Sub-clinical Hypothyroidism Linked to Fatal Heart Disease

A study of 25,000 people recently published in the Archives of Internal Medicine has confirmed that sub-clinical hypothyroidism (those with supposedly normal TSH test results) is positively linked to fatal heart disease in women. However, there were not enough cardiac deaths to extend this conclusion to men (note that this DOES NOT mean men are not affected, it simply means there were not enough events to prove it statistically within the 95% confidence interval established for the study). This study confirms the findings of a smaller study published in the Archives last year.

The message these studies provide is clear. Persons with TSH test results even in the intermediate range of "normal" (1.14-2.52 mIU/L) may be at heightened risk for cardiac death. The practical result is that patients should no longer rely on supposedly "normal" TSH test results to rule out hypothyroidism. You KNOW I'm not. Look for a future report on how to protect yourself!

Regards,


HeartHawk

More "Customer NO-Service" in Health Care

As many readers know, I have been trolling the rabbit-hole of hypothyroidism. In the past month I have been a pin-cushion for a legion of phlebotomists as I collect as much test data about myself as possible. I have already gone through two "crank turning" endocrinologists and am on my way to a third. One would think it is easy. Get your records, find a promising physician, make an appointment and voila, on we go. NOT!

The trouble all started when I went to retrieve my latest blood test results (TSH and T4) from a local clinic lab (where Endocrinologist 1 practices). I called the lab and determined the results were in. Of course, they won't give me the results and refer me to my doctor's nurse. The nurse attempts to mislead me into thinking the results aren't in. Of course, I know better and push the subject. She further argues that I need proper interpretation, diagnosis, and treatment that she cannot provide. I reply I am only interested in a number. Sorry, no can do, that's policy. So I call customer service at the clinic and they give the same inane arguments but inform me I can sign up to see all my labs online if I come down and sign up for the service (I did). Unbelievably, the nurse cannot give the info over the phone (HIPAA was not an issue), but I can see them immediately via the Internet. They finally relent and the nurse calls to give me the results. Geez, did it HAVE to be that hard? Here's the funny thing. In the interim I called the lab and asked them to fax the results to another physician. HA! They just took the fax number and sent it without even checking. I already had the results by the time the nurse called me back! Remember, there is always a way to get around bureaucrats if you are willing to think outside the box and used their allegiance to "crank turning" against them. OK, that problem is solved.

Next, I need to collect lab results from my primary care physician and Endocrinologist 2 (E2) who is part of his group. They also would not release new results to me and their group records department requires me to appear in person to sign a release. The kicker here is that they will not give me the records on the spot but will mail them to me in about one week. But, since these are somewhat older records my primary care physician's secretary agrees to mail them to me. E2's secretary is less forthcoming. She flatly refuses to send me "my file" but would release it to another physician. Finally, after arguing that I have only seen E2 a single time, that "my file" probably consists of only two sheets of paper, and that my primary care physician from her group is already sending my records she relents.

Now, armed with all my records, I try to find an endocrinologist that I think would be helpful. I first get a nice list of docs my insurance covers and select a relatively recent grad (1994) who practices at the local teaching hospital (Medical College of Wisconsin). I figure this is my best shot at finding a doc who is up to speed on the latest research and doesn't just "turn the crank." So, I call to set-up an appointment with Endocrinologist 3 (E3). Not so fast! I am rather bluntly informed that they will not set-up an appointment without a referral from my primary care physician. Further, they first must review my records and THEY will select which specialist in their group is most suited for me and set-up an appointment based on what THEY believe the severity of my problem is. Naturally, my next call is to their customer service department. I explain, for example, that I hire lawyers all the time based on MY selection criteria. I don't ask the local Sheriff for a referral to a particular group of attorneys nor do I accept whomever happens to be available that day. I wish to specifically hire one of your doctors for a consult to review my situation. Do you wish to do business with me? The nice lady said she would get back to me . . . tick . . . tick . . . tick.

Customer service? HA! Guess what pilgrims? It ain't just heart care that's screwed up. Somewhere along the line these arrogant SOBs think they are something special. They do everything they can to control information and work to keep patients from proactively becoming engaged in managing their own health care. As I have said in the past you have to take control of your health, demand good customer service, and don't take no for an answer.

Remember, stubborness can be beautiful. It can also save your life!


HeartHawk

This is Getting Embarrassing: TYP and Davis Score AGAIN!

