Introduction: In this podcast episode: everything you need to know about reducing your heart attack risk, water intake during exercise, protein:carb ratios for fat loss, detox and rashes, thyroid medications, testosterone, doping, drafting, and is too much produce a bad thing?
Ben: So after last week’s massive Listener Q and A, this is Ben Greenfield back with a somewhat more normal podcast episode where we will have our special announcements, we’ll have our Listener Q and A and we have a featured interview today with a guy named Dr. William Davis and he is a pioneer when it comes to assessing your cardiovascular risk. He’s written a book called Track Your Plaque and we’re going to talk to him today about heart attack considerations for both athletes and the general population. Some of the important things you need to know, some of the reasons why the test that they’re giving these days are outdated and it’ll be an interesting discussion with Dr. Davis. Also got a lot of Listener Q and A this week as well as a few special announcements and you’re going to want to tune in to those so let’s go ahead and move on to this week’s episode number 60 from www.bengreenfieldfitness.com.
Todd asks: Hi Ben, my name is Todd. I have a question about protein or I guess recovery supplements after a workout. I was confused. I see that some articles I’ve read indicate that a carbohydrate:protein ratio is best for recovery, like a 4:1 type ratio after a workout and other types of protein powders that are available that are more of a source of protein in general. I was just curious with respect to fat loss, are any of those two options after a workout better than one versus the other as far as retaining muscle as you’re losing weight or burning fat and as well as the general muscle recovery if you’re training for endurance sports at a 5 or 6 day a week training regimen. I was just confused on which product or types of products might be best for someone in that situation. Thanks again, I enjoy listening to your podcast. Have a great day.
Ben answers: Alright, Todd. That’s a really good question and this is one that I’ve gotten from many of the athletes who I work with who have read about the fact that research has shown it is ideal for recovery from any type of endurance activity as well as most types of sport conditioning activities to take in a 3:1 up to a 4:1 carbohydrate to protein ratio after exercise. So there’s a bunch of different formulations on the market that are in a good way based on this research. You could take something like Hammer Nutrition’s RecoverRite or you could take Endurox R4. Those are two examples of that 3:1 or 4:1 ratio. Now the flipside to this is that when you do take in carbohydrates, that can inhibit the amount of fat that you actually burn and we walk a very fine line when it comes to accessing the body’s fat stores but also giving the body enough recovery fuel after exercise to where you don’t get a cortisol release, a drop in lean muscle mass, an attack on your immune system. And so the general rule that I follow with the athletes that I work with or the clients who are exercising but still want to lose fat is we will take the most important and the most difficult workout sessions, the ones that are really considered to be structured workouts typically of an hour or longer in duration and those are the workouts that we really focus on refueling extensively for and using something like the 3:1 or 4:1 ratio. Now, for some of the shorter, what I would call fat burning efforts, you can actually get away with not fueling either before or after the workout. So you can do something like a morning, nice, easy fat burning session that’s at your fat burning heart rate that’s typically about 50 to 60% of your maximum heart rate. You cannot eat before that session and you can even delay eating for one to two hours after that session and actually tap into fat stores without doing a lot of damage to your body because the type of fat burning exercise that you engaged in was not tearing up muscle or not necessitating a very aggressive recovery measure. Now you contrast – and this is the other part of your question – those 3:1 and 4:1 ratio carbohydrate to protein mixes with the stuff that’s just pure protein. There’s a few different ways you can use something like a pure protein that doesn’t have a carbohydrate with it. One thing that I’ll use that for is an evening snack when you don’t want a lot of carbohydrate, you don’t want to spike the insulin levels but you do want to take advantage of the fact that protein can actually cause a nice little growth hormone release which causes fat burning and helps with forming and recovery for your lean muscle mass. You can actually take whey protein, a couple of scoops of that, put it in a little bit of water, stir it up or a little bit of fat free yoghurt, stir it up and take that in before bed and have a nice primarily protein based snack. The other thing that it comes in handy for is if you don’t have access to one of these 3:1 or 4:1 carb to protein mixes. You can take something like a scoop of protein powder and consume that along with a, for example, banana and a handful of whole grain cereal after a workout and get that 3:1 or 4:1 carbohydrate to protein ratio. The other thing that I’ll use the whey protein for is to actually substitute for carbohydrate in some of the meals that I would normally cook typically for breakfast meals. I will substitute pancake mix or waffle mix with about a 1:1 ratio of protein powder to the pancake mix or waffle mix. I substitute for about a half cup of oatmeal that I eat in the morning now, about a scoop and a half of the Mt. Capra double bonded whey protein powder and that works really well. So the whey protein can be used as a source for cooking as well. If you’re somebody who can’t tolerate whey protein, a lot of different forms of proteins out there. Pea protein, hemp protein, soy protein – you got to be a little bit more careful with. Rice protein is also out there. so there’s a lot of different sources in addition to the whey protein, but great question Todd. And remember if you have a question, you want to do the call in thing like Todd did, you can call the 800 number at 8772099439 and listen for your option to leave a question for the www.bengreenfieldfitness.com podcast. I will put that toll free number in the Shownotes so you can search over there, write it down. Say you’re driving along in your car and you realize you wanted to ask me a question, whip out that 800 number, call it up and ask. The other thing you could do is you could Skype pacificfit which is my online Skype name. So let’s go ahead and move on to the next question for this week. And this question is from Listener Jason who says… little bit of a long question here.
