The myth of “optimal medical therapy”

This is important because the heart is perpetually in motion through various cycles of its beating rhythm , with motion also provided by breathing . But these devices allowed us to precisely quantify calcium in the coronary arteries of the heart , the arteries that close and cause heart attacks .

My friend , dr John Rumberger , while at the Mayo Clinic , performed studies demonstrating that calcium consistently occupies 20% of total atherosclerotic plaque volume in the coronary arteries . In other words , quantifying calcium in the coronary arteries served as a gauge or dipstick for total atherosclerotic plaque volume in the heart's arteries .

Some years later , cardiologist Dr Arthur Agatston , whose name you may recognize from his popular South Beach diet books , developed a scoring system for coronary calcium , yielding something that came to be called an Agatston score . The higher the Agatston or calcium score , the more atherosclerotic plaque was present in the coronary arteries .

Subsequent research has shown that the Agatston or calcium score is , by a long stretch , the best predictor of future cardiovascular events , far better than crude measures like cholesterol . And these scores , in the 30 years since my team and I started doing these scans , have become well-established as predictors of cardiovascular events like heart attack .

But what to do with this score ? Can it be stopped ? Can it be reduced ? That's the topic for this episode of the Defiant Health Podcast , highlighting what my colleagues call , even to this day , optimal medical therapy . That has repeatedly been shown to not work . And the answers lie elsewhere , answers that I shall discuss Later in the podcast .

Let's talk about Defiant Health's sponsors Paleo Valley , our preferred provider for many excellent organic and grass-fed food products , and BioDequest , my number one choice for probiotics that are scientifically formulated , unlike most of the other commercial probiotic products available today .

I'd like to also make you aware of a new source for our favorite microbe , lactobacillus roteri , and a skin formulation I designed that improves skin from the inside out . As I mentioned in the opening comments , about 30 some years ago I helped set up the first heart scan device in Wisconsin one of the first in the Midwest and we started scanning people .

These are people without heart disease symptoms . They don't have chest pain , they're not in an emergency room . They're not having heart attacks . They're going about their business , riding bikes , going for walks , etc . With no limiting symptoms .

They'd come in because of some concern over having heart disease Perhaps their cholesterol was high or perhaps a family member had heart disease early in life , maybe in their 50s , and they'd come in to want to know were they headed in the same direction . They'd have a scan and they'd have a positive score . So a normal score is zero , meaning no calcium .

Recall that calcium occupies 20% of total atherosclerotic plaque volume , so it serves as an indirect measuring stick or dipstick for how much total plaque you have . So , for instance , if someone had two cubic millimeters of calcium , they'd have 10 cubic millimeters of total atherosclerotic plaque .

And the more plaque you have , the greater the volume of plaque , the more likely it is to rupture . That's what a heart attack is . People often wrongly think that a heart attack is when an artery progressively narrows , and that does happen .

But it's much more common for a minor plaque , maybe blocking only 30% of the diameter of the artery , to rupture like a little volcano . And when that happens , some of the internal components of that plaque are exposed to flowing blood and that is a trigger for blood clot formation .

So that's why it's very difficult to predict heart attack , because if you looked at blockages only you'd see a bunch of 10% , 20% , 30% , 40% blockages and you can't tell which one's going to rupture . That's why it's so difficult to manage this disease with procedures .

So instead we're measuring calcium as an indirect way to quantify the total atherosclerotic plaque volume lining all three coronary arteries . So a score of zero is normal and the more plaque you have , the higher the score . And your score is compared to other people of your same sex and age .

So , for instance , a score of 300 in a 55-year-old woman would be a very bad , very high score . A score of 300 in a 75-year-old male would be only a moderate score . So they should tell you how you compare to other people and it gives you a kind of sense how bad it is .

But know that when you get to a score of about a thousand , the risk for dying , having a heart attack , sudden cardiac death or a need for a procedure like stent implantation or bypass surgery is about 15% per year , meaning that those things are inevitable in about six to seven years .

In other words , you're given kind of a crystal ball for the future of whether you're going to have heart problems with your heart or not . So what happens if you do nothing ? Let's say you have a score of 400 at age let's just say 60 .