In the sports world there is a rather unsavory and embarrassing tactic called "running up the score." It is what happens when you face an inept opponent and simply thrash them because you are that much better. Since I have become a "full-fledged flack for Track Your Plaque" I never tire of pointing out when Dr. Bill Davis once again lives up to my billing of him as the "Nostradamus of Heart Disease." This time it is in relation to another of the TYP lipoprotein 60/60/60 targets (the foundation of the TYP program), HDL.

While doing additional research on Hypothyroidism I stumbled across another bit of research I had previously missed involving the Honolulu Heart Program. This is a decades-old study of Japanese men in Honolulu and San Francisco that researchers have drawn upon to develop numerous hypotheses and conclusions about heart disease. A study published in the Journal of Lipid Research not only verified the need to establish an HDL of at least 40mg/dl (old news) but went on to show that raising HDL to at least (you guessed it) 60mg/dl conferred a rather large additional reduction of risk.

Thank you, sir. May I have another! (a hip, trendy reference for all you "Animal House" fans out there). Dr. D., please feel free to score at will!

Regards,


HeartHawk

Hypothyroidism and Heart Disease: Now What?

When I went to see the second of my "dueling endocrinologists" I was was in the midst of a full blown episode I often experience where my stomach feels like it is trying to regurgitate a rock coupled with a nasty spate of heart palpitations (PACs confirmed by holter monitor). My research found that there is evidence to suggest that people with Hashimoto's Thyroiditis (my confirmed diagnosis by both Endo's) can episodically become hyperthyroid due to the thyroid releasing stored hormones as it deteriorates.

Because I was in mid-episode I thought it would be interesting to see if my thyroid could be the culprit and the doc agreed to retest my TSH and Free T4 that day. Wouldn't ya know it, my TSH was a sterling 2.0 with a 1.2 Free T4. The second doc has now has refused to prescribe hormone replacement therapy (too bad, the first one already did) and wants to do repeat testing for several more months. This test result is just what you might expect if for some unknown reason my diseased thyroid started dumping hormones. Hmmmm! Well, the episode has passed and I'm back to normal (stomach's fine and no palpitations). You just know I'll be getting another blood draw soon to see if my TSH shoots back up! I'll find a third endo if need be.

While the docs diddle I'll be doing my own thing. If they think I am going to sit around feeling like I was hit by a truck while they test me for another few months - they're nuts!

Regards,


HeartHawk

Hypothyroidism and Heart Disease: Round 2

Well, saw the second endocrinologist today. Let's compare notes!

1. Both agreed I have Hashimoto's Thyroiditis.
2. Both preferred synthetic T4 to the natural Armour Thyroid (AT) preparation citing inconsistency between lots of the AT (the company's website disputes this).
3. Both defended synthetic T4 as being preferable because T4 is longer acting, has to be taken only once per day (AT should be taken more often as it contains shorter acting T3) , and both say most of the body's T3 comes from T4 anyway.
4. Doc 2 also went on to say he wants me on name brand (Levoxyl, Synthroid, etc.) rather than a generic to ensure I get a consistent level of T4. His argument is that the generics are OK if you could ensure you got the same brand everytime but with generics pharmacies can substitute freely between generic brands.
5. Doc 1 wanted to start me at 75mcg (I talked him down to 25mcg). Doc 2 wanted to start me at 25mcg unprompted. I agree!
6. Doc 2 want to treat me to achieve a level of between (1.0 and 2.0). Doc 1 was never really mentioned a treatment level.
7. Doc 1 set me up for a sleep apnea test to see if that was the true source of tiredness. Seems that is not uncommon in thyroiditis. I also got the impression he was pushing it for financial reasons.
8. I mentioned having another TSH test and Doc 2 jumped right on it and ordered the test which was done at his onsite lab. Think perhaps he makes a buck there?
9. Both docs took fairly extensive health histories and physical exams with Doc 2 taking a little more health data and Doc 1 doing a little more physical examination.
10. Neither doc hurried me and answered any questions I had.

Well that's all for now. Pretty dry and clinical. Neither doc was a ball of fire! I'll add more as I think of it. Next, let's see what results I get from treatment but that may be a while!

