Sunday, January 28, 2007

Why Is It That Nothing Is Ever Easy?

Thanks go to Michael for asking an interesting question about why I stopped an antibiotic regimen. It points to difficult decisions we all make, some esoteric questions about using statistical analysis, and how heart disease can make your head spin.

I stopped the doxycyline because the effect (MMP suppression) is supposedly durable (its effect is permanent according to the initial studies but we have no long term data yet). I don't yet understand the durability aspect and am researching it (this all new stuff). The azithromycin was stopped because all the studies said it was worthless. So what remains is my anomaly. Here is the problem.

In a statistical sense we are all sample populations (the variable "n" in a statistical analysis) of one. As we all intuitively know, an "n" of one is not large enough to make an inference about a larger population in any analysis. However, that does not mean that "nothing" happened. It just means we cannot infer the same outcome will occur in another population (i.e. someone else). Also in statistical Design of Experiments (DOE) there is the problem of "confounding factors." In layman's terms, it means we all take so many damn medications, supplements, eat different, live different, etc. that it is often statistically impossible to determine with any confidence that a particularly factor (taking an antibiotic) was the primary or even contributing factor in any outcome (disease reversal).

So here I sit. After six scans, the ONLY time I either stopped progression or significantly limited it (below 10%) is in years when I took a course of antibiotics. Now every cardiologist I know who is up on the latest studies will tell me I'm nuts if I think the antibiotics had anything to do with limiting plaque growth. Remember, the doxycycline is to reduce MMP which inhibits plaque rupture, not plaque growth and large scale studies show azithromycin (one-time thought to be a magic bullet) to be worthless. Taking long-term antibiotics without hard proof of some beneficial effect is pretty stupid for obvious reasons. So what the hell do I do?

Now don't get me wrong. There is another possible explanation here and that is this newly postulated effect where niacin loses its effect against lipoprotein(a) which is my real problem. As I mentioned earlier, I am about to take a baseline blood test before withdrawing niacin and then restarting it later (yeah, yeah, HeartHawk, the human test lab). The bottom line here is that even I have doubts, suspicions, and anxieties even though I study this stuff almost everyday and can dice up the statistical data like a Japanese teppanyaki chef. Yup, heart disease can make you a real head-case. And I bet you thought you were the only one going crazy!

Hey, misery loves company.



neil said...

Hi HH,
"a marked improvement in endothelium-dependent vasorelaxation and blood flow, dramatic regression in atheromatous lesions, and decrease in superoxide production and oxidation-sensitive gene expression. These therapeutic effects were associated with concomitant increases in aortic endothelial NO synthase expression and plasma NO2- + NO3- and cGMP levels. These observations indicate that ingestion of certain NO-boosting substances, including L-arginine, L-citrulline, and antioxidants, can abrogate the state of oxidative stress and reverse the progression of atherosclerosis. This approach may have clinical utility in the treatment of atherosclerosis in humans."

And this...
"The lining of the vessel is very important for cardiac health," says John P. Cooke, M.D., Ph.D., head of Stanford University's vascular unit and one of the first researchers to pinpoint the role of NO in cardiovascular health. "When the endothelium is healthy it's like Teflon, and things don't stick." When it's unhealthy, it becomes more like Velcro, attracting blood-borne gunk like flies to flypaper."

Even though I know your biggest problem is that you have an LP(a) problem I think adding in the l-arginine might make a difference as shown in the article. The statements and conclusions drawn by the study authors are pretty strong words as you can see. I am having some arginine water as I write this!

What does Dr. Davis say about your year over year plaque growth?

And btw, my LP(a) is only 4, the worse value I have recorded was 6, and I still had a heart attack! This shows we are all so very different.

Cheers, looking forward to more of your blog!


HeartHawk said...


Yes, there is great evidence for NO-boosting substances like l-arginine. Most of the studies involved carotid plaque but its not much of a leap from the neck to the heart. I am planning a tutorial (months in the future) about different approaches one of which is strengthing the endothelial layer.

Funny how we are all so different. You have hardly any lp(a) and I have a ton. Same damn result however, but we are slowly closing in on a cure (depending on how you define it) - which by the way will be the subject of an upcoming blog!



neil said...

Hi HH,

Your mention of upcoming topics for this blog sound very intriguing. I will look forward to future installments!

This last Tuesday I gave a small blood sample to have my 25-OH vitamin D3 checked. We shall see what my winter level is.

BTW, did you see this link posted on Dr. Davis's member forum posted by someone named "cz"? A very interesting presentation by a Canadian researcher named Dr. Reinhold Vieth. His name comes up a lot in Google searches about vit D.
The presentation is a bit slow paced at first, but by halfway is downright fascinating.

And thanks for your post of "" for a resource. I have been checking them out and watching videos. I had not seen that site before for some reason. Good stuff...

Arginine cheers!


HeartHawk said...


Wow, a 69-slide Vitamin D extravaganza. I wished he would presented the heart disease story here as well.

Make mine an Arginine Double.

Down the hatch!


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