Plaque is the stuff of coronary heart disease. It is CONTROLLABLE, it is STOPPABLE, it is REVERSIBLE.
But you must be equipped with the right information on diet, nutritional supplements, and hopefully the avoidance of medication.
This is the blog that accompanies the 
Of all the various factors we correct in the Track Your Plaque program in the name of achieving reversal of coronary plaque, there are two factors that are proving to be our greatest challenges:
1) Genetic small LDL
2) Lipoprotein(a)
More and more people are enjoying at least marked slowing, if not zero change or reduction, in heart scan scores following the Track Your Plaque program. We achieve this by correcting a number of factors. Some factors, like vitamin D deficiency, are easily corrected to perfection–supplement sufficient vitamin D to achieve a blood level of 25-hydroxy vitamin D of 60-70 ng/ml. Correcting standard lipid values–LDL cholesterol, HDL cholesterol, and triglycerides–child’s play, even to our strict targets of 60-60-60.
However, what I call “genetic small LDL” and a subset of lipoprotein(a) are proving to be the most resistant of all.
Let’s first consider genetic small LDL. Small LDL is generally the pattern of the carbohydrate-ingesting, overweight person. It has exploded in severity over the past decade due to overconsumption of carbohydrates due to the ridiculous low-fat notion. Reduce or eliminate carbohydrates, especially wheat, which permits weight loss, and small LDL drops like a stone. But there is a unique subset of people who express the small LDL pattern who start at or near ideal weight. Take Chad, for instance. At 6′ 2″ and 152 lbs and BMI of 19.6, there’s no way excess weight could be triggering his small LDL. Yet he starts with 100% small LDL particles. All efforts to reduce small LDL, such as wheat, cornstarch, and sugar elimination; niacin; vitamin D normalization; thyroid normalization; and several supplements that yield variable effects, such as phosphatidylcholine, all leave Chad with more than 90% small LDL.
Lipoprotein(a) is a bit different. Over the past 5 years, our choices in ways to reduce Lp(a) expression have improved dramatically. Beyond niacin, we now have high-dose EPA + DHA, thyroid normalization that includes use of T3, and hormonal manipulation. In the Track Your Plaque experience, approximately 70% of people with Lp(a) respond with a reduction in Lp(a). (In fact, the 4 out of the 5 record holders for reduction of heart scan scores have Lp(a) that was successfully treated.) But about 30% of people with Lp(a) prove resistant to all these treatments–they begin with a Lp(a) of, say, 260 nmol/L and, despite niacin, high-dose EPA + DHA, and various hormones, stay at 260 nmol/L. It can be frustrating and frightening.
So these are the two true problem areas for the Track Your Plaque program, genetic small LDL and a subset of Lp(a).
We are actively searching for better options for these two problem areas. Given the collective exploration and wisdom that develops from such collaborative efforts as the Track Your Plaque Forum, I am optimistic that we will have better answers for these two stumbling blocks to plaque reversal in the future.
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Hi Dr. Davis,
What about exercise-induced hypertension? Do you still find that to be a persistent problem when all other biomarkers are optimal?
Thanks,
David
Also, is there a way to know one has exercise-induced hypertension? Would one get headaches?
Hi, David–
Yes and no. Following all the components of the program will reduce blood pressure. However, some people just don't respond as readily and hypertension with exercise and emotional stress persists. A simple stress test remains the best way to assess this.
Dr. Davis,
I've thought about that concerning the high dose of fish oil. I'm wondering possibly if it's a synergizing effect of all the supplements, including the C, Lysine and Proline.
I also wanted to mention that I split the doses up throughout the day. I've been informed that Vit C and L-Lysine only stay in the system for a short time, therefore, if you take it only once or twice a day, it's not going to have near the effect as splitting it up. I take 2g of the proline, lysine and C in the morning, then take the remaining amounts of C and Lysine throughout the day every 2 hours or so at 1g each, with my last dose at 5:00pm. I try to take my last dose a couple of hours before taking my Niacin, as I've heard the C can sometimes have a negative effect on the Niacin.
My brother has high LP(a) as well, without seeing it go down. He was taking pretty much everything I was, with the exception of proline and only 4-5g of fish oil. And he was only taking the lysine and C twice a day. He has altered it to match more of what I'm doing, so we're anxious to see what his next blood test reveal.
By the way, thanks to applying the principles you laid out in the book and here on your site, my other blood levels have been improved drastically. For that I am extremely greatful!
Dr. Davis,
thanks for your clarification. I appreciate that you remain open to possibly more positive results with Pauling's protocol in the future..
Hi Kent,
what is the negative effect of vit C to Niacin you heard of? I'm aren't aware of any, though I too take the biggest part of vit C separate from meals, during which I use the Niacin.
thanks..
For non-responders doing everything correctly but still holding on to lots of small LDL, what's happening to their heart scan scores?
I was wondering if there were any possibility that small LDL is more associative of heart disease than causative.
Hi Anon..
The negative effects I've heard about Vit C to Niacin are spotty. What I've heard is that there is a possibility of any anti-oxident to diminish some possitive effects of Niacin, such as reducing it's HDL raising ability a bit. I don't know anyone personally that has experienced this, I just try not to the two together if possible.
I try to filter out the "faith" based claims and stick with scientifically backed information. Niacin improved my very low HDL by 30% but complete elimination of the exercise induced angina I had suffered disappeared for me when I subjected myself to high dose K2 for 6 months. Nothing I have tried (including wheat elimination) enables me to stay off reasonably high dose statins
Thanks for the reply, Kent. Though my HDL did raise about 18% within one year of 1.5 gram Niacin use, at 33 now it's still much too low.
On your suggestion I'll try to take them more separated, beside raising the dose of Niacin. Which I think is advisable in my case due to Lp(a) anyway (57).
What is the advised upper limit of the daily dose of Niacin at TYP?
Anon..
I really noticed a huge jump in my HDL, when I bumped Niacin from 1.5g to 2g, introduced high intake of fish oil, at least 7200mg to 9600mg, got vitamin D levels up, and alomost eleminated wheat. I went from HDL's of 40's/50's to 86.
I believe the upper limit of Niacin depends on the type, wheter it be immediate, sustained, or slow release. Perhaps Dr. Davis could address that.
We are actively searching for better options for these two problem areas. Given the collective exploration and wisdom that develops from such collaborative efforts as the Track Your Plaque Forum, I am optimistic that we will have better answers for these two stumbling blocks to plaque reversal in the future.