Regards,


HeartHawk

Hypothyroidism and Heart Disease: The Saga Continues

Well, saw the endocrinologist this morning and he confirmed my self-diagnosis; I have Hashimoto's Thyroiditis a condition where my own antibodies are attacking and slowly destroying my thyroid. I am starting tomorrow on a daily regimen of 25mcg of levothyroxine (synthetic T4). I lobbied for Armour Thyroid (a natural compound made from pig thyroids that contains both T4 and T3) but, despite the company's assurances, the doc belives there is too much variation in composition from lot to lot. He also pointed out that 80% of the body's T3 is synthesized from T4 anyway. He wanted to start me out at 75mcg but I insisted we go more slowly. No sense taking more than I need and any additive treatment will get me moving in the right direction. I can always take more and will probably have to as my thyroid self-destructs!

Now for some fun! I actually made appointments with TWO endocrinologists and see the second one tomorrow. Won't it be interesting to compare notes. I'll keep you posted on the "dueling endos" and my treatment results. Of particular interest will be how it affects my rising Lp(a) and homocysteine.

Regards, HeartHawk

Hypothyroidism and Heart Disease: An Update

OK, folks, read 'em and weep. My thyroglobulin antibody test was a whopping 37.9 IU/ml (0-14.4 reference range) and my thyroid peroxidase antibody test was worse at 22.8 IU/ml (0-3.9 reference range). Guess what, I likely have a thyroid autoimmune disease, probably Hashimoto's Thyroiditis. Well, at least I now KNOW (think I know anyway) what is causing my symptoms!

Next step, find a doctor to confirm my own diagnosis and properly treat me. Good luck. I called the top endocrinologists in my area and the wait is out one to two months or more. So, I took what I could get and will see somebody this week. Hopefully, the doc can get me started on a thyroid hormone replacement strategy so I can see how it affects my lipoproteins as well as my general well-being. However, I kept my appointment with the other guy - just in case I need a second opinion.

You know, it's funny. When I started this gig seven years ago (well before this blog) I thought I would be researching the heart and its arteries and peripherally the liver (as it makes most lipoproteins). Now, I'm digging around in my neck! Go figure. Well, you go where the cure takes you. The lesson to be learned here is to take matters into your own hands, be proactive, leave no stone unturned, and keep searching until you unearth all the root causes of your disease.

I'll heep you posted on my journey!


HeartHawk

P.S. The good news is we won't have to start our own foundation as we are with Lipoprotein(a). There are LOTS of thyroid groups!

Hypothyroidism and Heart Disease: The Plot Thickens

Wow! This rabbit hole goes a lot deeper than I could have ever imagined. It seems hypothyroidism is clearly connected with heart disease, is largely undiagnosed/misdiagnosed, and generally misunderstood. If anything, the real problem is, because thyroid hormones are used in just about every body tissue, hypothyroidism is connected with a huge list of symptoms and conditions. Now, on to my sad story.

Here I am, feeling like crap, disgestive problems, myalgias, fatigue, anemia, rising lipoprotein(a) and homocysteine, palpitations, mild depression, lack of concentration - yeah all that fuzzy, amorphous, undifferentiated, "feel like a truck hit" me stuff. One day I am so fatigued that I drop by the local walk-in clinic (because I can't get a freakin' appointment with my internist for a month - sound familiar) where they find me to be anemic. I luck out and finally get in to see my "regular" doc and he orders tests that show I have a moderately high TSH (4.5) and a lower (but in range) Free T4 (1.0ng/dl) and T3 (2.68 pg/ml). Of course, the internist's staff won't give me the results because they want me to schedule another appointment in ANOTHER MONTH! With a little subterfuge, I get them to fax the results "elsewhere" for "continued care" (the magic words) where I retrieve them. (DON'T GET ME STARTED ON THIS PET PEEVE - THAT WAS MY GODDAM BLOOD AND MY TEST RESULTS THAT I PAID FOR. HOW DARE THEY WITHHOLD MY HEALTH DATA FROM ME!)

So armed with this data I start my investigation. It seems that the new upper limit for TSH is really around 3.0 (not 4.5 or 5.5). Upper and lower limits form test "Reference ranges" and are not absolutes. They are set by testing lots of people who are categorized as "healthy" and determining their blood levels. The problem is you can have a lot of people who are subjectively categorized as healthy but are really not. That appears to be the case with hypothyroidism. It is likely there were numerous undiagnosed subjects included in the old "normal" range. As I mentioned in my last post on this subject, the more enlightened docs in the medical community now use these tests as guides rather than absolutes and treat based on symptoms rather than blood levels.