Jason asks: Morning Mr. Greenfield. You said you like that. (I do like that. I do like it when you call me Mr. Greenfield. Again, it makes me feel old and responsible.) Been doing some flying lately and become a fan of listening to your podcast. I was hoping you could give me some feedback on an issue I had in my first tri I competed in a week or so ago. Basically the issue is that on my run I got severe stomach cramps and suffered from ab muscle pain for a few days after the event. A little bit of background and history is that I am in good shape, probably about 15 % body fat. I trained for the event for seven weeks and felt good going into it. I had some cereal and a slice of toast for breakfast. (Good breakfast, that’s what you want to do. Avoid fats and proteins. Have that carbohydrate. Jason I don’t know if you had it two hours before the race, but that’s about what you would want to do.) About 16 oz of water. Then after getting to the course had a Cliff bar. (That was probably a mistake Jason. You don’t need to take in any more food after breakfast. That’s just going to sit in your stomach.) Just before the race I had a GU. (Geez dude, this was a sprint triathlon. You could have rolled out of bed and done this with no fuel, but you ate a lot.) Did the 300 m swim in 5:47. Then did 15 mile bike in 47 minutes. I also had two bottles of water while doing the bike portion. Regular bike water bottles. In my transition to the run I had half of a small bottle of Gatorade. That’s where the problems started. Got out of the t2 area and started getting stomach cramps which hung around for the entire run which slowed me down to about 28 minutes instead of the 25 I was hoping for. I did the race in 1:24 which was 6 minutes faster than I was going for but am very competitive and want to improve. Any help you could give me would be appreciated. Someone said it was because I drank too much liquid.
Ben answers: Ok, Jason. Yeah I would agree with that someone who said you drank too much liquid. Look at it this way, about the amount of liquid that your body is going to tolerate during activity is right around 17 to 24 ounces and up to about 30 ounces per hour during exercise. Looking over what you took in, we have that 16 ounces of water you had for breakfast and I’m not sure if breakfast was two hours before like I said, but let’s just say that it was, and then I’m not sure if you took in any water between breakfast and the race. You may have been sipping on water but then you had two bottles of water during the bike portion which you said took you 47 minutes. So you had twice as much water as you needed during the bike. You got off the bike and you had half a small bottle of Gatorade, so there’s more liquid and at that point your stomach was cramping not only from all the liquid that you took in but also from the fact that you ate a ton. And this is one of my pet peeves, just a little rant – a lot of the fueling that people do for triathlon, it’s based off of advice that’s trickled down advice from Ironman triathlon where you eat or you die. In a sprint triathlon or even an Olympic distance triathlon, you can get up and do that event just fine with 0 fuel. Your body has enough fuel stores on board to be able to get through about two hours of exercise. Now granted, you don’t want to do that because sugar in your system can make you feel like you’re not working quite as hard and it can keep you a little bit more motivated mentally and there have been a couple of research studies that were done on that but you took in way too much. What I would have done is stuck with the breakfast that you had. I would have skipped that Cliff bar that you had just before getting to the course. You didn’t need that. Right before the race, the GU – yeah you could do that. I often encourage people to have a gel with a little bit of caffeine in it to give them a bump about five minutes before the race and then for a sprint distance triathlon, at that point – clear water – that’s all you need. Unless you plan on being out there for a very long time. 2 and a half hours and you’re going super slow, you might be able to take in a little bit extra but literally just pure water, equivalent of 1 water bottle per hour and really for a sprint triathlon – now I’m going to turn to your speed because you’re saying you’re very competitive, you want to improve… a little insider secret that most of the people who cross the finish line first are dehydrated when they cross the finish line. The speed that you have to race at