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 
Heart Scan Blog reader, Roger, brought this New York Times article to my attention.
In an effort to develop a better experimental model for obesity than mice, scientists have turned to monkeys and other primates. The emerging observations are eerily reminiscent of what you and I witness just by going to the local grocery store or fast food outlet:
“‘It wasn’t until we added those carbs that we got all those other changes, including those changes in body fat,’ said Anthony G. Comuzzie, who helped create an obese baboon colony at the Southwest National Primate Research Center in San Antonio.”
“Fat Albert, one of her monkeys who she said was at one time the world’s heaviest rhesus, at 70 pounds, ate “nothing but American Heart Association-recommended diet,” she said.”
Yes, indeed: The American Heart Association diet makes monkeys fat. Extrapolate this a little higher on the evolutionary ladder and guess what?
This is one of the many reasons why, when I have a patient who is counseled by the hospital dietitian on the American Heart Association diet, I advise them to 1) ignore everything the dietitian told them, and then 2) follow the wheat-free, cornstarch-free, sugar-free, whole food diet I advocate.
Not unexpectedly, much of this primate research is not being devoted to just manipulating diet to achieve weight loss and health, but to develop new drugs to “treat” obesity.
Would you like a banana?
Change your life in 60 seconds
This may clarify, in their recent 2010 paper, M Konner and SB Eaton, estimate the ancestral diet (as % of daily energy) composed of
35-40 acrbohydate,
25-30 protein, and
20-35 fat.
They comment that the carbohydrate source for “hunter-gatherers” (HG) was from fruit, vegetables, and nuts, not from grains. They go on to say that the reduction of carbohydrates to extremely low levels is not consistent with the HG model, but neither is a high-carbohydrate, “meat as a condiment” type of diet.
Konner and Eaton, both physicians, published their seminal paper on Paleolithic nutrition in 1985. The statistic above comes from their most recent paper of 2010. For those interested in how the popular interpretation of scientific research tends to “spin” the original detail, references to both their papers are below. Unfortunately, the 1985 article in the New England Journal of Medicine is restricted to paid subscribers only, while the recent invited article in Nutrition in Clinical Practice is available free online.
Eaton SB, Konner M. Paleolithic Nutrition: A consideration of its nature and current implications. N Engl J Med. 1985 312:282-289.
Eaton SB, Konner M. Paleolithic Nutrition: Twenty-five years later. Nutr Clin Pract 2010 25:594-606. http://ncp.sagepub.com/content/25/6/594
There seem to be a few anonymous people making posts giving their opinion about how this blog should be run. Some of their assertions remind me of the entitlement mentality ruining this country.
First, Dr. Davis is under no obligation to answer anyone's comments or questions. How much do you pay to come here and read? I thought so.
Second, when he chooses to respond, understand it is taking time out of his day that could go to his medical practice, (Real clients who pay for his services) his family, or without knowing the man personally, his hobbies or other interests. How much time do you think it would take to write an answer to each person who poses a question in the response section on this blog? Keep in mind how much slower writing is than speaking! It would take hours.
Maybe it hasn't occurred to some of you that an answer to one person in the comments section won't be seen by very many people. A much better use of his time is to write a short blog post at some time in the future that will be seen by many, and will be search-able, rather than answering the same question over and over again in the comments section.
It's not all about you, people. Get a life.
Worldinside, first, there's no one paleo diet. At certain times and places, like Cro-magnon Europe, the diet was nearly all meat. Paleolithic humans ate animals (snout to tail, not just muscle meat), fruit (in season), and, yes, tubers when they were available.
Second, probably unlike Paleolithic humans, many readers of this blog don't have normal blood glucose reactions to carbohydrates. As you probably know, carbohydrate consumption spikes blood sugar even in normal, healthy people. In people with diabetes or metabolic syndrome, eating a tuber can cause BG levels that can lead to organ and tissue damage. Overconsumption of carbs over a month in such people can lead to high triglycerides as well–not to mention weight gain.