Now here is where it gets good (or bad depending on whether you are manic or depressive today). I also mentioned that hypothyroidism is connected with rising Lipoprotein(a) and now discover it is also connected with rising homocysteine (that would be me on both counts) as well as other hyperlipidemias. It also seems that certain drugs and supplememts can interfere with thyroid production (like niacin - also me). The link in the previous sentence is a multi-page article I would recommend reviewing. I also recommend this well-reasoned discussion on the treatment of hypothyroidism (especially the undiagnosed and border-line variety).

Hypothyroidism, it is real and it can screw you up. But it is easy to detect and treat. If you have symptoms or suspect it, get a doc to test your TSH, T4 and T3. To reduce delays try to get them done all at once. Many docs will do just the TSH and then only do T4 and T3 if your TSH is elevated. This is just medical "crank turning" by docs who don't like to think. In my NOT so humble opinion, you really have to look at all three and interpret the results. I'll post my results once I start treatment.

Regards from the human guinea pig,


HeartHawk

Track Your Plaque: Continued Validation!

OK, since I am now pretty much a full-fledged flack for Track Your Plaque (ya gotta love the alliteration and rhyming), I don't feel quite as bashful about saying, "I told you so." Dr. William R. Davis continues his unbroken record of prognostication and retains the title I gave him as the "Nostradamus of curing heart disease" as I find yet another vindication of the Track Your Plaque principles, in particular the 60/60/60 precept (LDL/HDL/Triglycerides).

A new report from the Stop Atherosclerosis in Native Diabetics (SANDS) study suggests that aggressive lowering of LDL (<70mg/dl) and blood pressure (<115mmHG) regresses heart disease as compared to standard targets (100mg/dl and 130mmHg respectively). Admittedly, the researchers used carotid intima media thickness (CIMT) which is the easiest surrogate end point to regress. Also, the study only looked at Native American diabetics but diabetics are traditionally the TOUGHEST group to treat. It is also possible this result only applies to persons with Native American genetics but I doubt it. Either way, it is good news and pushes us closer to a cure.

The other nugget to come away with is the TYP principle that says plaque growth rates below 10% are nearly as effective as reversal (in terms of clinical events) is also supported by SANDS. While not a cure for all, this is still great news and another win for the lower is better philosophy.

The Lipoprotein(a) Foundation: An Update

Here is a synopsis of what is going on to establish the Lipoprotein(a) Foundation (LF).

1. I met with Mary Lou Ballweg, the head of the Endometriosis Association, an extremely successful group with many similarities to our proposed foundation. She informed me that the Milwaukee, WI area is a hotbed of start-up medical fiundations so I hope to take advantage of my location. Mary Lou provided a wealth of information and, I think, a powerful idea for jump starting LF. She recounted the key event in the growth of EA was the establishment of a database of self-reported information about endometriosis sufferers. The method they used was a simple brochure she mailed with instructions to fill it out and return it with a dollar to cover data-entry costs (this was the 1980's, no Internet). Universities like Dartmouth and Vanderbuilt were eager to get this type of research data as it was not available anywhere else and, voila, the research began in earnest. We should do the same and it will be a whole lot easier with the Internet (see next item).

2. Dr. Davis has formally agreed to donate all the necessary Track Your Plaque web resources to implementing the LF website. I now have admin privileges on the new development site and will begin to implement a web-based data collection tool within the TYP framework. Doc Davis also offered to donate the 501(c)(3) non-profit filing fee. When he mentioned the effort on his blog, several commenters offered their assistance as well (as they did on this blog). I would request that anyone still interested in donating skills or making contributions to contact me directly at hearthawk(at)wi.rr.com with their contact information. I have helped start two other non-profits but I am not an expert and could use all the help I can get. (see next item).

3. In addition to the web work I have also started the IRS filing process. I guess the only thing I can say is I'll work as fast as time will allow. Obviously, anyone with knowledge of this process would be extremely helpful. We do have to form a board of directors at some point. Major contributors of time, talent, and financial resources are always prime candidates for these roles.

4. If we can attract an "angel" investor we can obviously move a lot faster! I have broached the subject of investment capital with a professional fundraiser that would consider helping us at a reduced fee as time permits but she is booked for at least six month to a year. Whether it's a million people with one dollar or one person with a million dollars we will need to start raising money to fund research. Frankly, at the risk of appearing mercenary (I am), our best bets are people plagued (or "plaqued") with Lp(a)! The beauty of medicals breakthroughs is that once a cure is found for/by one person's efforts, it cures almost everybody.

