, hummus, other foods rich in fibers that nourish microbes.
Speaker 1:And because reducing cholesterol with statin drugs was proven to be a useless and perhaps even harmful practice, I resorted to using a better, a superior method of testing to identify the particles in the bloodstream that cause coronary disease. There are various methods, but the one method that has become kind of the gold standard is NMR nuclear magnetic resonance, lipoprotein analysis, and it became crystal clear that people who had coronary disease and continued to progress their coronary calcium scores had an excess of small LDL particles. So we knew that a low-fat diet actually worsened small LDL particles. So we knew that a low-fat diet actually worsened small LDL particles. So we also knew with good science science performed at University of California, Berkeley Hopkins and other places that the only foods that provoke formation of small LDL particles very dangerous particles were wheat, grains and sugars, the amylopectin A unique to wheat and grains, and then all forms of sugar, whether it's sucrose, fructose or glucose. Because the conventional methods of stopping the progression of plaque of calcium sugars did not work, I asked patients to try this instead eliminate wheat, grains and sugars.
Speaker 1:And that's when I saw small LDL measures. A typical measure in someone with coronary disease would be something like 1,800 nanomoles per liter. That's part of a count per volume. They would go wheat, grain and sugar-free and it would drop to zero or some other very low value. In other words, it wasn't just better by 10% or 30%, it was eliminated in the vast majority of cases. And this is also where it led to all the lessons I talked about in my wheat belly books, and that is, people would decimate small LDL particles. But they'd also say why did I lose 47 pounds and why did my waist shrink by eight inches? Why is my rheumatoid arthritis better? Why is my blood pressure now normal? I had to stop my blood pressure medication. Why am I no longer a type 2 diabetic or pre-diabetic? So it led to huge successes in regaining control over health, including a reversal of the factors that led to an increased carnic calcium score and carneric atherosclerotic plaque.
Speaker 1:By following this program, we've achieved reversal or reduction in cardiac calcium scores time and time again, and it became clear that statin drugs are simply not necessary. It's also not necessary to control cholesterol. We do control lipoproteins, so we don't rely on cholesterol testing. We use NMR lipoprotein testing to quantify VLDL particles and small LDL particles. Those are the real drivers, along with insulin resistance and inflammation, of cardiovascular risk, and so we focus on the real causes of heart disease.
Speaker 1:That also includes endotoxemia, by the way. That is when you have the infestation of the small intestine by fecal microbes. Because of our exposure to antibiotics and those other things, there's been an overproliferation of fecal microbial species like E coli and salmonella and Campylobacter and Pseudomonas that have infested the small intestine the 24 feet of small intestine. Now those microbes only live for a few hours and when they die they release some of their components, especially something called lipopolysaccharide endotoxin. That gains entry into the bloodstream and that's called endotoxemia. That is a major driver of increasing and growth of atherosclerotic plaque, increasing carnic calcium score. So we address that and you do that, starting with the reimplantation of lactobacillus roteri, lactobacillus gasteri and those other efforts we make to restore a healthy gastrointestinal microbiome. Now let's pause for a moment to hear something about Defiant Health's podcast sponsors, paleo Valley and BioDequest, and when we come back let's discuss some new findings from some recent clinical trials that shed light on how to achieve regression of plaque.
