Seven Important Measures of Cardiovascular Health--and It's Not Cholesterol

Ready for a heart-to-heart talk about the real culprits behind heart disease? Get ready to challenge everything you thought you knew about cholesterol and heart health. Our journey begins with debunking the age-old myth that cholesterol is the primary cause of heart disease—an erroneous belief rooted in misinterpreted studies from the mid-20th century. We're also laying out seven self-manageable measures of heart disease risk that you can address right at home. 

If you ask your doctor about how to reduce your risk for heart disease, i.e., coronary heart disease and heart attacks that remain the number one killer of Americans, he/she will tell you that reducing saturated fat, eating whole grains, perhaps taking a baby aspirin, and reducing cholesterol with a statin cholesterol drug are the keys. Is this true? Of course it’s not. 88 million Americans take statin cholesterol drugs, for instance, and there has been no measurable reduction in heart disease events. Many people have worked to reduce saturated fat intake and it’s part of the reason why we have record-setting levels of overweight and obesity. In other words, the conventional ideas of reducing risk for heart disease are nothing more than fairy tales based on misinterpretations, misrepresentations, and a desire to maintain the very profitable status quo of procedures for heart disease, the #1 moneymaker for hospitals. Of course, the real tragedy is that the focus on cholesterol, saturated fat, etc. takes everyone’s attention off the real causes of heart disease that are, in truth, identifiable, measurable, and readily correctable. Just don’t ask your doctor to tell you how. So, in this episode of Defiant Health, let’s consider this question and discuss seven measures of heart disease risk that you are able to address on your own. 

The path to understanding heart disease veers towards an in-depth look at coronary atherosclerosis, often ignored in conventional advice. Brace yourself as we expose how plaque buildup in your arteries, not cholesterol, poses a more accurate risk assessment for heart disease.

We end our expedition by revealing the unsung hero in heart disease prevention – lipoprotein analysis. Together, we'll explore how lipid levels impact coronary calcium scores and discover how Vitamin D and fish oil may work to curb this increase. Managing insulin and glucose levels is vital, and we'll explain why. We're also exploring the overlooked roles inflammation and disrupted bowel flora play in heart health. Lastly, we'll offer insights into a diet program teeming with key nutrients that can help achieve optimal heart health. Know your heart better, and let knowledge empower your journey towards a healthier heart.

Further discussion can be found on my DrDavisInfiniteHealth.com blog.

For access to my Inner Circle discussions, including weekly Zoom video discussions:
InnerCircle.DrDavisInfiniteHealth.com

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Transcript

William Davis, MD: 0:06

If you ask your doctor about how to reduce your risk for heart disease that is, coronary heart disease and heart attacks that remain the number one killer of Americans they will tell you that reducing saturated fat eating whole grains, perhaps taking a baby aspirin, and reducing cholesterol with the statin cholesterol drugs are the keys. Is this true? Of course it's not. 88 million Americans take statin cholesterol drugs, for instance, and there has been no measurable reduction in heart disease events. Many people have worked to reduce saturated fat intake and it's part of the reason why we have record setting levels of overweight and obesity now. In other words, the conventional ideas of reducing risk for heart disease are nothing more than fairy tales based on misinterpretations, misrepresentations and a desire to maintain the very profitable status quo of procedures for heart disease, the number one money maker for hospitals. Of course, the real tragedy is that the focus on cholesterol, saturated fat etc. Takes everyone's attention off the real causes of heart disease that are, in truth, identifiable, measurable and readily correctable. Just don't ask your doctor to tell you how. So in this episode of Defiant Health, let's consider this question and discuss 7 measures of heart disease risk that you are able to address on your own. Later in the podcast let's talk about Defiant Health's sponsors that include Paleo Valley, who provides fermented grass-fed beef sticks, bone broth, protein rich in collagen, organic super greens and low carb super food bars and now 100% grass-fed and finished pastured meats. And our newest sponsor, bioticuest, who provides unique probiotics such as sugar shift to support healthy blood sugars and simple slumber to assist in obtaining healthy sleep, probiotics crafted with unique property of combining synergistic microbes. So if you've been advised to reduce your saturated fat cholesterol, take a statin cholesterol drug, take a baby aspirin, exercise more, you need to know that you've done almost nothing to address risk for heart disease. Heart disease is everywhere. It's the number one killer of Americans. It's more common than cancers, dementia and other health conditions. As I mentioned in the opening comments, it's also the number one money maker for hospitals. That is, heart procedures like angioplasty, heart capitalization, bypass surgery and related procedures. This all began with misinterpretations of very bad clinical studies performed in the 1950s and 1960s that led to this idea that cholesterol is the cause of heart disease.