5. If anyone has any medical/research/academic contacts they would be useful to help form our advisory board. The University of Wisconsin is a top medical research facility and I have scheduled a meeting with a blood researcher there. As luck would have it, my daughter is a biochem major at UW working on here senior research thesis and is searching for addtional contacts (I oughta get something back for all those tuition payments!).

That's where we are. Let's slay the Lp(a) dragon!

Regards,


HeartHawk

Hypothyroidism and Heart Disease: Here we go!

Now what?! I just finished clearing up a low blood count and a mild case of anemia (watch your aspirin intake folks - it's hard on the tummy) only to find my Thyroid Stimulating Hormone (TSH) was above normal. TSH is excreted by the pituitary gland and stimulates the thyroid gland (nice video here - after the ad ends) to produce the hormones thyroxine (T4) and triiodothyronine (T3) which in turn is used by various organs and tissues of the of the body. Suffice to say your whole body pretty much needs the stuff (follow or Google these blog links if you want to dig into this stuff). The key here is to realize that a high TSH means low thyroid function or hypothyroidism. The pituitary essentially tries to kick-start the thyroid to secrete more of its hormones by overproducing TSH.

Hypothyroidism has a number of irritating symptoms (severe cases can result in a life threatening condition known as myxedema coma). The most common are fatigue and depression. Here is the list of symptoms from the American Association of Clinical Endocrinologists (AACE) for all of us hypochondriacs:

• Dry skin and cold intolerance
• Yellow skin
• Coarseness or loss of hair
• Hoarseness
• Goiter
• Reflex delay, relaxation phase
• Ataxia
• Constipation
• Memory and mental impairment
• Decreased concentration
• Depression
• Irregular or heavy menses and infertility
• Myalgias
• Hyperlipidemia
• Bradycardia and hypothermia
• Myxedema fluid infiltration of tissues

There is also additional evidence (About.com, American Thyroid Association) to suggest hypothyroidism (as well as hyperthyroidism) can have negative effects on the heart.

The real problem here is when and how to treat sub-clinical or mild hyperthyroidism. AACE has waffled in the past but their most recent statement is typical of head-in-the-sand traditional medicine; esentially, do nothing (gee, thanks, I was already doing that, slowly dying of heart disease, and feeling crappy in the process). Others disagree. Amazingly, the American Academy of Family Physicians (AAFP) makes a cautiously worded statement that suggests treating patients based on their symptoms rather than their TSH levels (what a concept). Mary Shomon (perhaps the "ThyroidHawk" of bloggers) takes a shot at the medical establishment in this article. Doubtlessly, the indifference and incompetence heart disease sufferers face is common among all the halls of traditional medicine.

I'll continue to update you on what happens in my "heart disease and thyroid saga." This is of particular importance to me since I discovered this article that suggests T3 rapidly lowers lipoprotein(a)! Oh, and you know darn well I'll be pestering Doctor Davis to chime in on the subject.

Regards,

HeartHawk

P.S. My next blog will update everyone on how the formation of the Lipoprotein(a) Foundation is coming. Suffice to say I am moving forward.

Vitamin D: The Evidence Keeps Rolling In

I guess I shouldn't be surprised but Dr. Davis of Track Your Plaque continues to demonstrate he is the Nostradamus of heart disease prevention medicine. For the last year he has trumpeted the powerful effects of Vitamin D in regressing plaque and presented his findings in early April at the Experimental Biology Symposium in San Diego.

Now, researchers using data from the National Health and Nutrition Examination Survey (NHANES) study have presented their similar findings at the Arteriosclerosis, Thrombosis and Vascular Biology Annual Conference. They found that persons with low Vitamin D levels have a higher incidence of Peripheral Artery Disease (PAD). PAD, also known as intermittent claudication, is a condition where blood vessels in the extremities become narrowed or occluded by plaque.

Once again, Dr. Davis proves to be ahead of the curve!

Regards,


HeartHawk

More on the Lipoprotein(a) Foundation

Looks like we may be on to something here. We have already had interest from several blog readers about keeping this idea going (see previous blog entry). Here is what has transpired in the past day.

1. Track Your Plaque (TYP) has graciously offered to host the Lipoprotein(a) website. I am meeting with their head web programmer on April 18th to lay the ground work.