in order to get to a podium finish does not allow for you to drink as much as you ideally should. So best case scenario, you might get a chance to take a couple of sips of water during that bike. But we’re looking at a race when you’re only out there… if you really are going as fast as you want, maybe an hour and 15 minutes. For any of you who have gone to the gym without a water bottle and exercised for an hour and 15 minutes, it’s doable. You can make it and you just think about how much time you save not taking the water breaks and how much more of an aerodynamic position you can hold and it makes sense. So, Jason, taper off that fueling a little bit. Taper off that hydration just a little bit unless you’re going out and doing an Ironman triathlon. And then moving on to Listener Maleah and just a little background on this question, Maleah was one of our competitors in the Shape 21 lean body challenge. As a matter of fact, Maleah came in second in that challenge. If you want to see a picture of Maleah and it was pretty amazing what she did, you can go check out www.shape21.com and actually see Maleah’s progress. Not her progress, but her final results. Her impressive before and after photos. And what Maleah says is…
Maleah asks: Doing the Shape21 thing made me start researching raw food diets since it is very similar. I don’t think I told you but in the second week of Shape21 I had a very bad cold. I took it particularly hard because I had not had a cold in about 4 years. I was afraid I was doing something wrong with your diet and exercise plan. But, in learning about raw food, this is a normal occurrence due to detoxification. I don’t remember that being in your materials. If I missed it, I guess that is par for the course because I missed several other things the first time through but if you did not include it, may I recommend adding it?
Ben answers: And Maleah, I think that’s a wonderful suggestion because that happens with almost everybody that I work with that comes to me, that is not eating an incredibly clean diet or that has fat cells that they need to burn through because as we talked about in last week’s podcast, when your body is in a toxic state, toxins can hide and embed themselves in your body fat and the fatter you are, the more toxins that you store. So this can cause your body to actually not function properly, become sluggish, lose efficiency, but when you actually start to lose weight the fat that you’re using as energy is basically broken up and burned as energy but the toxins that were stored around that adipose tissue is released and this can cause a variety of kind of annoying symptoms – headaches, mucus production, rashes, flu-like symptoms, joint pain and this can stay with you for a few days as you’re burning through a lot of fat as you’re cleaning up your diet and those are typical symptoms of detoxing. It’s kind of like when I try to get people to give up some of the sugar that they’re eating at night or to kind of back off their starch intake. What happens is they feel very sluggish and very slow for a few days as their body begins to utilize fat as a fuel, and if they’re eating a clean diet and not living in a polluted area, not exposed to a lot of cleaners, not taking in a lot of toxins from preservative laden foods and processed foods, then that’s about all they get. But if they were actually eating a fairly unclean diet then they along with that sluggishness will get a rash. A lot of times it’s on the arm, sometimes in the mid-section of the waste. I’ve had some people that I get down to about 10% body fat and as we take of the last few pounds of body fat – this is usually with the guys who we’re trying to get really flat abs with, we’ll see a little bit of a rash appear in the midsection as we eliminate that last little bit of fat. So absolutely, that is a fairly normal occurrence. So, we’re going to move on to a question from Listener Drew.
Drew asks: On a somewhat related note to the pollution question, I have a question that also relates to the harmful chemicals of our modern day world. Let’s suppose that an athlete is on a tight budget and honestly cannot afford to buy organic produce. Let’s suppose that he or she can only afford non-organic produce. Do you think it might be better in this case to forgo produce altogether and consume the necessary vitamins and minerals from other sources? In other words, does ingesting huge amounts of harmful pesticides and genetically modified produce outweigh the benefits the produce may provide?