William Davis, MD: 2:52

Let's be clear Cholesterol is not the cause of heart disease. At best is a crude indirect marker for the lipoproteins, the particles in the bloodstream that actually do cause heart disease, but it's been construed, it's been misconstrued as the actual cause for heart disease, and it is not. Cholesterol is a passenger on proteins that are able to transport fats through the blood. We call them lipoproteins fat carrying proteins, because cholesterol is a fat and fats cannot flow freely in the bloodstream because if they did, they would coalesce and form globules that blocked flow in arteries. So cholesterol does not do that. It instead is a passenger on a protein as a combined lipoprotein particle, and it's the character of these lipoproteins, their size, their number, their surface charge, their surface recognition proteins and various other aspects that determine their behavior, that is, to determine whether or not they're going to contribute to causing atherosclerotic plaque in arteries such as the heart's arteries, the coronary arteries or other arteries like the carotid arteries or the iliac or femoral arteries, to the legs.

William Davis, MD: 3:58

The real tragedy, though, in my mind, is not that everyone's being misguided and thinking about cholesterol and statin drugs. It's that it took everybody's attention away from all the real causes of heart disease, for which you hear almost no conversations at all from doctors, from the healthcare system, from TV ads for drugs. There's no mention of the other, the real causes of heart disease, beyond the silly notion of cholesterol. I did not appreciate all this until about 30 years ago when I opened someplace called Milwaukee Heart Scan. I did that because my mom, who went a successful two-vessel coronary angioplasty in New Jersey, where I grew up, and she went home and about two months later was found dead of sudden cardiac death. And so it drove home to me that the procedures that I was doing I was doing similar procedures in my hospitals in Milwaukee, wisconsin. These procedures are a very poor fix for a very dangerous disease and there are people like my mom who never make it to the hospital and already have their arteries opened. And so I went looking for a way to identify people who are at risk for heart attacks, sudden cardiac death a year, two years, five years, 10 years, before such catastrophes strike. This was true 30 years ago. It remains true today.

William Davis, MD: 5:15

The only real way to measure this disease coronary atherosclerosis, that is, the plaque that builds up in your arteries. The only way to truly measure it precisely, quantitatively is to generate what's called a coronary calcium score using a CT heart scan. It's a CT device and you can see calcium in the coronary arteries quite easily and you can measure its volume very easily. Now why do we measure calcium? Because calcium has been found to occupy 20% of total atherosclerotic plaque volume. This is proven by my friend, dr John Rumberger, when he was at Mayo Clinic and he showed that calcium can be precisely measured and gives us a dipstick or gauge for total atherosclerotic plaque. So if you have two cubic millimeters of calcium you have 10 cubic millimeters of total atherosclerotic plaque volume. So it's not a measure of blockage, that's a different kind of measure. It's a measure of the volume of plaque in the coronary arteries. Kind of think of it this way If I had a foot-long piece of iron pipe, a blockage measurement would tell me something like this Three inches down from the left side of that pipe there's a bunch of accumulation of rust that can block water flow. That's a blockage type perspective. The CT heart scan or coronary calcium scores. Instead of something like this in this one foot of pipe there's 253.4 cubic millimeters of rust. Two different kinds of measures. Now people say, oh, I want to have had blockage, but that's not what causes heart attacks.

