Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
Lessons Learned From 30+ Years of CT Heart Scans and Coronary Calcium Scores: The Critical Role of Vitamin D
My 30+ years of involvement with CT heart scans and coronary calcium scores has yielded many important lessons on how to halt, then reverse, the accumulation of coronary atherosclerotic plaque and thereby risk for heart attack, need for heart procedures, and sudden cardiac death.
Here, I discuss the crucial importance of vitamin D and how, by addressing this issue, it was the first time I saw actual reductions in coronary calcium scores.
YouTube channel: https://www.youtube.com/@WilliamDavisMD
Blog: WilliamDavisMD.com
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Books:
Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose Weight
I'd like to start a series of conversations here on what I've learned over more than 30 years of dealing with CT heart scans and carnary calcium scores. Because these is so this is so important for getting control over cardiovascular risk. So many people think that just addressing cholesterol is all you need to do. When addressing cholesterol is just close to useless. And that's why maybe your local hospital added an$80 million wing on their hospital for cardiovascular care. Because it remains, heart disease remains the number one moneymaker for health care. It also remains the number one killer of men and women in the U.S. and much of the world. So an 80 million Americans now take a statin cholesterol drug, yet it has had virtually no meaningful impact on reducing cardiovascular events. So the status quo has been maintained, and of course, your hospital, your doctors, like your cardiologists, healthcare systems, all make a lot of money by maintaining this deeply flawed status quo. Well, let me tell you how I got started in this whole conversation about CT heart scans and caronary calcium scores. So many years ago, about 35 years ago, my mom, living in New Jersey, I was living in the Midwest, had went to the hospital and had two coronary vessels, two coronary arteries in her heart, angioplasty, opened because of a severe blockage. Went home and four months later was found dead of sudden cardiac death in her bedroom. Well, I asked myself, you know, what could I have done ahead of time to have warned my mom in some way? Was there something I could do that could have provided her with a warning, say a month, three months, six months, a year, five years ahead of such a catastrophe? Well, most doctors would say cholesterol would do that, which is an absurd concept. If I said your total cholesterol is 240 milligrams, or your L-dill cholesterol is 160 milligrams, does that tell you you're gonna have a heart attack or die in a month? Six months? A year? Five years? Never. It tells you nothing. And there's a whole lot of uh there's a long list of reasons why cholesterol is an outdated and useless concept. See my other videos, see my many books that discuss this, my Wheat Belly series, undoctored series, super gut, superbody, how I discuss a lot of these issues at length, as well as my thousands of blog posts, WilliamDavismd.com blog, and of course, uh my YouTube channel. Where I discuss why we should have discarded cholesterol testing decades ago. And there are better methods, of course. Well, what could I have done for my mom before this all happened? One of the tests that was available, though only uh in certain areas back 35 years ago, was a heart scan that generated a carnary calcium score. Now, this was so long ago. Now we use CT devices or what's called multidetector CT scanners. Back then, we used the technology that preceded the multidetector technology. That was called electron beam CT scanners or EBCT, we said. This was a very elegant technology invented in San Francisco by an engineer, and he used magnetic fields to focus the X-ray beam. It did involve a low dose of X-ray, but this became a real plus, a real advantage in situations, for instance, like children or infants. If a child needed a CT scan, it's hard to get a child to sit still, right? And back then, conventional CT scanners required two seconds for each cross-sectional slice, and typically 30 slices or so were needed. And so, how do you make a child sit still? They they can't. Breathing involves motion, right? Just the motion of the lungs, of the diaphragm, of the chest, uh, and just fidgeting. It's hard for people to sit still for any length of time. So, this new technology, EBCT, was very rapid. It cut scan time by about 90% to about 0.2 seconds per cross-sectional slice. So this became a real plus in imaging the heart. Because if we want to image things that are fractions of a millimeter in the heart arteries, because the heart arteries are very small, typical diameter is about three millimeters. You need a you need a device that moves very quickly to acquire images because the heart beats. And it beats with multiple phases of motion. The top of the heart, the atria, beats differently than the ventricles below, and there's other forms of motion in the heart. So the heart is a moving, a rapidly moving object, and you need a very rapid scanner. Well, this EBCT did it, and it gave us exquisite images. Now, around the same time, Dr. John Rumberger, who's become a friend, was at the May Clinic, and he did something extraordinary. He took the hearts of people who had died, car accidents, cancer, heart attacks, all different causes, and studied their coronary arteries, their heart's arteries, specifically looking at of the atherosclerotic plaque that these people had. And by the way, it's very common, even in your 20s, to have atherosclerotic plaque. Not a lot, perhaps, but you still have the start of it. And of course, older people have lots more. Well, he studied that atherosclerotic plaque and found that 20% of the total volume of that plaque was occupied by calcium, that hard substance calcium. So, in other words, if there was 10 cubic millimeters of total atherosclerotic plaque, you could count on having two cubic