Ben answers: Well Drew, it is true that there are a lot of herbicides, a lot of pesticides and more of the herbicides and the pesticides in the produce that’s non-organic. That’s kind of one of the definitions of organic produce, is that they haven’t sprayed it with a lot of that stuff. But foregoing produce altogether, it does not take into account the fact that there is an option you haven’t considered and that would be actually removing as many herbicides and pesticides as possible from the non-organic food that you purchase. And you can do this very easily by taking that produce home, and this is just an extra step that you’ll need to make a part of your lifestyle and you take that produce, you put it in the sink, you fill the sink with water until the produce is submerged and then you dump about a half a cup of vinegar into the water. Kind of stir the vinegar in, let your produce sit for about 10 minutes and then take it, rinse it and put it in the vegetable crisper in your refrigerator and that will move a lot of those herbicides and pesticides. Yes, if they weren’t farmed using organic methods you may notice that there’s not quite as many minerals, quite as many nutrients in that produce but you’re still going to remove some of the herbicides and the pesticides. So that’s what I would do and as a matter of fact to take that even one step further, if you go and look at the archives at www.bengreenfieldfitness.com and you go back and listen to the interview with Dr. Ann Louise Gittleman, she actually does the same thing but she uses Clorox which blew my mind when I heard about this. I personally haven’t switched to using the Clorox but she had a very logical rationale for why she used it and why she has a lot of her patients use it and so you could go and listen to that as well and get some tips on it. She called it a Clorox bath or you could probably just Google “Clorox bath” and read more about it that way, to actually soak your produce to remove some of the harmful chemicals. I in no way think that you should try to replace all your produce with vitamins and minerals because there is a synergistic effect of what you get from say a whole piece of fruit that you’re not going to get from the isolated vitamin C and the isolated phytonutrients and the isolated antioxidants from that fruit. It’s one of the mysteries of nature that scientists still haven’t quite figured out. But you actually get more benefit from eating the fruit itself rather than all the extracted ingredients from the fruit or from the vegetable. So good question.
Pete asks: Hi Ben, Got a more general question in regards to the Ironman and half Ironman bike leg. Whenever I listen to the pros talking via podcasts, they always mention, “riding with or being dropped from the group”. Are they talking about riding together with a 3 bike length gap, or are they just straight out drafting. Also, noticed the WTC (which for those of you listening stands for World Triathlon Corporation) have introduced anti-doping laws across the board for pro and Age group qualifiers. I’d like to know your thoughts on what percent of people are actually cheating, both pro and age grouper. Do we have a big problem in our sport?
Ben answers: Well Pete, let’s address the first part of your question and that’s about when the pros say they’re riding with or being dropped from the group. What happens is especially up near the front where everyone is riding fairly competitively, is people are for the most part not drafting in terms of braking that bike length rule that they have set – 3 bike lengths in some triathlons, it’s up to 4 in others that you see. It’s about 7 meters. But if you have ever tried sitting on the wheel of another cyclist at 7 meters ahead of you, it really is quasi draft legal. And it does help you out quite a bit, I’ve heard people say that you can get a draft as far back as 50 meters and when a car passes you on the road you can definitely feel that draft for quite some time after a car passes you on your bike. But the idea is that the pros have to learn how to use their competition effectively but also ethically in a triathlon. So when they’re drafting or when they’re talking about being in a group, they’re not drafting in a way that breaks the rules of the sport. But they are catching a draft that’s within a legal draft zone and you can easily experiment for yourself and see how much energy you save by keeping those 7 meters between you and the bike in front of you. You also realize that they give you a certain number of seconds – I believe it’s 20 seconds now, it might even be 15 in WTC – to pass a cyclist and that’s another area where you do get a little bit of a draft and there is some passing that goes on back and forth among the pros near the front of the pack that gives them a little bit more of a slingshot if you will past the competition, now they will actually get a draft penalty if they’re seen sling shotting quite frequently, meaning passing, dropping back 15 seconds and then doing it again and basically leap frogging each other. But as long as it’s done here and there, a little bit adds up especially over 112 miles and yeah they are in a way drafting but it’s legal drafting done quite strategically. So, the second part of your question with regard to the WTC enforcing the anti-doping rules – I think that there are a lot of supplement companies out there that a lot of age group athletes are using in their training and in their racing that may not be 100% clean. So, if you want complete peace of mind that you’re not doping or that if you do qualify for the world championships and get tested that you’re not going to test positive, what you want to look for is that whatever supplements that you’re using are approved by the WADA, that they are actually what’s called WADA certified and they’re tested for WADA prohibited substances and WADA is the World Anti Doping Agency. The other thing that you can look for is that the product is produced in what’s called a CGMP facility which is a Current Good Manufacturing Practices facility. Probably the one supplement company that I use that would most toe the line when it comes to well gosh is that just an ergogenic aid or is it illegal, would be Millennium Sports because I use their cortigen product, I use their electrolyte product, I use their creatine product, their nitric oxide product. I use a lot of stuff from that company. That company is 100% WADA approved. It is CGMP certified and it’s something that I can actually use with peace of mind. Every year I qualify for either the half Ironman or the Ironman World Championships since I started doing those distances and I’m not concerned at all about testing positive because the only other supplements that I take are just vegetable supplements and Omega 3 fatty acid supplements. So in terms of the number of people that are cheating, I don’t think that there’s that many people cheating. In terms of the number of people who are cheating without knowing it, yeah, there are probably quite a few people because there are a lot of supplement companies out there and if you take someone that was just into general fitness and then got into triathlon and they were used to ordering all their supplements from something like bodybuilding.com, yeah I can’t guarantee that some of those supplements are 100% clean. So, you just have to be careful. I really think that most triathletes are fairly ethical but that sometimes they might be taking things into their body without even knowing about it. So finally, we have a question from Listener Jim. Listener Jim had a little bit of a difficult question.