William Davis, MD: 6:44

Heart attacks are caused by the rupture of a plaque. That's not blocking flow, maybe it's only 30% reduction in diameter of the artery. And that plaque is active. It's got inflammatory cells in it, it's got red blood cells and it can rupture like a little volcano. When it ruptures and its internal contents are exposed to blood that's flowing past, this is a potent trigger for blood clotting. So it takes only a relatively minor plaque that's active and erupts and then triggers blood clot formation. That is what a heart attack is. So the best predictor is not percent blockage at one point in an artery, it's how much volume of atherosclerotic plaque you have, because the greater the volume, the more potential there is for plaque rupture or heart attack.

William Davis, MD: 7:29

Well, because of my interest in preventing heart disease events, I set up Milwaukee Heart Scan and we scanned people left and right, thousands and thousands of people. One of the first scanners in the Midwest, one of just a handful that were available in the region. But we scanned thousands of people and when you start looking for hidden heart disease in people who are going to work, going to school, jogging, riding their bikes, active with no symptoms, you find it everywhere. Now we score it A normal score. Calcium score is zero and increasing scores signify increasing potential for heart disease events like heart attack, because you have a greater volume of atherosclerotic plaque. So if you get to a score of 1,000, for instance, the risk for heart attack and sudden cardiac death is about 10% to 15% per year. So very high risk. And you can imagine, over about five, six, seven, eight years you're guaranteed to have a major cardiac event.

William Davis, MD: 8:21

So what do we do about it? Well, this goes back over 25 years ago. Back then I would put people on the standard regimen, that is, a low fat diet, put them on a high dose of a statin cholesterol drug to reduce LDL cholesterol, a baby aspirin, sometimes other drugs like beta blockers, an exercise program. Now it's important to know we help publish these data. If you do nothing for your carnal calcium score which is unwise, of course right. But let's say your score is 300 and you do nothing, what will the score be one year later? It will be 25% higher. So it'll be 375. And then another year later, another 25% higher. And so with each leap you're closer and closer to heart attack and death. What if you go on the best there is in conventional medicine, conventional cardiology, baby aspirin, low fat, low saturated fat diet, a high dose of a statin cholesterol drug, exercise program, maybe some other drugs too? How fast will that score go up? 25% per year.

William Davis, MD: 9:20

That has been corroborated many times. It has virtually no impact on the growth of arthroscopic plaque, yet it's the only thing that you're given to reduce heart attack risk. Well, at a practical level, I had thousands of people essentially freaking out on me because they saw their scores going up, up, up, getting closer to danger. Unfortunately, my colleagues would often say things like well, let's do the real test, a heart catheterization, to see if you need a stent, angioplasty or bypass surgery. Now recall, these are not people in the emergency room with chest pain and can't breathe. These are people like you and me, going to school, going to work, exercise and climbing stairs, having no symptoms at all.

William Davis, MD: 10:00

So what they were doing, what my colleagues often do, is advocate a prophylactic or preventive procedure. That, by the way, has been disproven. It has no benefit whatsoever Because, regardless of where you put the stent or where you put the bypass, you cannot predict where plaque will rupture, because if you're going to be going by the worst blockage, that's not where the rupture occurs. The rupture can occur in a 10% blockage, a 20%, 30% blockage, and you can't stent the entire three coronary arteries. Of course, right, you can't bypass everything either, so you can't predict where an event's going to occur, where a plaque rupture is going to occur. So it's clear in the number of studies that doing prophylactic procedures is of no benefit, and it's done all the time.

William Davis, MD: 10:45

And people are scared when they're told that heart attack or other major cardiac event is imminent, so they often resort to such ridiculous procedures for indications that are not real. And of course, the hospital, the doctor, makes a lot of money doing unnecessary procedures. Sad to say, this is very common. So what do we do? This is over 20 years ago. Well, I stumbled about trying to find better solutions. There are no experts in this.

William Davis, MD: 11:11

These purported experts said things like this Well, if you can't stop the increase in the coronary calcium score, just don't repeat the scan. Let them have their heart attacks and other events and then deal with it. They actually said that. A number of so-called experts actually said that. Well, I refused to accept that. So I said about trying to identify factors that would put a stop to this 25% per year relentless increase in Carnarick-Halsam scores.