millimeters of calcium. So it provided kind of a dipstick or a guide or a or a measure of total atherosclerotic plaque in all three arteries. Well, that's well and good, but how do you put that to use in a living human? Well, it became clear that these new EBCT devices could do that. And then Dr. Arthur Agatston, whose name you may recognize because he was the author of the South Beach Diet many years ago. Well, he also created something called the Agatsten scoring system. It was a way to score the calcium so that you compare the calcium in one person to another person, or you could track it over time as an indirect way to quantify the volume of atherosclerotic plaque in the caronary arteries. Now, this was revolutionary. A lot of my colleagues objected to it because they continue to think that the only important measure was percent blockage. They wanted to find things like, oh, there's a 95% blockage in the left anterior descending, the L we say the LAD, the major artery in front of the heart. Because that's what leads to angina chest pain symptoms. That's what they thought led to heart attack, and that's what justifies doing things like stent implantation, open that blockage, or bypass surgery to bypass that blockage. What they fail to recognize is that most heart attacks and other cardiovascular events like sudden cardiac death are not driven by that progressive worsening of blockage, you know, 30, 50, 70, 95, 100%. Here's how most heart attacks work. You have what would be regarded as a minor plaque. Maybe it doesn't reduce the diameter of an artery more than 30%. But that's active tissue. That atherosclerotic plaque is active tissue. And because it's inflamed and there's enzymes chewing away at it inside of it, it ruptures and exposes its internal contents to the blood flowing past it. And that is, we say, thrombogenic. It provokes formation of a blood clot. So 30% blockage or some other minor blockage ruptures, and within minutes you have complete closure of the artery from a blood clot. That's why back 25, 30 years ago, we used to use something called thrombolytics. These were drugs, intravenous drugs, that uh in many cases could dissolve the blood clot. And it worked maybe 80, 90% of the time, but it also was dangerous because thrombolytic agents also cause hemorrhage in places like the brain. So that practice has fallen out of favor. But point being, vast majority of heart attacks don't occur from a 95% blockage or something like that. It occurs from what we would regard as a minor plaque that's metabolically active and then ruptures. And so that's why getting a carneur calcium score is so powerful, because it gives you a gauge of total athropolotic plaque lining all three arteries. Now, the lesson I want to focus on today is vitamin D. Let me tell you why. So let's say you had a scan, right? So maybe an old EBCT scan or maybe one of the more modern MDCT. And why by the way, why did uh multidetector technology take over? Because General Electric, the company that was pioneering some of the MDCT technology, didn't like this competitive technology, EBCT. So GE literally bought the intellectual property, bought the company, Immetron, locked it up. So even if you want it, you can't get it. So that allowed the proliferation and success of the competitive multidetector CT technology. So if you have a heart scan today, it's always a multidetector device. So let's say you had a score, right? So we're going to quantify the calcium in your arteries as a means to gauge total atherosclerotic plaque. So a normal score is zero. No calcium, thereby little to no atherosclerotic plaque. And then the scores can go up to the thousands. And the higher the score, the greater the risk, the greater the likelihood. Such that a score of a thousand, say, which is very high, there's about a 10 to 15% chance per year that you die, have a heart attack, or develop angina that leads you down the path of procedures. So if it's 10 to 15% period, you can imagine over five, six, seven year periods virtually guaranteed that something bad will happen if you take no action. So let's say your score is 400. What if you did nothing? Which is not smart, right? What if you did nothing? How fast will that carniarcalcium score and thereby the atrophologic plaque grow? It will grow 25% per year. It's horrifying, right? Imagine your money growing 25%. It'd be fantastic, right? You'd be hanging out at the country club with Bill Gates. But it's plaque. It's going to be growing at 25% per year. What if you went on a high dose of a statin cholesterol drug, like 40 milligrams of Lipitor, and cut the saturated fat and cholesterol and total fat in your diet, exercise, took a baby aspirin, maybe added other things like a beta blocker. How fast will that score increase? The science is very clear. 25% per year. That those, what my colleagues to this day have the nerve to call that optimal medical therapy. Optimal medical therapy has no impact on progression of a carnal calcium score and thereby the progression of uh atrophyroid plaque. There may be modest benefits of statin drugs, wildly exaggerated by many of my colleagues in the pharmaceutical industry. There's very little benefit to taking a statin drug. And there are the but the real tragedy of all that is that it took everybody's focus of attention off the real causes of heart disease, which you can identify readily and address readily. And you know what? To be honest, you don't even need the doctor to do it. You can do it on your own. Another conversation for a conversation for another time. So let's say your score is 400, and unfortunately, this causes many people to panic when they see that 400, a year later, 500, a year later 625, and they're getting closer and closer to bad things happening, right? So unfortunately, many of my colleagues, many of whom sadly are not most honest, interested more in money than science or someone's welfare, will tell you, let's do the real test, a heart catheterization, and see if you need a stent implanted or a bypass operation. Of