Thirteen catheterizations later

When I first met her, Janet couldn't stop sobbing. She'd just been through her 10th heart catheterization in two years.

It started with chest pains at age 56, prompting her first heart catheterization that uncovered severe atherosclerotic blockages in all three coronary arteries. Her cardiologist advised a bypass operation.

Six months after the bypass operation, Janet was back with more chest pains, just as bad as before. Another heart catherization showed that two of the three bypass grafts had failed. The third bypass graft contained a severe blockage that required a stent, along with multiple stents in the two now unbypassed arteries.

In the ensuing 18 months, Janet returned for 8 additional catheterizations, each time leaving the hospital with one or more stents.

Janet's doctor was puzzled as to why her disease was progressing so aggressively despite Lipitor and the low-fat diet provided by the hospital dietitian. So he had Janet undergo lipoprotein testing (NMR):

LDL particle number: 3363 nmol/L
Small LDL particle number: 2865 nmol/L
HDL cholesterol: 32 mg/dl
Triglycerides: 344 mg/dl
Fasting blood glucose 118 mg/dl
HbA1c 5.8%

Unfortunately, Janet's doctor didn't understand what these values meant. He pretty much threw his arms up in frustration. That's when I met Janet.

From her lipoprotein panel and other values, it was clear to me that Janet was miserably carbohydrate-sensitive and carbohydrate-indulgent, as demonstrated by the extravagant quantity (2865 nmol/L) and proportion (2865/3363, or 85%) of small LDL, the form of LDL particles created by carbohydrate exposure. Janet struggled with depression over the years and had been using carbohydrate foods as "comfort" foods, often resorting to cookies, pies, cakes, breads, and other wheat-containing foods for emotional solace.

It took a bit of persuasion to convince Janet that it was low-fat, "healthy whole grains," as well as comfort foods, that had led her down this path. I also helped Janet correct her severe vitamin D deficiency, mild thyroid dysfunction, and lack of omega-3 fatty acids.

Since meeting Janet and instituting her new prevention program, she has undergone three additional catheterizations (performed by another cardiologist), all performed for chest pain symptoms that struck during periods of emotional stress. All showed . . . no significant blockage. (Apparently, the repeated "need" for stents triggered a Pavlovian response: chest pain = "need" for yet more stents.)

In short, correction of the causes of coronary atherosclerotic plaque--small LDL, vitamin D deficiency, omega-3 fatty acid deficiency, and thyroid dysfunction--and Janet's disease essentially ground to a halt.

Imagine, instead, that Janet had undergone 1) a heart scan to identify hidden coronary plaque 5-10 years before her first heart procedure, then 2) corrected the causes before they triggered symptoms and posed danger. She might have been spared an extraordinary amount of life crises, hospital procedures, expense (nearly $1 million), and emotional suffering.

Comments (16) -

  • Martin Levac

    1/21/2011 5:55:49 AM |

    $1 million just so she can have her cake? And they say it's the cheap foods that kill us.

  • Reijo Laatikainen

    1/21/2011 6:44:09 AM |

    Very informative case. Thanks! What happened to Janet's triglyserides and LDL size (and other risk markers) as she adopted your regimen? What is exactly the evidence on the role of thyreoid dysfunction in coronary artery disease?
    RL -dietitian from Finland

  • Apolloswabbie

    1/21/2011 4:18:45 PM |

    I can't get over how powerful your approach is, and how much better it comports with the "first do no harm" idea which would ideally be the bedrock of medicine.  Thank you for sharing these stories with us, I get fantastic leverage for a non-medical approach to health by referencing what you write.

  • Anonymous

    1/21/2011 4:28:45 PM |

    Wait, how many caths? How many stents? And how much does each one cost...?

    She must have good insurance!?

  • Anonymous

    1/21/2011 4:53:56 PM |

    Thirteen  times in the cath lab???  I cannot imagine anyone not wising up after the first time through the cath lab... and I'm speaking from experience.

    Two visits, three visits, four... a patient might get a little curious about what was causing all this, and why they 'needed' all these procedures. The emotional toll of all those procedures alone would motivate me to a). Find another approach and b). Her doc didn't have a clue?  Find someone who does!

    Dr. Davis, your approach is so powerful, does no harm... and it surely doesn't cost $1M.

    Best wishes to you,

    Paso Robles, CA

  • Thrasymachus

    1/21/2011 5:23:30 PM |

    The preference for grains in American society has deep religious, cultural, and political roots that can't be uprooted by anything as insignificant as science or medicine. Those opposing it will be voices crying in the wilderness for the forseeable future.

    My brother got me a package of the fine-ground oatmeal and I went through most of it. I was feeling woozy the other day after eating it and checked my blood sugar- 194. No more of that!

  • Jack

    1/21/2011 6:21:11 PM |

    Oh my! Those are some pretty scary numbers. HDL/Trig ratio of 1:10 and 85% small, dense LDL!