William Davis, MD: 11:36

And there was a lot of trial and error and use of logic and resorting to the science, but it led to lessons like this when you add vitamin D, the way we do it, the way I do it which is to add an oil-based gel cap form of vitamin D3 or Colycalciferol at a dose sufficient to raise your 25-hydroxy vitamin D blood level to 60 to 70 nanograms per milliliter. Typical dose would be 6,000 units for an average size man, 4,000 to 5,000 units for an average size woman, and it was the first time I saw coronary calcium scores plummet. Score of, say, 700 would come back as 420 or something like that. At first I didn't believe it and I went back to the original scan of somebody and then the follow-up scan and yes, indeed, the coronary calcium you can see quite easily has shrunk dramatically. Even though these heart scans are made to visualize calcium, you can also see the softer elements to some degree and you could actually see that the other components of the abscleric plaque has shrunk. Now, before I added vitamin D, I had used fish oil and used some other efforts to try to stop, and I did manage to slow it down from 25% to maybe 12% to 18%, but still growing quite rapidly. When I added vitamin D, it was the first time I saw scores drop, not in everybody, but in the majority.

William Davis, MD: 12:58

So having a coronary calcium score generated by a CT heart scan gives you something to track. It tells you whether or not you're having success in your heart disease prevention program. Cholesterol does not tell you this and that's why, once you build this house of cards on this false premise that cholesterol causes heart disease, it leads you to useless methods of dealing with it, such as statin cholesterol drugs that reduce cholesterol. So if you do nothing, coronary calcium score is up 25% per year. If you take a statin cholesterol drug and all the other things they do in conventional care, it still goes up 25% per year. There are other tests, other lessons we can use. So let's discard this idea that cholesterol is the cause for heart disease and that cholesterol tells you what your risk is. It does not. It is extremely poor predictor. But there's a superior predictor when it comes to lipoproteins. So rather than indirectly gauge what your lipoproteins are doing by using cholesterol values, let's actually measure the lipoproteins Now.

William Davis, MD: 13:56

There are a number of ways to do this, but the method that has emerged as the most available, gold standard and expensive also, is NMR lipoprotein analysis nuclear magnetic resonance lipoprotein analysis. It's the MRI device. It's also called MRI, just like the kind you get to scan your chest or your pelvis or your abdomen. You can put plasma the clear part of your blood into an MRI device or NMR device and you can actually count the number of various lipoproteins in your bloodstream. It's available, it's been around for over 30 years. It's inexpensive.

William Davis, MD: 14:31

But don't be surprised if you ask your doctor and say, hey, I'd like to get an NMR lipoprotein test in place of my cholesterol. He or she is likely to say, oh, it's unproven, it's experimental, or insurance won't pay for it. None of that is true. It's been around for decades. It typically costs about $100. So a little more than a cholesterol test, but it gives you the real information.

William Davis, MD: 14:54

But there's two pieces of information you really need off your NMR lipoprotein analysis, and that is the number of small LDL particles and how much VLDL. And you can make this even easier. So, while I bash cholesterol testing, the triglyceride value on your cholesterol testing is a helpful measure, because triglycerides perfectly parallel VLDL, and so we know that any triglyceride value greater than 60 milligrams per deciliter is accompanied by both an increase in VLDL that directly causes carnal atherosclerosis, and VLDL, a particle that's very low density. Vldl is rich in fat triglycerides, and when you have a lot of VLDL particles, as signified by a higher triglyceride level, over 60,. Vldl particles interact with LDL particles, not LDL cholesterol. Ldl particles and the VLDL particles rich in triglycerides make the LDL particle also rich in triglycerides. That leads to a subsequent series of events, of reactions, that leads to formation of small LDL particles. So you want to know how much small LDL particles you have and you want to have your triglyceride level of 60 milligrams per deciliter or less, so that you don't have VLDL available. Now.