2. I am meeting with Mary Lou Ballweg one of the founders of the Endometriosis Association (EA) on April 23rd to pick her brain on how to start and run a successful medical Foundation. Endometriosis was a little known disease and, similar to Lp(a), had little or no research or funding. Mary Lou grew (EA) from a humble start of one person working from her living room to an international association with its own headquarters building. She will be a fantastic resource for us.

3. I have talked briefly with Dr. Davis of TYP and while he cannot become directly involved due to time constraints, he has agreed to help us in any way he is able. He can be our "in" in the medical community.

4. I am about to contact other Lp(a) researchers such as Drs. Marcovina and Scanu to get their input.

The rest is pretty much up to us to keep the "viral marketing" campaign going and build a list of potential members and contributors. I will also attempt to start scaring up a few bucks and will talk to the programmer on the 18th about setting up a PayPal online contributions page as well. The oft repeated bromide is true here, "If every Lp(a) sufferer kicked in just $1, we would have millions." Finally, anybody know any non-profit lawyers and accountants who suffer from Lp(a) and want to help save their own lives? Sooner or later we will have to form a board of directors if we get this thing off the ground. Say, you don't suppose Warren Buffet or Bill Gates has Lp(a) do you?

The Lipoprotein(a) Foundation: Time to Start One?

I just received some disheartening news from Dr. Sally McCormick one of the world's few Lipoprotein(a) researchers. I had asked her how her lead anti-Lp(a) compound was fairing in trials and the answer was not good, "some of the animals were quite sick after dosing with the peptide, we think due to the peptide being unstable and aggregating in the circulation."

On the bright side she also mentioned she is about to publish some preliminary research on DMPC (dimyristoylphosphatidylcholine which is not to be confused with PPC or phosphatidylcholine being studied in the Track Your Plaque Virtual Clinical Trial). Additionally, Dr. McCormick does have one other lead compound in the pipeline but it is not in trials yet.

Sally did make one other statement at the end of her letter that stuck with me, "Sorry I can't be of more help to you and other high Lp(a) sufferers as yet, we are trying to develop something but its just really slow when time and funding is limited." This reminded me of a woman I know (right here in my hometown) with another neglected medical condition called endometriosis. Like Lp(a), few people were doing any research and fewer companies were investing any money in finding a cure. She started the Endometriosis Association to provide support and create pressure to find remedies for persons with her condition and was immensely successful.

Perhaps all of us Lp(a) sufferers should do the same. I have started a 501(c)(3) educational charity in the past - it's not fast or easy thanks to the U.S. government. It takes lawyers (or really knowledgeable people) at least a little money (the filing fee alone is around $500) , and a lot of work to grow the organization. My vision would also include raising a boat load of money to fund independent medical research similar to what is being done by some of the pioneers like Dr. McCormick (I'll bet there are as many wealthy people as poor people slowly dying of Lp(a)).

So there you have it, the Lipoprotein(a) Foundation! I know Track Your Plaque will front us the web presence and let us use their new community/networking software they are developing. Dr. Davis as well as several other professionals associated with Track Your Plaque have expressed interest but they are too busy to start it or run it. Now, can the rest of us develop the critical mass to put something like this together and cure ourselves?!

Regards,

HeartHawk

More on Vitamin D and Testosterone

Lot's of great comments on my last blog concerning Vitamin D and testosterone. A few commenters rightly took me to task for my less than rigorous data regarding the association between my Vitamin D intake and my testosterone level. So, here is what we can say.

1. For my "n of one" study there is an "association" between between Vitamin D and testosterone levels. However, it cannot be concluded it is causative. It could be that can of "Coke Zero" I drink every day that's doing the trick!

2. It is not outrageous to speculate that there could be a link between Vitamin D and testosterone given chemistry. We just cannot prove it with my results. There is some excellent material on Vitamin D pharmacology put out by the Vitamin D Council (really level-headed stuff not marketing hyperbole) and for those who lean toward the "geeky" side this cite from AACC is nice.

3. It is unlikely my low testosterone stayed high several years after stopping my use of topical testosterone. What I really need to do is stop the Vitamin D for several months and re-check my testosterone to see if it goes lower. The problem is that Vitamin D is good for so many other things that it does not seem appropriate to discontinue it. Perhaps a new Track Your Plaque Virtual Clinical Trial might be useful where we measure "before" and "after" testosterone levels.

