OT: Heart Disease-Do you have it

From what I've read, thats where its going. But currently, there are less doctors doing it, than not.
As i said, it is part of the recommended guidelines of the AHA for "middle risk" patients.

937...holy crap, Pratoman. You might have posted that before, but I had no context for it previously. That's high.

RIP. He seemed like a good guy.

But, you know, this discussion bears some relationship to prostate cancer. You know, in the same way that for the vast majority of us, even a lot of us high risk guys, will never die of PC before something else ( like heart attack/stroke! ) gets us?

Well, play around with that calculator I linked to. Plug in some bad numbers. For example, if I go from my zero to 937, changing nothing else, it bumps my 10 year risk of an event from 2.9% to 17.3%. Now OK, that increases my risk by about 5 or 6 times. But the other side of that is that I still have an 82.7% chance of no event, is that correct? Is that the right way to look at it? So there is still an 8 out of 10 chance of no serious problems in 10 years, even if I had a bad number. I agree that with that # it is very much worth looking into what can be done to improve the odds and maybe even miraculously lower the plaque load, but depending on other factors that go with it, a bad # is not exactly a death sentence.

I don't understand that either, Billybob. It's a mystery.

In another new development, reports of my demise have been greatly exaggerated. Even with a 937 score - I am doing spin class 3 days a week, lots of walking the other days. Some weights. And am feeling good.

I think the biggest value in CAC is that a high score gets your attention. I've made lifestyle changes that I could never muster up the willpower to make (unfortunately), before I was diagnosed with heavy plaque. And I think I'm healthier for it.
Even if you have a high score, like me, if you stop the growth, your soft plaque becomes calcified, and thus less dangerous, and with no new plaque forming, there is no dangerous soft plaque that might rupture. I don't know that I'm there yet, but that's my goal, or hope

So, radiation-associated coronary artery disease is a thing.

As the number of cancer survivors grows because of advances in therapy, it has become more important to understand the long-term complications of these treatments. Especially true for the "younger" set who will suffer the various late-term effects of radiation therapy (moreso than older folks). Who knew? Or probably more correctly, who thought about this?

In this observational study (that is, they looked back at after-the-fact results), prior cancer radiation predicted poorer survival after PCI (angioplasty).

http://circinterventions.ahajournals.org/content/9/6/e003483.abstract

a 0 score means congratulations is in order. With this score, you have a 99% chance of a 15 year warranty on the coronary arteries in your body. (nobody gets a 100% pass i think)
So congrats.

Thanks for the "congrats," pratoman. Frankly, I'm surprised. With my family history, plus I have a large frame (6'5") which I know is more prone to heart issues, I anticipated something worse (which is why I previously said I was nervous about the test). I may, perhaps, still have heart issues, but not, apparently, plaque in my arteries...which was my dad's issue.

I am 70 % va disabled for coronary artery disease with Heart stint with Ejection Fraction of 38%. I have had skin cancer and now (5/15/2016) been diagnosed with prostate cancer I got a Gleason score of 9 with low PSA.. All from exposure to agent orange. There is no family history of any of this what so ever . I am 66 and all of my parents and siblings are very healthy.

JackH said...

BillyBob@388 said...

Welcome to the other zero club, Jack. It appears we are highly likely to die of something other than heart disease, at least for a long time. Of course, there are plenty of other causes of death to choose from, we will have one picked for us sooner or later. Heck, for some of us it might even be PC!

So I am curious: what types of cholesterol numbers did you have, the LDL and HDL and TGLs? How about symptoms or use of statins or BP meds?

Haha...I guess that's right, BillyBob...another "zero club." Thanks!

I appreciate your inquiry into the other aspects which might also or eventually contribute to heart disease. I chose my words very carefully, as I always do, in my last post when I said: "I may, perhaps, still have heart issues, but not, apparently, plaque in my arteries." There can be other problems besides plaque, which seems to be the intent of your inquiry and I do indeed have some lingering concerns in those areas...not major concerns.