William Davis, MD: 16:12

Small LDL is important because small LDL particles persist for an unusually long time in your bloodstream. So large LDL particles, provoked by consumption of fats and oils, only stick in, stick around the bloodstream for about 24 hours because the liver recognizes it readily and clears it from your bloodstream. But if you eat something, a food, that triggers formation of small LDL particles, the small LDL particles have a different surface shape and the liver has a hard time recognizing it, and that means small LDL particles circulate in the bloodstream around and around for five to seven days, giving it lots of opportunity to enter the wall of the artery, such as the coronary artery. So small LDL particles stick around for a lot longer than large LDL particles, by the way. By the way, what foods cause formation of small LDL particles and VLDL, the amylopectin A of wheat and grains and sugars. Period. Not bacon, not fat, not saturated fat, not pork, only wheat, grains and sugars. Small LDL is dangerous, all because it's very adherent to the arterial wall. When it enters the arterial wall it's much more likely to provoke an inflammatory response. So small LDL particles triggered by consumption of wheat, grains and sugars is a very potent cause for heart disease and has nothing to do with LDL cholesterol.

William Davis, MD: 17:32

The indirect way to try to guesstimate lipoproteins we're measuring lipoproteins directly. So we try to get those small LDL particles below 200 nanomoles per liter. It's a particle count per volume measure. A typical starting number would be 1800, 2400, oodles of small LDL particles. So we go wheat, grains and sugar free in our diets and you have dramatic reductions, typically to zero or certainly below 200 nanomoles per liter. So if you have a positive coronary calcium score, now you're armed with the information from your NMR lipoproteins. You now know what diet causes coronary disease. And, by the way, the first time you have your NMR lipoprotein analysis you have to specifically request this. A lipoprotein A. It's a genetic pattern that heightens the risk for coronary disease. That's a whole other conversation of its own, but people with lipoprotein.

William Davis, MD: 18:27

There's some additional steps we take to control that source of risk. As I mentioned earlier, knowing what your vitamin D status is critical. So we aim for a 25-hydroxy vitamin D blood level very easy to do of 60 to 70 nanograms per milliliter. Most people start out in the teens, like 14 or 15, especially if you live in a northern climate and then we supplement vitamin D at a dose sufficient to raise the 25-hydroxy vitamin D blood level to 60 to 70. The level that I believe is the ideal and we've never seen a single instance of toxicity at that level in thousands of people. And, of course, beyond reduction in carnal calcium scores and reduction in cardiovascular acerisks many other benefits to taking vitamin D. Another important set of measures are the measures that are relevant to your thyroid status.

William Davis, MD: 19:17

Thyroid dysfunction is very common. We start by supplementing iodine. Iodine, people have forgotten, was a worldwide public health problem for as long as humans have been on this planet. People who lack iodine intake can develop hypothyroidism and then more severe levels of hypothyroidism. It's called myxodema and you can go into heart failure and die. Many people have died of iodine deficiency over the years. They might die of the goiter, the enlarged thyroid gland that compresses the airway or infiltrates the great vessels, or they die of the hypothyroidism. They gain 50, 60, 70 pounds, they can't function, they sleep 14 hours a day and then they eventually die of heart failure.

William Davis, MD: 19:57

So iodine deficiency was a major problem until 1924 when the FDA finally recognized that it was due to lack of iodine that goiters and hypothyroidism. Many cases are due to lack of iodine. So they added iodine to salt, iodized salt and advised people to consume a lot of salt. People listened and goiters essentially went away for many years. But then the FDA misinterpreted what happened. When people used a lot of salt, they thought it was causing hypertension and other problems with sodium. What they didn't recognize was that their diet the cut saturated fat, cut fat, eat more grains causes sodium retention because it causes insulin resistance. That is a sodium retaining phenomenon. So rather than blaming their misleading dietary advice, they misinterpreted as overuse of salt and told everybody to cut back on their salt. So guess what's coming back? Iodine deficiency and goiters.

William Davis, MD: 20:52

So replacing iodine, very easy, you could use iodized salt. But you have to know that once you open the canister of iodized salt, the iodine is volatile and it's gone within three or four weeks. So a better way to do this is to buy simple, inexpensive kelp tablets, dried seaweed tablets or potassium iodide drops that you can add to any drink beverage or other food, and we try to get around 300 to 400, somewhere in that range micrograms per day more than the RDA, because I believe the ideal intake of iodized is higher than the 150 micrograms per day intake that's set by the RDA. Some people will have to have further efforts to identify thyroid dysfunction. That's always worth looking at and a full thyroid panel would include a TSH thyroid stimulating hormone. It's a pituitary hormone, a free T3, a free T4, the two important thyroid hormones, a reverse T3 and thyroid antibodies. With those measures you'll have a full handle on what's going on in your thyroid. Now just bear in mind there's a conversation for another day.