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Speaker 1:So for years we've been seeing that this combination of the diet where we eliminate wheat, grains and sugars the foods that provoke formation of small LDL particles. And, by the way, the reason why small LDL particles are so harmful is because they're very prone to oxidation. They're prone to glycation, which makes them much more dangerous. They are better able to enter the walls of arteries and start the process of forming atherosclerotic plaque when they're in arteries. They're very adherent to the structural proteins in the walls of arteries. They're more likely to provoke an inflammatory response, because it's inflammation in the wall of arteries in atherosclerotic plaque that is a major driver of those plaque ruptures that cause heart attack, and small LDL particles, after being formed from your consumption of wheat, grains and sugars, persists in the bloodstream for five to seven days, as compared to only 24 hours of a large LDL particle formed from consumption of fats and oils. So it's the amylopectin A of grains and all those sugars that trigger formation of small LDL particles. That are exceptionally bad. But you can get rid of them by just following a diet and then also our nutritional supplement program. Now the nutritional supplements very simple Omega-3 fatty acids, magnesium, iodine and vitamin D, when combined, minimize insulin resistance and inflammation, because it's those two processes, insulin resistance and inflammation, that serve as an amplifying effect on the production of small LDL. So those supplements contribute to a marked reduction in small LDL particles. Then we go even further. We address all those factors in your gastrointestinal microbiome to minimize or reverse SIBO small intestinal bacterial overgrowth and the endotoxemia it causes, because the endotoxemia is a major contributor to, once again, insulin resistance and inflammation. So you'll be given an extraordinary panel of powerful tools to gain control over coronary atherosclerotic plaque and putting a stop to the progressive rise of your coronary calcium score. And we have done this time and again without having to introduce statin cholesterol drugs or other efforts to reduce LDL cholesterol. Instead, we're focusing on small LDL insulin resistance, inflammation, endotoxemia.
Speaker 1:Now there's been a recent several trials. You know there's always been a debate about just how helpful fish oil is for reducing cardiovascular events, and that's because in 1999, the Gissi-Pravenzione trial, that's an Italian study of thousands of people who took 1,000 milligrams of EPA and DHA from fish oil and there was a 10% reduction in cardiovascular events. So that sparked a lot more interest in fish oil. But a number of smaller studies, often using lower dose or low doses of omega-3s, did not show benefit. And then more recently in the last few years, there have been a series of very large studies involving 10,000 to 25,000 people, each given higher doses of omega-3 fatty acids, and those studies have consistently shown decreased cardiovascular events. For instance, the JEALIS trial, j-e-l-i-s In Japan, that is, a fish-consuming population were given 1,800 milligrams of EPA alone only EPA, not the DHA and there was a 19% reduction in cardiovascular events. There was the REDUCE-IT trial that showed that 4,000 milligrams of the EPA alone reduced cardiovascular events by 25% over three years. And there's the vital study of 25,000 participants who took 1,000 milligrams of EPA and DHA and experienced a 25% reduction in cardiovascular events over five years.
Speaker 1:Now the clincher in this are two studies using CT coronary angiography, and all that means is the CT heart scan device, but participants were given an intravenous bolus of a die, a radiographic die, so they can see the arteries. This yields exquisite three-dimensional pictures. But in both of these studies, fish oil was given. In the EVAPORATE trial, 4,000 milligrams of EPA alone over 18 months, and in the HEARTS trial, 3,360 milligrams of EPA and DHA were given over three years. And in both trials, and with use of coronary CT angiography, it was shown that both the fibrous and soft elements of plaque were reduced. And these were both trials.
Speaker 1:Everybody took a statin drug, because my colleagues feel that it's unethical to not give somebody with heart disease a statin drug. We could argue about that, but nonetheless everybody in both those trials were on statin drugs and the people who got placebo had progression of disease on a statin drug. And the people who got fish oil either EPA 4,000 milligrams or EPA and DHA 3,360 milligrams showed regression of fibrous plaque and of soft elements of plaque, that's, the soft elements that are more prone to rupture. And one of the studies also showed regression of the coronary calcification measure. We now have good evidence that omega-3 fatty acids not only reduce the likelihood of cardiovascular events, they also facilitate regression or reversal of coronary disease. And these studies also show that statin drugs are insufficient. They allow progression.
Speaker 1:It's the fish oil that is the active component, at least in these trials that achieve regression. So there you have it the diet, wheat, grain, sugar, elimination, supplements combined that synergize to minimize insulin resistance and inflammation, the factors that amplify the production of small LDL particles. And then we address SIBO and endotoxemia by our program of fermented foods, re-implantation of keystone microbes and ingesting lots and lots of probiotic fibers to nourish beneficial microbes. Now, if you've learned something from this episode of the Defiant Health Podcast, I invite you to subscribe to your favorite podcast directory. Post a review, post a comment. Let's help build this movement of self-empowerment and health. Thanks for listening.