While it's useful to look at how Paleolithic humans ate, we also need to look at medical science and keep our own individual quirks in mind. Humans need to eat protein. We also need to eat fat; we can't make essential fatty acids ourselves, and dietary fats have a unique ability to allow us to absorb vitamins A, D, E, and K. But there's no such thing as an essential carbohydrate (people who have hypoglycemia aside). Our liver can make blood glucose from protein. And just because something is natural and somebody else can eat loads of it, doesn't mean everybody can eat it.
Assuming your goal is longevity and health in old age, it doesn't matter what our hunter-gatherer ancestors ate, because they didn't live much beyond age 70, which is quite young by modern standards. Living to 100 and being healthy in your 90's is very unnatural, so it follows that those of us who want to live that long should eat unnaturally. All the evidence I've see suggests that being lean and conditioned is the way to go, regardless of diet, but that a mostly vegetables diet is most conducive to longevity. Eating mostly grains is also okay. Eating high-fat or high-meat is NOT conducive to longevity.
If you are not lean and conditioned, then first priority is to become lean and conditioned, and any diet which helps towards this primary goal is a good diet. Only after you become lean and conditioned do you really need to start worrying about diet.
… as always such enlightening comments …
In my neighborhood, it is generally accepted that the life expectancy at birth for preindustrial populations was 30-35 years. This was due not to the absence of older people but due to the extremely high infant and child mortality. Deaths overwhelmingly were due to infectious diseases that are now under control, more or less. With the longer average life spans came the advent of the diseases of civilization: atherosclerotic cardiovascular diseases, type 2 diabetes mellitus, chronic obstructive pulmonary disease, lung and colon cancers, essential hypertension, obesity, diverticulitis, and even dental carries. As of 2011, US life expectancy at birth is 78 years.
For sure, aerobic fitness is essential to health and longevity in the modern world however, medical science has demonstrated that many of the diseases of civilization would be minimized with appropriate dietary modification. Yes, the same medical science that we are throwing rocks at in the current “cutesy” survey of the AHA offered in this blog session.
One method of analysis in medical research is the examination of the Paleolithic diet supporting the discordance hypothesis that tries to explain that the mismatch in our modern diet from that what our genome has evolved is the cause of some chronic diseases. As an example, consider the modification of sodium intake. Studies of our ancestors diet estimates their sodium intake at about 800 mg/day, compared to a current adult average of 10,000 mg/day estimated by the WHO. Well-validated computer simulations predict that a reduction of 3000 mg/day (30%) in sodium intake would result in 40,000 to 90,000 fewer deaths from coronary heart and stroke each year in the US. On the other hand, moderate ethanol intake has been shown to reduce cardiovascular risk. Ethanol consumption was probably nonexistence before the invention of agriculture and not part of the paleo lifestyle.
No one has all the answers but blindly following any particular lifestyle or lifestyle advocate will probably not get you to a healthy 9th decade or simply a healthy older life. However, with a little luck and the judicious adoption of demonstrated healthy habits in fitness, nutrition, and lifestyle we all may get there.
I think the problem people have with The Heart Scan Blog is that they forget the doctor is referring to people who have metabolic problems. I've met many people who are fat and who eat potatoes and fruits yet keep their cals low and lose a ridiculous amount of weight. But at the same time I know people who, if they ate the same way, they would gain weight.
In general, the info on this blog is really good. Sure there are times where it seems that the doctor has recanted his hate of weight so much that he begins going after the most random stuff (i.e.. butter), but realize that this is a blog and that – as mentioned previously – everyone is different.
Closing anecdote: My grandfather is 94. He's incredibly healthy (runs a whole mango farm in Asia). His diet would be deemed bad by most of the people on this blog. He eats oatmeal topped with mangoes for breakfast, Hawaiian Bread with SPAM sandwich (because he's out on the farm), and he eats white rice for dinner. His cholesterol is perfectly fine. His heart is perfectly fine. In fact, the doctors are always amazed at how healthy it is.
So it goes to show, it depends on YOU. Do your research, see what info is out there, don't rely entirely on any one source of info. So a doctor recommended you a diet you don't agree with? Guess what? Go see another doctor! Just be sure you aren't going from one doctor to another until you hear the answer you WANT to hear as opposed to the one you NEED to hear.