William Davis, MD: 21:56

But if you do have hypothyroidism, most commonly identified as a high or high-ish TSH. So an ideal TSH is 2.0 micro units or less. Let's say you come back with a 4.2 where you have mild hypothyroidism sufficient to add hugely to the growth in your carnarate atherosclerotic plaque. So if iodine doesn't correct it now it's time to turn to thyroid hormone replacement, because there's lots and lots of thyroid dysfunction in this world probably do a number of things. One reason may be the consumption of the glydein protein of wheat, which triggers autoimmune attacks on your thyroid, such as Hashimoto's thyroiditis, or it could be due to exposure to halogenated industrial compounds like perfluoroacnolic acid and other so-called forever chemicals, or PFAS PFAS that also had the capacity to disrupt thyroid physiology.

William Davis, MD: 22:48

And if you do have hypothyroidism, I urge you to talk to a doctor who is willing to prescribe a combination tablet that contains both the T3 and the T4 thyroid hormones, because the majority of people do better on it. A typical story is this someone says I had hypothyroidism. My doctor put me on levothyroxine or a synthroid which is the T4 thyroid hormone alone, but not the T3. Well, one of the problems is that those chemicals block the conversion of T4 to the T3 the active, the truly active thyroid hormone, t3. So you're taking lots of T4, but you're also being exposed, as all of us are, to a compound that blocks conversion to the active T3. And people say things like this I take my levothyroxine, but I still have. I'm gaining weight, I have leg edema, I'm tired all the time, my hair is falling out, I'm depressed. It's because they are not getting enough T3, so a better solution than taking just T4 is to take a combination tablet that contains both T3 and T4. These go by names such as Armour, thyroid, naturophyroid, irfa, erfa and some other brands. The problem is to persuade the doctor that people do better on T3 and T4, not just T4 you may have to consult with a functional medicine practitioner or some other better informed doctor than your general practitioner or endocrinologist.

William Davis, MD: 24:11

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William Davis, MD: 24:57

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William Davis, MD: 26:07

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William Davis, MD: 27:17

Another set of measures very important for you to understand and manage to redress your cardiovascular risk are all the measures that surround insulin and glucose, and these are very simple. So blood draw for a fasting insulin, a fasting glucose and a hemoglobin A1C that shows you long-term behavior of glucose. And we aim for a fasting glucose of between 70 and 90 milligrams per deciliter. We aim for a fasting insulin as close to zero as possible, no higher than four micro units per liter. Commonly, in people who are insulin resistant, which is very common, levels of 30, 70, 100, 130 are very common, in other words, as much as a hundred fold higher than ideal. And then, lastly, hemoglobin A1C. That reflects 90 days, your previous 90 days of blood sugars. We aim for a level of 5.0 percent or less.

William Davis, MD: 28:08

Many times you have to ignore the advice of my colleagues, of doctors. They say things like hemoglobin A1C up up to 6.5 is okay. Is that true? No, that's when you become diabetic. A hemoglobin A1C of 6.5 percent or greater signifies type 2 diabetes. What they're saying to you is you don't need insulin or a collection of diabetes drugs yet, so you must therefore be okay. The lack of drug need for drug in their mind is means you're okay, which is not true. For instance, for hemoglobin A1C of 5.7, which is the cutoff for pre diabetes, there's a 300% increase in cardiovascular risk. How is that normal? It's not normal. So at what level does all the excess risk provided by hemoglobin A1C disappear? 5.0 percent and less. So we want all three of those measures fasting glucose, fasting insulin and hemoglobin A1C all in perfect range.