If you do nothing , that score and this is well worked out , we helped contribute some of these data that score will increase 25% per year . So a year later it would be 500 . Another year later , 625 and so on , and with each increase in score you're a step closer to heart attack and other events . Well , this goes back now 30-some years .

What do you do about this ? Well , back then all we had was baby aspirin , a high dose of a statin cholesterol drug , a low-fat , low-saturated fat , low-cholesterol diet and an exercise program what my colleagues back then called optimal medical therapy , and to this day they still call it that . Well , we help publish these data .

If you do that optimal medical therapy baby aspirin , statin cholesterol drug , low-fat diet , exercise how fast does that coronary calcium score and thereby coronary atherosclerotic plaque grow ? 25% per year , maybe more so . Several studies even showed that it accelerates , that optimal medical therapy accelerates the increase in score to 27% or so per year .

It became clear that what my colleagues were calling optimal medical theory was useless medical therapy . It did virtually nothing . That program may reduce some of the soft elements of plaque , but it does not put a stop to the disease , not even close . So you can imagine . I had many panicked people coming in who saw their scores going up .

Unfortunately , when they consulted with my colleagues , all too often they were told that even though they had no symptoms , they were told to undergo what my colleagues called the real test , a heart catheterization , to see if they needed a preventive stent implant or bypass operation .

Well , it's well established that doing such procedures on people with no symptoms , that is , no chest pain , no breathlessness etc . Provides no benefit Because you can't bypass or stent everything and you don't know which plaque is going to rupture and cause a heart attack .

So it's been clear preventive procedures we call them revascularization procedures do not benefit people without symptoms , do not benefit people without symptoms . So what do you do if the best they have in conventional healthcare , so-called optimal medical therapy , does virtually nothing for the progression of coronary atherosclerosis ? What can you do ?

Well , it took some years , some trial and error and logic and consulting science . We had to come up with a program . It led to insights like adding vitamin D and achieving a 25-hydroxyvitamin D blood level of 60 to 70 nanograms per milliliter was a major factor in achieving regression Not a slowing but a regression of carnic calcium progression .

In other words , we went from 25% per year progression to drops of a score , say from 400 to 240 , something like that . Now , when you do that , when you stop the progression let's say 0% change your risk for a cardiac event like heart attack is virtually zero .

If you reduce the score , your risk for a heart attack or other events is also zero and you don't have to get back to a heart scan score of zero to be safe .

In other words , if you did reduce your score from 400 , say , to 290 , 290 sounds like a bad score but because it was achieved via reversal of plaque , your risk for heart attack , provided you stay in the program , is virtually zero . It's highly unusual to have any kind of heart event when you've had regression of carotid plaque .

So by having this means of tracking the growth or regression of carotid atherosclerotic plaque , it taught us that vitamin D , as I mentioned , was very important . It was the first time we saw actual drops in calcium scores

. Omega-3 fatty acids very important Iodine , because people have forgotten that iodine deficiency was a major public health problem up until 1924 , when the FDA advised salt manufacturers to add iodine and then urged everybody to use lots of salt to prevent goiters . Well , you know what happened since then ?

Right , the use of salt and the other advice to cut fat and increase consumption of grains led to insulin resistance , which in turn leads to sodium retention . The problem was not the salt , the problem was the insulin resistance from diet . So the FDA wrongly advised Americans to cut back on salt and what do you think is coming back ?

Thyroid dysfunction and goiters . And so we add back iodine and of course we take steps in the program to reverse insulin resistance so that you do not retain sodium . We also add magnesium because we drink filtered water , we have to .

Water in streams and rivers has sewage and farm runoff and other things , and so we filter our water by necessity , and water filtration removes all magnesium , so we have to supplement magnesium .

Then we take steps to address the modern disrupted gastrointestinal microbiome , because all of us have been exposed to antibiotics off in many courses over a lifetime , to glyphosate and other herbicides in food preservatives that are antimicrobial in your food but also in our GI tracts , other food additives like emulsifying agents like polysorbate 80 , carboxymethylcellulose and

carrageenan that disrupt the intestinal mucus barrier and change the microbiome composition and many other factors . So we address that . We do so by making sure we add back fermented foods , lots of fermented foods like kimchi , kefir , sauerkraut , fermented vegetables .