Jim asks: I take the Armour Thyroid, should I consider specific times that I dose in the morning on race days? I currently dose once a day in the AM when I wake. Also I take Adroderm testosterone patches, I also have some gels. I take 3 per day and usually replace them when I go to bed, they are 5 per for a total of 15mg per day. I understand you are not a doctor…but I would like to know if the levels of both of these prescriptions affect performance.
Ben answers: Now for those of you listening in, Armour Thyroid is a natural alternative to something like Levathoroxin which is primarily what’s called at T4 based supplement, whereas Armour Thyroid is what’s called a desiccated thyroid supplement which means that it comes from essentially the ground up thyroid of a sheep or a pig and it’s higher in what’s called T3 and what a lot of natural physicians and a lot of now allopathic physicians are realizing is that when you take something like Levathoroxin, it just replaces the body’s T4 levels and you can often get a better response in someone who has hypothyroidism or someone who has a low thyroid and is experiencing weight gain when you give them just a little bit of T3 along with that T4 and that’s what the Armour Thyroid is. It’s something that I actually recommended to someone back in my podcast on 8 ways to improve your metabolism because this person was on a synthetic thyroid and I was recommending that they actually switch to an Armour if their physician was willing to speak with them about that. I think that in that case they ended up just going and ordering it themselves from a Canadian pharmacy but I don’t really recommend doing self-dosing. I definitely recommend going hand in hand with a physician who knows what they’re doing. Anyways though, he says about that Armour Thyroid should I consider specific times that I dose in the morning on race days? T3 which is what’s in that Armour, that’s pretty short lived. It usually spikes and then declines pretty quickly and so a lot of people will split their Armour Thyroid doses up throughout the day like into 3 to 4 portions throughout the day. Either way though, that’s going to be best absorbed and utilized by your system if you take it on an empty stomach and so that means if you’re getting up in the morning and you’re eating your race morning breakfast 2 hours before the race, then you’re going to want to get up and take your Armour Thyroid two and a half hours before the race for optimal absorption. Now here’s the quandary, is that because it spikes then declines very quickly, it might be out of your system – the actual T3 effect might be out of your system by the time you toe the starting line. If you are hypothyroid then that might leave you a little blah, a little sluggish right about the time that you’re supposed to be starting the race. So the other option would be you could eat your breakfast, wait a couple hours, let some gastric emptying occur and then take your Armour Thyroid dose about a half hour before the race. And what a thyroid medication does is it’ll increase body temperature, it’ll speed up metabolism and technically this could be conducive to enhanced exercise performance. There are some physicians that argue that not only that no patient needs to use T3 but also that T3 could be dangerous, that it could actually negatively affect exercise and when I went through and looked for research to show that T3 could actually cause you to not have as effective an exercise session or could experience adverse health effects during exercise, I could find no research that showed that at all. I do know that based off of just the fact that pharmaceutical companies have a huge amount of swing in education of physicians these days, that they’re not big fans of using Armour Thyroid as an alternative to Levathoroxin or synthroxin and that may be the reason that there is a little bit of jadedness against Armour Thyroid and T3 and then the other reason that I know that people wonder about it is that Mohammed Ali took a bunch of his thyroid supplement that included T3 prior to the match that he actually lost. He took an overdosage of T3 and that excessively high dosage left him weak, fatigued and a pretty poor match when he fought Joe Frazier. And so I know that there was kind of an urban legend out there that T3 would impair exercise. The one thing that I did find in terms of T3 and muscle mass was a study that investigated the mechanism of reduced exercise tolerance in hypothyroidism and essentially all this study found was that long term use of a hypothyroid medication caused more protein catabolism and lean muscle mass loss when compared with a control group that was not on the T3. And so, the fact that you’re taking a testosterone supplement is probably good. The other thing that I would bear in mind is that you would want to make sure that you are taking in a complete amino acid profile and you are actually doing things like lifting weights because that study did show that T3 could cause a little bit of protein catabolism. But that wasn’t immediate. That wasn’t short term. That was long term – let me just see if I can see how long that study actually went for. Doesn’t actually say the number of days. Ok, 2 weeks. Yeah. So what that means is if you’re taking it right before a race, obviously you’re not going to undergo 2 weeks of protein catabolism right before the