From my most recent tests, my total cholesterol is very good (168 mg/dL), and this number has been consistent over the last 10-years (between a low of 142 and a high of 177).

However, my balance of HDL and LDL is not great. My LDL (bad cholesterol) was ok recently at 102, but my HDL was low and "out-of-range" at 35...again, both of those numbers have been relatively consistent for at least 10-years. Triglicerides were recently 131 and have bounced around above and below the 150 threshold, recently mostly below (favorable).

I have been on BP medication 10-years since my mid-40s...a combination of a calcium channel blocker and an angiotensin II receptor blocker. I've always tended to have a somewhat elevated BP; not grossly out-of-whack. No statins or other heart-related meds.

So for my low HDL, generally the message from my internist is "diet and exercise." Neither seem to affect my number. My diet in the last several years since I got (re-)married has been very good...my wife is an outstanding cook and prepares very healthy meals; heavy on things that grow in the ground (fruits and vegetables), and very light on red meat. My exercise ebbs and flows; over the last 10-years, I've been in great shape, drifted out, and returned back, and drifted out...and I can't seem to get my HDL to budge.

What's your assessment, doc BB?

My assessment? For raising HDL(and slashing TGLs as a bonus)? OK, don't shoot me, I know it is way unconventional, but probably more fat( maybe even more saturated but less Omega 6) and/or fewer carbs.

There are of course numerous studies showing that this works despite the advice of most MDs and dieticians to the opposite, though they are slowly (glacially) coming around. But I mainly have to go by my personal experience, and that of a good friend who saw my success and joined me after a couple of months and also had spectacular success. Plus several guys here at HWPC who have had pretty much the same results. My HDL rose dramatically- by probably 25% as my TGLs dropped 75% and BP came down from 140/90 to 105/60 after 6 months of low carb/high fat/adequate protein eating. My TC rose about 10, but who cares it was mostly HDL. It was a few weeks or so of 1st Sugar Busters, followed by a few months of the Zone, finally going whole hog with Atkins. Didn't much matter, all worked quite well. But the lower the carb and probably the higher that fat the better it worked, and certainly faster. And once I was past the 1st few weeks, I was never hungry again. Would often forget to eat lunch, only noticing my stomach growling loudly near supper time.

Apparently, with my zero score(like you), I did nothing to clog things up during that 6 months 16 years ago. (plus numerous short term returns to this system whenever my weight would start creeping up again with my high carb ways) But maybe I gave myself PC? Who knows, but I bet there are plenty of vegetarians or "healthy eaters" who also got PC, so who knows.

Yes, I know it is hard for most folks to hear, the authorities have been advising us to low fat/high carb for 30 to 40 years. As diabetes and obesity have sky rocketed I might add. Even despite more joggers and gym rats than anytime in history. Still, if your main concern is how to raise HDL, I can assure you lowering fat is not the way to do it, and increasing fat almost certainly will, especially if combined with cutting carbs.

OTOH, it could be argued that, with your zero score, who cares? If you go into those online risk calculators, put in a zero score, and then play around with different cholesterol numbers, you will find they only make a small difference compared to what the calcium score tells you.

Just the way I see it, no doubt many will strongly disagree with me. And this only refers to Cardio-vascular issues, says nothing about cancer.

Personally, I really need to get back on the low carb wagon. Cautions about eggs and chicken's association with PC recurrence have held me back, I just have not had the balls. ( it's very inconvenient to hi fat/low carb while avoiding chicken and eggs! )But,
1:all studies on eggs/chicken ave probably been guys who were also eating high carb with them.
2: High blood Insulin has been implicated in all cancers, and eating low carb slashes blood insulin
3: Though a couple of recent studies looked scary for chicken and eggs(but NOT red meat) and PC recurrence, results are very inconsistent, with meta-analysis showing essentially nothing. So I should probably just get on with it.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4741082/
cancerpreventionresearch.aacrjournals.org/content/4/12/2110/T4.expansion.html

Pratoman said...
I agree with everything BillyBob said. Even for me, educated about the issue, higher fat consumption is counterintuitive. But that's due to low fat being drilled into our heads as a society and it's wrong. Google the book "The Big Fat Lie" on Amazon. A very interesting read.