We re-implant keystone microbial species that colonize the small intestine , like Lactobacillus roteri and Lactobacillus gasseri , and we do so by fermenting them in something that looks and smells like yogurt . It's not yogurt , don't be fooled by that . It's nothing like the stuff you buy in a store which will not accomplish this .

But we make the yogurts or other fermented foods with those microbes and re-implant them at very high numbers and that starts the process of reacquiring beneficial species .

We also include lots of fibers , prebiotic fibers from foods like asparagus , brussels sprouts , legumes like black beans , white beans , chickpeas , hummus , other foods rich in fibers that nourish microbes .

And because reducing cholesterol with statin drugs was proven to be a useless and perhaps even harmful practice , I resorted to using a better , a superior method of testing to identify the particles in the bloodstream that cause coronary disease .

There are various methods , but the one method that has become kind of the gold standard is NMR nuclear magnetic resonance , lipoprotein analysis , and it became crystal clear that people who had coronary disease and continued to progress their coronary calcium scores had an excess of small LDL particles . So we knew that a low-fat diet actually worsened small LDL particles .

So we knew that a low-fat diet actually worsened small LDL particles .

So we also knew with good science science performed at University of California , Berkeley Hopkins and other places that the only foods that provoke formation of small LDL particles very dangerous particles were wheat , grains and sugars , the amylopectin A unique to wheat and grains , and then all forms of sugar , whether it's sucrose , fructose or glucose .

Because the conventional methods of stopping the progression of plaque of calcium sugars did not work , I asked patients to try this instead eliminate wheat , grains and sugars . And that's when I saw small LDL measures . A typical measure in someone with coronary disease would be something like 1,800 nanomoles per liter . That's part of a count per volume .

They would go wheat , grain and sugar-free and it would drop to zero or some other very low value . In other words , it wasn't just better by 10% or 30% , it was eliminated in the vast majority of cases . And this is also where it led to all the lessons I talked about in my wheat belly books , and that is , people would decimate small LDL particles .

But they'd also say why did I lose 47 pounds and why did my waist shrink by eight inches ? Why is my rheumatoid arthritis better ? Why is my blood pressure now normal ? I had to stop my blood pressure medication . Why am I no longer a type 2 diabetic or pre-diabetic ?

So it led to huge successes in regaining control over health , including a reversal of the factors that led to an increased carnic calcium score and carneric atherosclerotic plaque . By following this program , we've achieved reversal or reduction in cardiac calcium scores time and time again , and it became clear that statin drugs are simply not necessary .

It's also not necessary to control cholesterol . We do control lipoproteins , so we don't rely on cholesterol testing . We use NMR lipoprotein testing to quantify VLDL particles and small LDL particles . Those are the real drivers , along with insulin resistance and inflammation , of cardiovascular risk , and so we focus on the real causes of heart disease .

That also includes endotoxemia , by the way . That is when you have the infestation of the small intestine by fecal microbes .

Because of our exposure to antibiotics and those other things , there's been an overproliferation of fecal microbial species like E coli and salmonella and Campylobacter and Pseudomonas that have infested the small intestine the 24 feet of small intestine .

Now those microbes only live for a few hours and when they die they release some of their components , especially something called lipopolysaccharide endotoxin . That gains entry into the bloodstream and that's called endotoxemia . That is a major driver of increasing and growth of atherosclerotic plaque , increasing carnic calcium score .

So we address that and you do that , starting with the reimplantation of lactobacillus roteri , lactobacillus gasteri and those other efforts we make to restore a healthy gastrointestinal microbiome .

Now let's pause for a moment to hear something about Defiant Health's podcast sponsors , paleo Valley and BioDequest , and when we come back let's discuss some new findings from some recent clinical trials that shed light on how to achieve regression of plaque .

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So for years we've been seeing that this combination of the diet where we eliminate wheat , grains and sugars the foods that provoke formation of small LDL particles . And , by the way , the reason why small LDL particles are so harmful is because they're very prone to oxidation . They're prone to glycation , which makes them much more dangerous .

They are better able to enter the walls of arteries and start the process of forming atherosclerotic plaque when they're in arteries . They're very adherent to the structural proteins in the walls of arteries .