William Davis, MD: 29:01

How do you achieve perfection? By the program that I advocate, that is, the diet program, replacing the nutrients lacking in modern life magnesium, vitamin D, omega-3 fatty acids, iodine and then addressing the microbiome, which we'll get to in just a moment. Getting some measure of inflammation helps you also gauge whether your program is working or not. Most common one is a high sensitivity C-reactive protein. There are many others, like IL-6, il-1-beta, tuned in the crossfactor alpha, but you don't really need those If you just get a basic C-reactive protein and we try to get that value as close to zero as possible, because inflammation is an amplifier of a lot of the abnormal patterns that lead to heart disease. And then, lastly, we address the disrupted bowel flora.

William Davis, MD: 29:45

You have either dysbiosis confined to the colon or, very commonly, if you have coronary disease by some measure let's say, a positive calcium score, coronet calcium score, it's highly likely that you have SIBO, that is, fecal microbes from the colon have been allowed to proliferate and then ascend into the 24 feet of small intestine and now you have trillions of microbes that live for only a few hours they don't live very long Turning over rapidly. Trillions of microbes living and dying rapidly. When they die they are breakdown products, especially something called LPS or lipopolysaccharide. Endotoxin is able to penetrate the intestinal wall because a small intestine, where fecal microbes are not supposed to be small intestine, is by design very permeable because that's where you absorb nutrients, vitamins, minerals, fatty acids, amino acids and other things. So the small intestine is meant to be permeable but when you have fecal microbes that have invaded the small intestine, trillions of them, rapid turnover, you have a flood of endotoxin from the breakdown products of these microbes into the bloodstream, first to the liver, then to the systemic circulation, and these amplify all the other abnormalities. It amplifies the LDL particles, it amplifies production of small LDL particles. It worsens inflammation, it inflames the walls of the coronary arteries and other arteries. It raises blood sugar, it raises triglycerides, it raises blood pressure, has emotional effects like anger, frustration and depression and anxiety.

William Davis, MD: 31:20

So we identify SIBO in a number of ways. One way to look for what I call our telltale signs. So if you see fat droplets in the toilet during a bowel movement, that's a sign because that means microbes fecal microbes have reached the duodenum. That's where the bile is emptied from the gallbladder and that's where pancreatic enzymes are secreted into the duodenum. So if you have failure to absorb fats, that shows you that your microbes interfering with fat digestion in the duodenum. If you have a food intolerance whether it's to FODMAPs or fruit or nightshades or histamine-containing foods or any other form of food intolerance think SIBO, because SIBO causes food intolerances and the vast majority of food intolerances go away when you correct the SIBO.

William Davis, MD: 32:08

There are also conditions that are virtually synonymous with SIBO. That is, the occurrence of SIBO is so high that if you have any of these conditions you can safely assume that you have SIBO. Fibromyalgia very high, perhaps as high as 100% of people with fibromyalgia have SIBO. Chronic fatigue syndrome, ural bowel syndrome, any autoimmune or neurodegenerative disorder, restless leg syndrome these are all very highly associated with SIBO, such that you can pretty much assume you have SIBO even without confirmatory testing. Fatty liver is another one, obesity very high association with SIBO.

William Davis, MD: 32:43

Now if you want to confirm testing, the most common test is hydrogen breath testing. That you can do in a lab or clinic. Unfortunately, it means having a doctor who understands SIBO and has kept up with the science. Most practicing physicians have not, so you may have to find somebody who can do that for you. Or you can buy the consumer device called the air device A-I-R-E made by a company in Ireland named Food Marble. You can measure hydrogen gas on the breath. The exact way to do it is in my super gut book. There's a process you follow, there's a prep and then you do testing and you supplement something like inulin in your coffee or other food and then you test and see how soon hydrogen gas is released, because the sooner it's released after consuming the inulin, the higher up microbes are living in the GI tract. So please consult my super gut book or my drdivsinfinitehealthcom blog. I tell you how to use the device Now should you suspect that you have SIBO or you confirm that it is present with positive H2 breath testing hydrogen breath testing.

William Davis, MD: 33:42

How do you get rid of it? Well, you could go to a conventional doctor. If the doctor even knew what it was that is SIBO and positive hydrogen breath, they would at best prescribe the antibiotic Zifaxin or Rhafaxamin. Well, you know, I'm reluctant to advocate that because antibiotics overexposure to antibiotics is a big part of the reason we have this problem that is SIBO. So how about we try something different?