Thank you to all the Anonymousi, Lori and Revelo who replied to my question, especially the first responder. I've downloaded the paper and am looking forward to reading it. I was pleased to note that, as I believed, those early diets were pretty well balanced.
And thanks, Lori and another, for pointing out that this site is intended largely for people with CVD and/or metabolic disorders. (That explains the every 15 min BG readings!)
I was not questioning because I was confused about which diet to follow, but rather, was confused by the way the term "Paleo" [diet] was being thrown around on this site by several commenters, as in "I've been Paleo for two months now and feel great. No more carbs for me." And I wondered if that was the site terminology for the diet plan envisioned by Dr Davis.
Revelo, I don't think I agree with your statement, " Only after you become lean and conditioned do you really need to start worrying about diet." First of all, unless you've a metabolic disorder I think you should be mindful rather than worrying about your diet. Second, I'm inclined to believe that once you're conditioned that's when you can stop worrying, if you were so inclined. You've cranked up the mitochondria and they're working away at increased effectiveness even while you're not working out.
By the way, I used to love oatmeal in the morning. Several years ago I started what turned out to be about two years of oatmeal for breakfast every single morning – with half and half or cream and brown sugar. Then I stopped as suddenly as I had started. I think my body needed something the oats supplied, and then it no longer did. And I stayed slim all that time. Now I don't touch fructose except in fresh fruit (Thank you, Dr Lustig), so no sugar either white or brown should I ever again get the oatmeal urge.
To all the "anonymous" posters-
After reading Dr. Davis' blog for some time now, I can assure you he will respond if the comment is worth his time.
General bad mouthing is rampant on a blog and if he spent most of his time refuting narrow minded opinions he wouldn't have time to be a cardiologist or write. So chill out or go elsewhere.
Also- his views aren't directed to just people with metabolic syndrome. It's for people who seem to be the American picture of "health" but are a ticking time bomb for diabetes, stroke, heart attack. His knowledge delves deeper than just a typical lipid panel (LDL, HDL, triglycerides).
People should know what they speak of, before the pop of at the mouth about topics they aren't well suited to debate.
Good post Dr. Davis.
Anonymous February 23, 2011, said "…. after looking it over following a very strong recommendation, I can say that I will not be back."
Thank you anonymous – based on your silly comment from which I took the quote, you have absolutely NOTHING to say. I am delighted you are going.
r Davis, thank you for yet another informative, intelligent post.
Some are not abreast of the science and how it is clinically relevant. A 33 year 14,000 patient study of Danes, published 18 Feb 2011 in Annals of Neurology, indicates Doc's insistance is well founded.
(In case you wonder why neurologists' data are relevant it is because 87% of fatal strokes are ischemic strokes. Now on to the science reported.)
Danes followed those with strokes over 33 years and found that NON-fasting triglyceride levels were more of an indicator than cholesterol level.
Specificly: women and men with over 89 mg/dl NON-fasting triglycerides had 1.2 times more stroke risk.
Doc's rants about blood sugar after eating, including butter induced spike, are in line with NON-fasting triglycerides being
a risk factor. He does detail
triglyrerides in other posts and goes into the VLDL mechanism too. My layman's focus on LDL & genetics overlooked what this blog clued me in to.
Laboratory lipid blood work shows the fasting trigylceride number. Doc pushes home test of
post-meal blood sugar since it is a surrogate of VLDL and NON-fasting triglycerides getting elevated (or not).
Non-diabetics, like me, think blood sugar science is for the other guy. Doc seems to be trying to hammer it home that it is relevant to some more of us.
Let's focus on coronary problems, like multi-vessel coronary disease, although it is all tied in to cardio-vascular "events". A meta-analysis of 20 studies covering 90,000 non-diabetics is worth summarizing.
Over 12 years those 90,000 non-diabetics' heart risk (multi-vessel coronary artery disease) correlated exponentially with both fasting and post-meal blood glucose levels. This was irregardless of the person not meeting the diagnostic criteria for being diabetic; and irregardless of "normal" fasting blood sugar, or even signs of glucose intolerance. In other words, the +/- 2 hour span of blood sugar dynamic is connected to cardio-vascular events.