My triglycerides which were consistently I the 300's, even on 3 diffence meds known to bring down TG, is down to 83. That is after 9 months of a low carb high fat diet. The low carb part is responsible for the TG drop, more than the high fat.and as TG goes lower, HDL tends to rise, as told to me by an expert lipidologist. My HDL is also habitually low, like yours, (Jack), although as TH got under control, it's risen slowly from 27 to a reading last week of 37. Still to low and I exercise a lot. But with an LDL fluctuations between 33 and 60 (no typo) I'm told it's not that big a deal.
The other issue is LDL particle size. Small LDL is more harmful than large LDL . This can be tested for as well, by labs doing advanced testing. In your case, Jack, it probably doesn't matter much with a 0 calcium score.

Now see, I just find that a really discouraging fact regarding the medical profession. Even assuming that there really is a significant heart and all cause longevity advantage to lower TGLs and higher HDLs ( as well as weight loss and lower blood insulin and sugar), didn't our doctors know these actual facts about what diet accomplishes these things? If not, why not?

If they know, that must mean they would rather advise you to cut fat and eat plenty of carbs(even though they know this won't work and in fact will probably make it worse) while trying to manage your TGLs on 3 different meds- all with cost and possible SEs of their own- than actually advise you as to what will work impressively even without meds. Above what is good for you, the important thing is to keep you on medication for better or worse. (Do you still take the 3 different TGL meds?)

If they do not know, then what do we pay the megabucks to these supposedly brilliant guys for? Are they actually highly paid ignoramuses? I doubt that, but they certainly know what the drug companies tell them.

But here is a problem, Prato: you and I and a few others at HWPC are just anecdotes. While there are a few well done smaller studies out there that back up what I say, and none that I know of that disprove it(and keep in mind many studies are bogus as they don't cut carbs enough to get results), I ask again: where are the large scale studies to put this to the test? After 30+ years of low fat diets and drugs to treat things that diet has a profound effect on, after 30+ years of ever escalating national obesity and diabetes, why is this still going on? Why hasn't there been a large scale, high quality study to show whether or not the results you and I and several others I know have seen are the real deal?

And if there have been good studies showing that cutting fat will probably lower HDL, and at the same time replacing fat with carbs will raise TGLs, then why have those not been trumpeted in the media? I would say that the great bulk of advice available to us from our medical pros and dieticians is to cut fat. Which - unless we are also going to starve which few people are wiling to do for very long- almost by default means replacing fat with carbs. We can see what the results of this advice has been.

JackH said...
I've gotta absorb this. What you are saying is counterintuitive...it seems to go against what I thought I knew. But that's sorta like, perhaps, overcoming the "you have cancer" triggering a "get it out" reaction because of what we've supposedly learned about "cancer" when, counterintuitively, if it's "the 'good' prostate cancer," rushing to get it out is a mistake.

I gots some learnin' to do in this area. The lingo doesn't roll off my tongue in the same way that I've educated myself on PC...I still have to think about which was is the "good" cholesterol and which is "bad."

Pratoman, as you suggested, I googled "The Big Fat Lie." What came up first was the book "The Big Fat Surprise," by Nina Teicholz...is that the book you meant? I did see some articles titled "The Big Fat Lie" which might be bit-sized starting points for me, but not a book by that title.

BillyBob, you've mentioned several studies in this area. Your most recent post decries the lack of a "major" study, but if you have a link to any of those...please post me the "best" one in your mind. I'm pretty good, usually, at ferreting out the value of medical studies base on things like who wrote it, who sponsored it, where it was published, and the quality of how many similar study outcomes one can find...even though as you said this thought process may be fairly new.

thanks, guys

Well, like I say, the lack of big studies that don't screw it up is a problem. For example, I have seen some studies that made the news that conclude something like "no difference in low fat vs low carb". Then when I look at the details I see they were neither true low carb ( although even moderate reduction can be a help), not low enough to get the big effects, nor were they long enough to get the effects. But usually they are reluctant to reduce carbs enough to cause even low level ketosis, which is where the effects kick in big time.