They're more likely to provoke an inflammatory response , because it's inflammation in the wall of arteries in atherosclerotic plaque that is a major driver of those plaque ruptures that cause heart attack , and small LDL particles , after being formed from your consumption of wheat , grains and sugars , persists in the bloodstream for five to seven days , as compared to only

24 hours of a large LDL particle formed from consumption of fats and oils . So it's the amylopectin A of grains and all those sugars that trigger formation of small LDL particles . That are exceptionally bad . But you can get rid of them by just following a diet and then also our nutritional supplement program .

Now the nutritional supplements very simple Omega-3 fatty acids , magnesium , iodine and vitamin D , when combined , minimize insulin resistance and inflammation , because it's those two processes , insulin resistance and inflammation , that serve as an amplifying effect on the production of small LDL . So those supplements contribute to a marked reduction in small LDL particles .

Then we go even further . We address all those factors in your gastrointestinal microbiome to minimize or reverse SIBO small intestinal bacterial overgrowth and the endotoxemia it causes , because the endotoxemia is a major contributor to , once again , insulin resistance and inflammation .

So you'll be given an extraordinary panel of powerful tools to gain control over coronary atherosclerotic plaque and putting a stop to the progressive rise of your coronary calcium score . And we have done this time and again without having to introduce statin cholesterol drugs or other efforts to reduce LDL cholesterol .

Instead , we're focusing on small LDL insulin resistance , inflammation , endotoxemia . Now there's been a recent several trials .

You know there's always been a debate about just how helpful fish oil is for reducing cardiovascular events , and that's because in 1999 , the Gissi-Pravenzione trial , that's an Italian study of thousands of people who took 1,000 milligrams of EPA and DHA from fish oil and there was a 10% reduction in cardiovascular events .

So that sparked a lot more interest in fish oil . But a number of smaller studies , often using lower dose or low doses of omega-3s , did not show benefit .

And then more recently in the last few years , there have been a series of very large studies involving 10,000 to 25,000 people , each given higher doses of omega-3 fatty acids , and those studies have consistently shown decreased cardiovascular events .

For instance , the JEALIS trial , j-e-l-i-s In Japan , that is , a fish-consuming population were given 1,800 milligrams of EPA alone only EPA , not the DHA and there was a 19% reduction in cardiovascular events . There was the REDUCE-IT trial that showed that 4,000 milligrams of the EPA alone reduced cardiovascular events by 25% over three years .

And there's the vital study of 25,000 participants who took 1,000 milligrams of EPA and DHA and experienced a 25% reduction in cardiovascular events over five years .

Now the clincher in this are two studies using CT coronary angiography , and all that means is the CT heart scan device , but participants were given an intravenous bolus of a die , a radiographic die , so they can see the arteries . This yields exquisite three-dimensional pictures . But in both of these studies , fish oil was given .

In the EVAPORATE trial , 4,000 milligrams of EPA alone over 18 months , and in the HEARTS trial , 3,360 milligrams of EPA and DHA were given over three years . And in both trials , and with use of coronary CT angiography , it was shown that both the fibrous and soft elements of plaque were reduced . And these were both trials .

Everybody took a statin drug , because my colleagues feel that it's unethical to not give somebody with heart disease a statin drug . We could argue about that , but nonetheless everybody in both those trials were on statin drugs and the people who got placebo had progression of disease on a statin drug .

And the people who got fish oil either EPA 4,000 milligrams or EPA and DHA 3,360 milligrams showed regression of fibrous plaque and of soft elements of plaque , that's , the soft elements that are more prone to rupture . And one of the studies also showed regression of the coronary calcification measure .

We now have good evidence that omega-3 fatty acids not only reduce the likelihood of cardiovascular events , they also facilitate regression or reversal of coronary disease . And these studies also show that statin drugs are insufficient . They allow

progression . It's the fish oil that is the active component , at least in these trials that achieve regression . So there you have it the diet , wheat , grain , sugar , elimination , supplements combined that synergize to minimize insulin resistance and inflammation , the factors that amplify the production of small LDL particles .

And then we address SIBO and endotoxemia by our program of fermented foods , re-implantation of keystone microbes and ingesting lots and lots of probiotic fibers to nourish beneficial microbes . Now , if you've learned something from this episode of the Defiant Health Podcast , I invite you to subscribe to your favorite podcast directory . Post a review , post a comment .

Let's help build this movement of self-empowerment and health . Thanks for listening .