course, procedures that yield thousands and thousands of dollars for the cardiologist, for the healthcare system, for the hospital, et cetera. Even though the evidence is quite clear, if you're a person going about your business, you're going to the office, you're going to work, you're going to school, whatever, you're riding your bike, you're doing things with no symptoms. There is no benefit to those procedures, yet they're done all the time. Because the financial incentive is irresistible, sadly, for my colleagues. So you'll see unnecessary procedures. Ask anybody you know who works in a cat lab where we do those angiograms of the heart, and ask, how often do you see unnecessary We say revascularization procedures, stents, angioplasty, athletorectomy, bypass surgery? They'll tell you um all the time. It's very common, it's a frequent thing, and it's widely known, but almost nothing done about it. It's widely known that many procedures are unnecessary because they pay so well. So what what what did I do though? I have people, I I so back then I held open then an EBCT scan center, and we were scanning people left and right. And you uncover heart disease everywhere. So what do you do if someone's on Lipitor, baby aspirin, low-fat diet, and yet their disease is progressing? Well, we had to find new ways to deal with this. And up till then, doing everything we can think of. Back then it was omega-3 fatty acids, uh, statin drug, niacin, fibrate drugs, L-arginine, the amino acid, all kinds of things we tried. And we did manage to slow the progression down from the expected 25% per year down towards maybe 12-15% per year. So slower, but still pretty bad, right? Once again, if it was money, it'd be great, but it's plaque growing at a rapid rate. Now, I'm doing this in a northern climate where vitamin D deficiency is quite severe. A typical blood level of vitamin D at 25 hydroxyvitamin D for this area would be something like 15 or 17 nanograms. We're trying to aim for an ideal level, 60 to 70 nanograms per milliliter. So when I put people on vitamin D, oil-based gel caps only, to assure absorption, not capsules with powder, not tablets. They can be absorbed, but they're erratically absorbed. They're unreliable. So uh oil-based gel caps, inexpensive, widely available. A typical dose would be 8,000 units, but also then adjusted over time to your body size race. There are other factors that influence how well you process vitamin D. But a common dose would be 8,000 units or base gel cap per day to achieve. So let's say somebody started with a 25 hydroxy vitamin D level of 12. We put them on, say, 8,000 units or 10,000 units. We check it three months later, it takes that long for the vitamin D level to stabilize. And maybe now it's 68 nanogram right on target. That's what we want. When I started doing this in hundreds and then thousands of people, it was the first time I saw those cornea calcium scores drop. The first time this happened, this is many years ago, of course, someone had a score about 680 or thereabouts, and it went dropped into the 400s. I thought, no, this is not right. This is impossible. So I pulled up the original scan and the more recent scan. And yes, indeed, the calcium you could see clearly had shrunk considerably. Now, people say you can't see the softer elements like fibrous tissue and inflammatory tissue and fatty. Yes, you can. You just can't quantify it precisely. At least back then you couldn't, because the technology was insufficient to uh quantify three-dimensional space voxels. It's like a pixel in three-dimension. Back then we didn't have the technology. I tried to do it, but couldn't do it. Now you can do it, and that's a conversation from another day. But back then we couldn't do it, but you could still see it. You could still see the softer elements, and indeed, not only had the calcium shrunk, but the softer elements had also shrunk. So it became clear that one of the most crucial things you can do to gain control over heart disease risk, but specifically carinaric calcification score, is to address vitamin D, to get your 25-hydroxyvitamin D blood level to, I would advocate, 60 to 70 nanograms per millimeter. Now, that vitamin D also has other great benefits. It also reduces insulin resistance, it induces arterial relaxation because disease arteries are constrictive. It raises HDL, reduces triglycerides, reduces blood glucose, reduces blood pressure a little bit, it improves your emotional state, improves your mental focus. In other words, huge benefits from vitamin D that include giving you back control over the progression of carneary artery calcification. Now, let this conversation be the start of a series of conversations I'll be providing that recounts. I suppose I should have done this years ago, but uh I'll be recounting many of the lessons learned from this 30-plus year experience with CT heart scans and carneur calcium scores. Now, if these conversations interest you, you want to go further, I invite you to see my books where I talk a lot about these things, the Wheatbelly series of books, Wheatbelly Revised and Expanded, the Undoctored book, issues more focused on the microbiome, super gut, and then issues relevant to body composition, my new superbody book. Or if you want to talk with me and other people about these kinds of things, I have a membership website, the inner circle.dr Davisinfinite Health dot com, where you talk about these things. And you can even do such things as post some of your laboratory values, like your lipoprotein. A lot of us get uh what's called NMR lipoprotein analyses, which gives a lot of data, or maybe your microbiome analysis, and you can share it with us in it, for instance, in our forum. We have a very busy discussion forum, and you can get feedback from other members, from me, from other people on my staff, and we give you feedback so that you are not impaired because the ignorance of the doctor or the doctor who continues to believe silly things like cholesterol is all you need to address for heart disease risk.