I have posted many studies here at HWPC before, but I don't know what threads those are in. So I will just start with this link, which itself links to 23 other studies, which they claim are even RCTs. I have only skimmed over a couple of them so far, but at a glance I am seeing results that tend to support my experience. But if you decide to look through them, keep in mind one thing difference that is rarely mentioned but is pretty big: Even if the results are over all similar, almost always the low fat diet is calorie restricted. Almost always the low carb/higher fat group eats until they are not hungry. That can be a big difference over the long term. Few are willing to stay hungry for months or years. Not vouching for the quality or lack of bias of any of these studies, have not even looked closely at any yet. And I don't know yet which of these speak to HDL. But might be a good place to start.

A couple of quick looks:
/authoritynutrition.com/23-studies-on-low-carb-and-low-fat-diets/

Somebody said...
1.Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.

Details: 63 individuals were randomized to either a low-fat diet group, or a low-carb diet group. The low-fat group was calorie restricted. This study went on for 12 months..............Conclusion: There was more weight loss in the low-carb group, significant at 3 and 6 months, but not 12. The low-carb group had greater improvements in blood triglycerides and HDL, but other biomarkers were similar between groups................................

2. Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003.

Details: 132 individuals with severe obesity (mean BMI of 43) were randomized to either a low-fat or a low-carb diet. Many of the subjects had metabolic syndrome or type II diabetes. The low-fat dieters were calorie restricted. Study duration was 6 months.

Weight Loss: The low-carb group lost an average of 5.8 kg (12.8 lbs) while the low-fat group lost only 1.9 kg (4.2 lbs). The difference was statistically significant...............Conclusion: The low-carb group lost significantly more weight (about 3 times as much). There was also a statistically significant difference in several biomarkers:

Triglycerides went down by 38 mg/dL in the LC group, compared to 7 mg/dL in the LF group.

Insulin sensitivity improved on LC, got slightly worse on LF.

Fasting blood glucose levels went down by 26 mg/dL in the LC group, only 5 mg/dL in the LF group.

Insulin levels went down by 27% in the LC group, but increased slightly in the LF group.

Overall, the low-carb diet had significantly more beneficial effects on weight and key biomarkers in this group of severely obese individuals...........

23 Studies on Low-Carb and Low-Fat Diets – Time to Retire The Fad
By Kris Gunnars, BSc |
599,260
views

Young Woman Staring at a Plate of VegetablesFew things have been debated as much as “carbohydrates vs fat.”

Some believe that increased fat in the diet is a leading cause of all kinds of health problems, especially heart disease.

This is the position maintained by most mainstream health organizations.

These organizations generally recommend that people restrict dietary fat to less than 30% of total calories (a low-fat diet).

However… in the past 11 years, an increasing number of studies have been challenging the low-fat dietary approach.

Many health professionals now believe that a low-carb diet (higher in fat and protein) is a much better option to treat obesity and other chronic, Western diseases.

In this article, I have analyzed the data from 23 of these studies comparing low-carb and low-fat diets.

All of the studies are randomized controlled trials, the gold standard of science. All are published in respected, peer-reviewed journals.
The Studies

Most of the studies are being conducted on people with health problems, including overweight/obesity, type II diabetes and metabolic syndrome.

Keep in mind that these are the biggest health problems in the world.

The main outcomes measured are usually weight loss, as well as common risk factors like Total Cholesterol, LDL Cholesterol, HDL Cholesterol, Triglycerides and Blood Sugar levels.

1.Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.

Details: 63 individuals were randomized to either a low-fat diet group, or a low-carb diet group. The low-fat group was calorie restricted. This study went on for 12 months.

Weight Loss: The low-carb group lost more weight, 7.3% of total body weight, compared to the low-fat group, which lost 4.5%. The difference was statistically significant at 3 and 6 months, but not 12 months.

Foster, et al. 2003.