We certainly need more clinical data on the relationship between Vitamin D and testosterone. We have chicken data (and more chicken data here - what is it with chickens anyway) and we have rat data that suggests Vitamin D increases male (rat) fertility but we just do not have anything that says Vitamin D increases human testosterone (yet).

Anecdotally Yours,

HeartHawk

Vitamin D and Testosterone: Another "Fountain of Youth" Find

When Dr. Davis of Track Your Plaque first reported his phenomenal success using Vitamin D to reverse coronary plaque I pretty much blew it off as coincidental and too good to be true. But, once again, Dr. Davis has proven to be the "Nostradamus of Heart Disease Reversal" as breaking data continues to support his prediction and clinical evidence.

After much brow beating, I finally decided to try Vitamin D. With some rather interesting results. Let's first set the table for my experience.

When I first became a follower of Dr. Davis (long before there was a Track Your Plaque) I had my testosterone tested and it was fairly low (near the bottom end of normal). Because testosterone can be an effective Lp(a) remedy (my scourge) I tried using a testosterone cream to raise my level and it promptly went up to the high end of normal. But, for various reasons (no effect on Lp(a), lowering of HDL, and it's inconvenient as hell to use) I stopped. But look at my Testosterone (T) blood levels since I started using Vitamin D!

Date	T (ng/dL)	Vit D (ng/mL)	Notes
10/18/01	328	Unknown	Baseline testosterone
02/06/03	774	Unknown	Started topical testosterone
08/04/06	792	53.0	Stopped T 1 year earlier/started 2100IU D
12/26/07	735	40.7	8000IU Vitamin D (increased for winter)
03/06/08	728	69.2	10000IU Vitamin D (needed more to hit TYP threshhold)

As you can see the Vitamin D was just as effective at raising my endogenous testosterone as was using synthetic, topically applied testosterone cream. Also note that I had to signficantly raise my D dosage in winter months to offset the lack of sun. The other goofy thing is that for some reason there is a threshhold effect at around 50ng/mL (although mine kicked in at 40). This Vitamin D stuff is damn interesting. The numbers do not lie and for a numbers guy like me its all the proof I need.

Regards,

HeartHawk

Mammography and Calcium: More Steadfast Denial

It is often absolutely stunning how tradition medicine continues to remain in a state of denial over the efficacy of calcium scoring as a measure of heart disease risk. A new study revealed that women who display arterial calcification on their mammograms are over twice as likely to develop cardiovascular disease. Ya think?!

Dr. Michelle A. Rotter (University of Connecticut School of Medicine, Farmington) and colleagues reported their findings in the March/April 2008 issue of Menopause. Dr. Rotter went on to comment, "it has yet to be determined whether screening for BACs is an effective tool in screening for CAD." But that is not the point as the evidence continues to mount and doctors continue to ignore it. Arterial calcium is the strongest predictor of heart disease and future events - period - and it appears that detection via routine mammography can be an important predictive tool much like heart scans.

Although the link between arterial calcification, especially calcification in coronary arteries, has long been established as the single greatest predictor of heart disease, the traditional medical community continues to dither over supportive findings such as this lastest study. It is not as though this were the first time such a study came up with this discovery. Another study published in 2000 found a similar association between breast arterial calcifications and atherosclerosis.

When is traditional medicine going to 'fess up to the truth and stop letting people become so sick they have no choice but to pay big bucks to be butchered on their operating tables. This is utterly repugnant! We already know that arterial calcium is the greatest predictor of future heart disease in asymptomatic individuals and the COURAGE trial proved that non-surgical therapies are just as effective as surgical therapies in non-acute patients. One day, this is going to come back to bite these negligent hospitals, doctors, and insurers in the butt to the tune of billions!

Still holding my nose and holding out hope,


HeartHawk

Additional commentary on this study from Medscape, heartWire

More on Aspirin Resistance, NSAIDs, and Stroke

In an earlier blog I discussed aspirin resistance as a factor in heart attack. A new study now confirms similar results in stroke victims. You are 14 times more likely to have a recurrence of stroke if you are aspirin resistant.

Similar to previous studies, 20% of partcipants were found to be resistant to the effects of aspirin on the interruption of the arachodonic acid cascade that inhibits platelet aggregation (clotting). Of the 87 patients who had recurrent strokes while taking aspirin, 57 (66%) were nonresponsive to aspirin. That an odds ratio of more than 14 times greater. Put another way, of the patients who were aspirin responsive, only 5% were among those who suffered recurrent symptoms while taking aspirin.