(Multi-vessel coronary disease is when the left ventricle functions, but there is +/- 70% stenosis narrowing of blood vessel from plaque.)
European Diabetes Epidemiology Group's 2003 "DECODE" research shows that the interplay of blood sugar and cardio-vascular risk can start even in the "normal" blood sugar range. The risk progresses in a linear
fashion, yet there is no specific point where can say individual has passed the point of no return into danger.
Again, the DECODE data's
significance is that post-prandial (after meal) glycemia, and to a lesser extent fasting blood sugar level, is relevant to cardio-vascular events even in some non-diabetics.
Non-diabetics can still share some of the 30 risky genes with type II diabetics and yet not become diabetic. We don't know which of us has what of those allelo-morphs (a.k.a. allele; a DNA sequence on a chromosome).
So, non-diabetics (specificly those with the alleles similar to diabetics) may have normal fasting &/or normal post-prandial blood sugar yet be at risk of a cardio-vascular event. Furthermore, non-diabetics with suspiciously elevated fasting blood sugar are thought to be manifesting one of those genetic SNPs (single nucleotide polymorphism, a.k.a. mutation).
Clinically 35% of diabetics have cardio-vascular events and 5 years later 35% of those go on to have a fatal incident. In comparison 24% of non-diabetics have cardio-vascular events, yet 5 years later 33% of those who share the risky allele(s)go on to have a fatal incident. In other words, everybody who took a first "hit" has virtually the same chance of dying; speculation is the non-diabetics who go on to die share the dying
diabetics risky allele(s).
Discussing what (say) grand-dads
eating habits is annecdotal; as is we non-diabetics assumption time won't alter things for us.
Many of us do not share genes with any diabetic risk, so Doc's "gluco-phobia" is irrelevant. He obviously
sees plenty, diabetic and non-diabetic, who come to him so they won't die unnecessarily.
For you who may live long enough to see routine testing, or doing research, here is a list of the 10 alleles most associated with European ancestry adult onset diabetes relevant to what was discussed above.
It bears mentioning that each may have up to 3 allele sub-variations for each risk
gene. In no particular order, they are:
FTO rs8050136, IGFBP2 rs4402960,
CDKAL1 rs7754840, HHEX rs1111875,
SVC30A8 rs13266634, PPARG
rs1801282, KCNJ11 rs5219, TCF7L2
rs7903146, CDKN2A/B rs10811661and rs93000039.
Wow. I see I enter a fascinating conversation.
In response to a question posed by Worldinside: The difficulty with carbohydrates differs substantially from person to person, based on 1) genetics, e.g., apo E2, 2) intensity of physical activity, 3) preceding lifelong carbohydrate exposure, 4) current weight and insulin sensitivity, 5) vitamin D status, 6) lectin content of consumed foods. There are other factors.
Point: There cannot be a one-size-fits-all approach to diet. This is one of the main reasons I advocate postprandial glucose checks, a means to assess a specific individual's carbohydrate tolerance.
And thank you, Eric and Terrence, for understanding that this is a blog and that I do my best to respond, given my time constraints. I've just finished a 10 hour day in the office, spent 2 hours starting in the early a.m. editing a new book (to be released by Rodale in fall). I now turn to website responsibilities until late tonite.
There's only so much you and I can fit into a day.
Can't wait for the new book, the first one was truly a God send.
Does it have a title yet?
I find this blog to be very helpful in sorting out what to eat and how it may effect me.
I have increased the amount of Vit D and fish oil that I take daily.
He is providing a good public service with the blog for which I thank him.
Dr. Davis- I've been following your blog for a while now and always enjoy your posts! Informative for sure – both the posts and all of the comments. Your sign off question gave me a good giggle. Keep up the good work!
artsynina.blogspot.com
@Kent
You can read the already written chapers of the book if you log in to the TYP site: trackyourplaque.com.
This blog is always giving good information. This is really good health blog. This is also really good article.
The American Heart Association had always given good advice on caring for one’s heart. It is up to us if we heed them or not.
buy pgx