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 
One of the things I do in practice is consult in complex hyperlipidemias, the collection of lipoprotein disorders that usually, but not always, lead to atherosclerosis.
First order of business: Make the diagnosis–familial combined hyperlipidemia, hypoalphalipoproteinemia, lipoprotein(a), familial heterozygous hypercholesterolemia, familial hypertriglyceridemia, hyperapoprotein B with metabolic syndrome, etc. These are the disorders that start with a genetic variant, e.g., a missing or dysfunctional enzyme or signal protein, such as lipoprotein lipase or apo C3.
I then ask: What can be done that is easy and safe and preferably related to diet and lifestyle?
By following an effective diet, many of these abnormalities can be dramatically corrected, sometimes completely. Familial hypertriglyceridemia, for instance, an inherited disorder of lipoprotein lipase in which triglyceride levels can exceed 1000 mg/dl, high enough to cause pancreatic damage, responds incredibly well to carbohydrate restriction and over-the-counter fish oil. I have a number of these people who enjoy triglyceride levels below 100 mg/dl–unheard of in conventionally treated people with this disorder.
Then why is it that, time after time, I see these people in consult, often as second or third opinions from lipidologists (presumed lipid specialists) or cardiologists, when the only solutions offered are 1) Lipitor or other statin drug, and 2) a low-fat diet? Occasionally, an aggressive lipidologist might offer niacin, a fibrate drug (Tricor or fenofibrate), or Lovaza (prescription fish oil).
Sadly, the world of lipid disorders has been reduced to prescribing a statin drug and little else, 9 times out of 10.
I don’t mean to rant, but I continue to be shocked at the incredible influence the drug industry has over not just prescribing patterns, but thinking patterns. Perhaps I should say non-thinking patterns. The drugs make it too easy to feel like the doctor is doing something when, in truth, they are doing the minimum (at best) and missing an opportunity to provide true health-empowering advice that is far more likely to yield maximum control over these patterns with little to no medication.
All in all, I am grateful that there is a growing discipline of “lipidology,” a specialty devoted to diagnosing and treating hyperlipidemias. Unfortunately, much of the education of the lipidologist is too heavily influenced by the pharmaceutical industry. Not surprisingly, the drug people favor “education” that highlights their high-revenue products.
Seeing a lipidologist is still better than seeing most primary care physicians or cardiologists. Just beware that you might be walking into the hands of someone who is simply the unwitting puppet of the pharmaceutical industry.
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Anonymous lipidologist–
I'd love to hear more about your perspective. Rarely do we hear directly from the "inside."
I've suspected as much about the NLA, but wasn't sure. Judging by the prescribing habits of the lipidology community, I figured that "education" was slanted in this direction.
Maybe you have the same thinking pattern, Dr Davis. You speak of "inherited" yet continue with "dietary intervention". It's not inherited when the solution is to stop eating what causes it. It might have a genetic factor but only because our genes are not adapted to eating that crap. That trigs can go as high as 1000 mg merely shows that some have an extreme response to the same stimuli, not that their genes are somewhat less adapted to eating the same crap. The others who's trigs still go up but not as high aren't adapted either, they're just sturdier.
It's like comparing strong vs weak. He's not strong because he's got good genes. He's strong because he lifted heavy weights for 10 years. The other guy just didn't bother to do that. Ergo, one guy can lift heavy weights today while the other can't lift the same heavy weights today. But back when they were both weak, neither could lift heavy weights.
In the same line with diet and trigs. His trigs don't go high because of his genes. His trigs go that high because he's been eating more crap for longer than the other guy. But back when neither was eating so much crap, they had the same response amplitude to the same stimuli, i.e. they were both weak.
I'm just saying.
So I have a family history of heart problems. My father had his first heart attack at age 49 and it was similar to mine in symptoms and artery. He wasn't eating a healthy diet as I was and he wasn't in the shape I was either as I kept myself fit. Yet I had my heart attack at age 52, just 3 years difference. Coincidence? Now my cardiologist says that I don't fall into the same guidelines as everyone else as far as cholesterol etc. Is this true? Does family history make me a special case? Diet and exercise didn't work for me the first time around.
Dr. Davis I have been following your blog with interest as I am trying to combat high LDL as much as possible via diet (low carb) and exercise. I am female, age 48 with early menopause, hypertension under control with lisinopril, and TSH normal. My HDL averages 85, triglycerides average 45 (stable over 10 years), but my LDL particles have ranged from 1600 to 2000 over this last year, corresponding to LDL of 160 to 200. LDL seems to go up on low carb for me, while my HDL and triglycerides are fine with or without diet intervention. The NMR indicates that I am highly insulin sensitive, with the type "A" profile. My endocronoligist has been willing to work with me regarding diet and exercise but we have seen little change, and he now thinks that I really need to go on a statin. I just had my arterial wall thickness measured, which showed no signs of plaque or narrowing. My CRP has been elevated but is going down ( I am also recovering from plantar fascitis — so it is not clear what is causal here), and I take 1 81 mg aspirin a day. He has not pursued genetic testing, due to costs (other than lipo A which is fine), but believes that my high LDL is genetic. My grandfather had a non-fatal heart attack, and both sides of the family have high cholesterol. I will keep working at exercise (I need to take off 10 to ideally 20 pounds more).
Would you please comment more on the best diets for various genetic causes for LDL? Even within the low carb group there seem to be so many variations. Are there situations where statins should be used in women?
Thanks!
@Anonymous LDL
You're numbers look good. Stop worrying about the LDL so much.
Looks like you are following a good diet as long as you are avoiding veg oils. I highly suggest reading some cholesterol books like the one by Uffe Ravnskov.
Anonymous with lipoproteins–
Allow me to make one point: Calculated LDL will often misleadingly go up with a low-carbohydrate diet. This is GOOD.
It means that LDL size is increasing. But it provides the false impression of an increasing calculated LDL. That's why a repeat measure by NMR LDL particle number or apoprotein B is required.
I agree that not enough doctors think deeply enough about what they are doing.
Reminds me of the old saying, 'Whenever you see a doctor lost in thought its usually because he's in unfamiliar territory'
Great comments.
NPA is most definitely a front for the drug companies. I've attended many of there scientific meetings and most of what I hear is brainwashing at it's best. I once had a discusstion with the group head and told him how I felt about their pro-statin bias and he couldn't even fathom where I was coming from he was in so deep. When I presented my concerns about low LDL and cancer, he actually spouted off some industry funded research indicating that statins actually lowered cancer risk. Unbelievable….
It's easy to be an unwitting puppet when it's making you lots and lots of cash.
Hell I'd even do it if I didn't have morals.