Conclusion: There was more weight loss in the low-carb group, significant at 3 and 6 months, but not 12. The low-carb group had greater improvements in blood triglycerides and HDL, but other biomarkers were similar between groups.

2. Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003.

Details: 132 individuals with severe obesity (mean BMI of 43) were randomized to either a low-fat or a low-carb diet. Many of the subjects had metabolic syndrome or type II diabetes. The low-fat dieters were calorie restricted. Study duration was 6 months.

Weight Loss: The low-carb group lost an average of 5.8 kg (12.8 lbs) while the low-fat group lost only 1.9 kg (4.2 lbs). The difference was statistically significant.

Samaha, et al. 2003.

Conclusion: The low-carb group lost significantly more weight (about 3 times as much). There was also a statistically significant difference in several biomarkers:

Triglycerides went down by 38 mg/dL in the LC group, compared to 7 mg/dL in the LF group.

Insulin sensitivity improved on LC, got slightly worse on LF.

Fasting blood glucose levels went down by 26 mg/dL in the LC group, only 5 mg/dL in the LF group.

Insulin levels went down by 27% in the LC group, but increased slightly in the LF group.

Overall, the low-carb diet had significantly more beneficial effects on weight and key biomarkers in this group of severely obese individuals.

3. Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.

Details: 30 overweight adolescents were randomized to two groups, a low-carb diet group and a low-fat diet group. This study went on for 12 weeks. Neither group was instructed to restrict calories.

Weight Loss: The low-carb group lost 9.9 kg (21.8 lbs), while the low-fat group lost 4.1 kg (9 lbs). The difference was statistically significant.......Conclusion: The low-carb group lost significantly more (2.3 times as much) weight and had significant decreases in Triglycerides and Non-HDL cholesterol. Total and LDL cholesterol decreased in the low-fat group only.

And 21 others. Another thing to keep in mind is what Prato said about LDL particle size. While low fat/low calorie might decrease LDL better than low carb, I have read a few times that low carb is associated with changing the LDL to the "light, fluffy" kind that is not associated with HD. But we need to look into that one.
www.examiner.com/article/how-to-increase-the-size-of-your-small-ldl-particles-with-food-choices

Somebody said...
.................Can you treat small LDL particles with a low saturated fat diet, weight loss, exercise, or must you be 'forced' to take statin drugs that don't really stop you from getting that attack? What factors other than your genes also lower levels of small, dense LDL particles and turn them into large LDL particles?

That's what nutritionists are trying to find out.................

This one does not look at low carb, but only at various amounts of fat, I think:
jn.nutrition.org/content/134/10/2517.abstract

Somebody said...
were subjected to 3 dietary periods, each lasting 4 wk. The first was an SFA-enriched diet (38% fat, 20% SFA), which was followed by a carbohydrate (CHO)-rich diet (30% fat, < 10% SFA, 55% carbohydrate) or a monounsaturated fatty acid (MUFA) olive oil–rich diet (38% fat, 22% MUFA) following a randomized crossover design..............................
LDL size was smaller (P < 0.02) after the CHO diet than after the MUFA or SFA diets. After the CHO diet, a significant increase in LDL particle size (P < 0.035) was noted with respect to the MUFA diet in apoE 4/3 subjects, whereas a significant decrease was observed in the apoE 3/3 individuals (P < 0.043). In conclusion, a Mediterranean diet, high in MUFA-fat increases LDL particle size compared with a CHO diet , and this effect is dependent of apoE genotypes.

This is not a study, just an article mentioning studies, just food for thought, something to be looked into:
/www.verywell.com/ldl-cholesterol-a-low-carb-diet-2242028

Somebody said...
2. Particle Size Patterns Usually Improve on a Low-Carb Diet

So why do we care about the size of the particles of LDL? It turns out that when you have more small, dense LDL particles (called Pattern B), it is much more predictive of coronary artery disease than when the particles are large and less dense (Pattern A). In every study I am aware of that looked at the LDL particle size when people switch to a low-carb diet, the patterns changed in the favorable direction.

Hope that helps. Though no doubt there are studies out there that show the opposite, I just have not found them yet.