    I too would be curious how your recommendations affected her lipid numbers. I know this... she's far better off under your guidance than the docs that counseled her right into that mess.

    Thanks Dr Davis.
    Jack Kronk

  • Anonymous

    1/21/2011 7:51:25 PM |

    dr davis how did you fix the thyroid dysfunction? im really interested and what alerts you to the thyroid issue?

  • Anonymous

    1/21/2011 11:42:58 PM |

    anything that increases the cardiac CRP can alter the throid axis.  So a patient with an increased Cardiac CRP due to heart disease fits that bill.  It could be either a conversion problem or frank throid recpetor resistance.  T4 is the inactive form of thyroid hormone. It must be converted to T3 before the body can use it. More than 90% of thyroid hormone produced is T4.  This common pattern is caused by inflammation and elevated cortisol levels. T4 to T3 conversion happens in cell membranes. Inflammatory cytokines damage cell membranes and impair the body’s ability to convert T4 to T3. High cortisol also suppresses the conversion of T4 to T3.

    That is how it happens.  

    Dr. K

  • Anonymous

    1/21/2011 11:54:10 PM |

    There is also a well known connection between lipids and thyroid fxn that most docs seem to have forgotten. Last January in 2010, as part of Thyroid Awareness Month, the American Association of Clinical Endocrinologists (AACE) has released the results of a new survey on the thyroid-cholesterol connection, looking at the connection between undiagnosed hypothyroidism and high cholesterol.

    Materials released by the AACE in support of this information campaign include:

    •Americans Urged to "Take Cholesterol by the Neck"

    •Understanding the Thyroid-Cholesterol Connection

    •Facts about Thyroid Disease

    •Take the Thyroid Neck Check -- The Neck Check Card

    The survey had several important findings:

    •Fewer than half of the adults who had been diagnosed with high cholesterol know if they had ever been tested for thyroid disease, despite the well-documented connection between the two conditions.

    •Ninety percent of those surveyed were unaware of the thyroid gland's impact on cholesterol regulation.

    According to AACE President Richard A. Dickey, M.D., "Patients who have been diagnosed with high cholesterol should ask their physician about having their thyroid checked. If they have an underlying thyroid condition in addition to their high cholesterol, the cholesterol problem will be difficult to control until normal levels of thyroid hormone are restored."

    The patient shown by Dr Davis clearly has a lipid issue as seen in the example. Her SDLDL is off the charts and her other docs had no idea that her lipid profile will cause her hypothyroidism.  Hence the teaching point and it shows that the study was right about that 90% number.  Most PCPs have not a clue about this and they treat these people all the time!

    Dr. K

  • Sophie

    1/22/2011 1:23:16 AM |

    I cannot believe she had undergone the 10th catheterization in two years. She must be a strong woman to undergo such procedures.
    Isn't it a protocol to do a heart scan before doing a catheterization? I am deeply saddened with her case. It is good to hear that she is in good hands now with an expert cardiologist.
    Nutrition is indeed a great factor that affects our health. We must be very cautious to what we eat before experiencing the symptoms of heart diseases.

  • Anonymous

    1/22/2011 11:55:56 AM |

    Cool Dr. K
    Thanks for the inputs. Going to an anti inflammotory lifestyle would cure the thyroid dysfunction as well i would suppose? whatelse can be done to keep the thyroid healthy.

  • Lacey

    1/22/2011 2:35:00 PM |

    Anonymous said: "The patient shown by Dr Davis clearly has a lipid issue as seen in the example. Her SDLDL is off the charts and her other docs had no idea that her lipid profile will cause her hypothyroidism."

    Don't you mean that her hypothyroidism will cause her lipid profile? That's what the AACE literature says.

  • Anya

    1/22/2011 2:38:41 PM |

    Stand in bare feet on a wet ground every day for at least 30 - 40 minutes and/or sleep 'grounded'.
    Results :
    - thyroid stabilisation
    - less inflammation
    - blood thins
    - less cortisol spikes
    Sounds goofy ? Yep !
    Try it.  I did, it works.

  • Dr. William Davis

    1/22/2011 7:50:17 PM |

    Correcting Janet's thyroid dysfunction, i.e., hypothyroidism, was simple: Just iodine and Armour thyroid.

    Because the iodine yielded minimal improvement in thyroid function, she required the extra "boost" of exogenous thyroid hormones, T3 and T4. This has also contributed to substantial weight loss.

  • Anne

    1/23/2011 10:26:30 PM |

    I was in the cath lab 6 times. Three stents and 2 balloons and then off to bypass. My cholesterol numbers were never horrible(I don't have those records) but my hs-CRP was 13.8 indicating inflammation.

    Three years after bypass(2003) I was close to going back to the cath lab as I was having pitting edema and SOB. Before I went, I stopped eating gluten and other grains and these symptoms, along with many more, disappeared. My hs-CRP is now 2.2(not perfect but better)

    I too can only imagine what life would have been like if I had understood the power of food earlier. I am also thankful that I found this out when I did.