William Davis, MD: 34:07

This is the sequence of logic I followed. What if you took just an off the shelf commercial probiotic for your SIBO? Will your SIBO go away? Will you push down fecal microbes back to where they belong, in the colon? No, you might reduce bloating a little bit or diarrhea, but you'll still be left with that, this problem, the SIBO.

William Davis, MD: 34:25

So what if we ask different questions? What if we chose microbes, probiotic microbes that we know will colonize the small intestine? That's where the battle is right Not the colon, but the small intestine. And what if we chose species and strains of microbes that are known to produce what are called bacteriasins? These are natural antibiotics effective against the species of SIBO. So I chose three. Initially, I chose a strain of lactobacillus gasarii and a strain of lactobacillus rhodii. Both colonize the upper GI tract and produce up to a total of 11 bacteriasins. I also threw in bacillus coagulants because it has a good tract record in reducing bloating and symptoms of urinal bowel syndrome. I'm less confident how necessary the bacillus coagulants is, but I will tell you that adding bacillus coagulants makes the yogurt much tastier. And that's what we're gonna do. We're gonna ferment these creatures as yogurt it doesn't have to be dairy, by the way, but dairy's the easiest to use and we co-ferment those three, or at least the gasarii and the rhodii.

William Davis, MD: 35:28

And so far we've had 90% success in normalizing breath-hydrogen testing and witnessing the reversal of numerous SIBO associated phenomena. We see reversal of food intolerances, reversal of fibromyalgia, urinal bowel syndrome and other conditions. And along with correction of your SIBO and endotoxemia and hydrogen gas breath testing or reversal of the associated conditions, you're gonna see all sorts of other positive effects that have benefits in cardiovascular health. You're gonna see a reduction in blood pressure, a reduction in the inflammatory measures like C-reactive protein, a reduction in triglycerides and VLDL, a reduction in small LDL particles. In other words, you've seen across the board improvement by reducing this flood of endotoxemia in a company's SIBO. So there you have it. Those are the seven tools, your measures, you can use to gain full control over cardiovascular risk from coronary disease and related events. We're going to get a carnicalcium score. We're going to get NMR lipoproteins to gauge the small LDL particles as well as VLDL.

William Davis, MD: 36:36

Be sure to have a lipoprotein A run the first time you have it. You don't have to repeat that lipoprotein A because it doesn't change. It's genetically programmed. There's no need to reduce it. By the way, we just add some additional steps to manage lipoprotein A. Get your vitamin D, get your thyroid assessed and start iodine. Get your glucose, insulin and hemoglobin A1C assessed. See what your blood sugar and insulin status is. Get a measure of inflammation, such as C-reactive protein, and then consider dysbiosis, but even more so, sibo and endotoxemia. You now have a means of eradicating it by making you yogurt. By the way, the recipe for the yogurt that I call SIBO yogurt is in my super gut book. It's also in my drdavisinfinitehealthcom blog. If it's all confusing to you, I urge you to once again get my super gut book, as well as the wheat belly books if you want a more deep dive into the diet.

William Davis, MD: 37:30

You can always join our conversations. We have extensive conversations, including face-to-face talks via Zoom on my drdavisinfinitehealthcom inner circle. So, for instance, most Wednesdays we meet for about two hours. Typically 90 people show up and we talk about how to make SIBO yogurt, what do you do when you don't achieve your 60 to 70 nanny run, familiar vitamin D blood level, how to interpret thyroid panels. We do all this in our inner circle. You can post your information or your questions in the forum, which is extremely busy. Hundreds of thousands of posts, there's lots of learning materials, many, many videos, our two-way interaction and lots of other learning materials and resources, the goal here being equipping you with information and tools because the doctor's not doing their jobs. So if you learned something from this episode of Defiant Health Podcast, I invite you to subscribe to your favorite podcast directory, post a review, post a comment and join the conversation, the movement to empower you in health and keep you as free of the healthcare system as possible. Thanks for listening. I'll see you in the next one. I'll see you soon.