In another paper in the Journal of Clinical Pharmacology, the same researchers found an interesting association between people taking both aspirin and NSAIDs (ibuprofen for example). All of the participants who took both aspirin along with some other NSAID showed signs of aspirin resistance. However, when they stopped taking the NSAID, the aspirin resistance disappeared.

Dr. Gengo, one the head researchers commented in a Heartwire interview, "There are many people out there who are taking an NSAID while on aspirin and therefore putting themselves at increased risk of ischemic events (e.g. heart attack and stroke - HH). This study shows that there are many strokes every year that could be prevented."

The New Hub-Bub Over Metabolic Syndrome

Metabolic Syndrome has long been identified as a risk factor for heart disease. However, idientifying exactly what it is and what its cause or causes are has been a subject of much debate. Now, a new study published in Cell Metabolism has thrown the issue into a full-fledged brouhaha over whether Metabolic Syndrome is a multi-cause condition or more simply a single cause condition with multiple symptoms. For example, is small-LDL a contributor to a diagnosis of Metabolic Syndrome or is some other single root cause driving a host of symptoms such as small-LDL to appear.

The Multi-Cause camp has labored long and hard at defining what group of causes is sufficient to render a diagnosis of Metabolic Syndrome. Different organizations have different standards but all require having some combination of common symptoms such as:

• Presence of diabetes
• Microalbuminuria
• High blood pressure
• High triglycerides
• Low HDL
• Overabundnace of small-LDL
• Insulin resistance
• High fasting blood glucose
• High waist to hip ratio

Here are links to the various guidelines NCEP ATP III (what most U.S. doctors use), American Heart Association, World Health Organization (pages 32 and 33), European Group on Insulin Resistance (EGIR).

This latest study by the Joslin Diabetes Center focuses on insulin resistance in the liver as the key factor in the cause of metabolic syndrome and its association with heart disease. It advances the theory that metabolic syndrome is not simply a collection of abnormalities that should be treated independently but a group of closely linked disturbances in glucose and cholesterol metabolism that stem from a defect in insulin signaling in the liver. This thinking suggests the cure for Metabolic Syndrome is not to treat a variety of symptoms but rather to find and treat the underlying cause perhaps with a single "magic bullet." This is tantatmount to treating and eliminating a cold virus rather than treating the associated symptoms aches, sore thoat, congestions, and sniffles associated with the cold.

OK, great! Now let's find that magic bullet!

HeartHawk

Do YOU Worship at the Alter of LDL Cholesterol?

Many years ago, doctors would simply measure total cholesterol and call it a day. As the snail-slow medical community progressed it identified LDL Cholesterol as the "bad" guy and basically did little else for decades but beat up on LDL and develop LDL lowering drugs like statins and, more recently, ezetimibe. But a funny thing happened on the way to the temple.

Much like the COURAGE trial delivered a much different than expected result on stenting (it's not much better than drug therapy for non-acute heart disease) , the ENHANCE trial found that lowering LDL with ezetimibe provided little improvement in outcomes. Track Your Plaque proponent Dr. William Davis often opines, "The average LDL Cholesterol of a heart attack victim is 134mg/dl, the average LDL Cholesterol for someone who does not have a heart attack is 131mg/dl." It is a statistical dead heat!

The latest theory is that what matters most is not merely how low you drive LDL Cholesterol but how you go about lowering it (statins deliver pleiotropic effects beyond simply lowering LDL). Ezetimibe can dramatically lower LDL when taken in combination with a statin. You have probably seen the commercials for Vytorin (simvastatin plus ezetimibe) that proclaim it treats the "two sources of cholesterol" (genetic and dietary). The ENHANCE studiers naturally expected to prove ezetimibe was a blockbuster drug that whose LDL lowering effects would earn billions. But it didn't happen. Moreover, the researchers were accused of delaying publication of the bad news.

Dr. Eric Topol has an interesting Video Blog on the subject that is worth the 4-1/2 minutes of your time to see and hear. He suggests that the true cuplrit is oxidized LDL. It makes a lot of sense as we begin to "peel back the onion" on LDL Cholesterol. Stay tuned! You know my next move. Find a test for it so I can hang on number on it!

Regards,


HeartHawk