race. Of course it would be ideal if you didn’t have to take a hypothyroid medication at all, but that’s not the scenario and so we’re just trying to figure out what would be practical versus what would be ideal. And then your other question about the Androderm testosterone patches – for those of you listening in – Androderm is something that a lot of older males will take to prevent what’s called Andropause, which is the natural decline in testosterone as you age. Big, big difference between the amount of testosterone that’s in Androderm and the amount of testosterone that’s in, say, what you would see someone in the Tour De France taking as an illegal substance. So, the deal with testosterone is that it is a proven performance enhancer and that if the Androderm causes you to test high for free testosterone, in a situation like we were talking about above with Pete’s question, then you could be DQ-ed. Androderm is classified under the anabolic steroids control act as a schedule 3 controlled supplement. That puts it in the same category as something like Andro which you saw a lot of baseball players using. So again you’d be banned from the sport if high enough levels of testosterone were found in your system and you were using this stuff. And what high enough levels would be considered under WADA rules would be any ratio of testosterone to epitestosterone that is greater than 4:1. Now how much testosterone are people taking, that are testing at these levels? 100 plus per day. And in some cases, well above 150 mgs per day. Jim is taking 15 mgs per day. And it’s not even an orally administered testosterone that he’s taking. It’s a time release patch. And so, there’s very, very, very small chance that you would test positive if you’re using this stuff. And I would not encourage those of you who are healthy, young males who aren’t testosterone deficient to rush out and get your hands on Androderm to bring your testosterone levels back up illegally enhancing your performance in triathlon. You do have to be careful with artificially replacing your testosterone levels, but in Jim’s case I do happen to know from another contact with Jim that he is taking this for medical reasons. And so I think it would be fine for him to continue as a physician has advised him to take testosterone. Now the one final caution is that oral androderm has been associated with fluid and electrolyte disturbances, meaning that it’s caused people to retain sodium chloride, water, potassium, calcium and phosphates and once you’re getting up to the longer distances like half-Ironman or Ironman distance, that would be something that it could be prudent to avoid. So, you may just want to back that off a few days before a race of that distance.
So great questions this week. Remember if you have a question you can email me [email protected]. You can call 8772099439, and leave me a voice mail. I love to get your questions and I will try to answer them to the best of my ability but remember that nothing that I say on this podcast is meant to be medical advice. It’s not meant to replace the advice that would be given to you by your physician. I do recommend that for any medications or for any medical conditions that you do go speak with your physician and not use this podcast as your sole means of getting advice. So, with that being said, let’s go ahead and move on to this week’s interview with Dr. William Davis on tracking your plaque and reducing your cardiovascular risk.
Hey podcast listeners, this is Ben Greenfield and on the other line I have Dr. William Davis. And Dr. Davis is the author of Track Your Plaque which is described as the only heart disease prevention program that shows how new CT heart scans can be used to detect, track and control coronary plaque. Dr. Davis is a cardiologist and the medical director of Milwaukee Heart Scan, member of the Nutritional Magnesium Association and he basically created the Track Your Plaque program to help apply cutting edge technology in heart disease prevention. So thanks for coming on the show, Dr. Davis.
Dr. William Davis: Thank you Ben, good to be here.
Ben: I’d like to hear a little bit more about your background in cardiology and how you actually progressed to create this Track Your Plaque program.
Dr. William Davis: Well my background starts as many of my colleagues did, and that is about 15 years ago, I was young and full of testosterone – all I wanted to do were high tech cardiac procedures. So I had trained to do that and that’s what I did for the first several years of my career. Back then I did the angioplasties, atheroctemies, laser atherectomy, all those fancy devices that you may have heard about in the past and that’s what I did from 7am to 9pm at night. I think I did it fairly well. My mother died. My mother died at age 62 and this was about three months after she had her own angioplasty at a very high quality facility in New Jersey where I’m from, and it took me a while to sink in but I realized that what I was doing was really a fruitless exercise. That it is stinting atheroctomy, ballooning, all that stuff was nothing more than a fancy band aid for a disease that continues. All you buy at best is a little bit of time, and so I began to think a lot and explore about this notion of can we track the progression of this disease and even better can we identify its causes and put a stop to it? And that was the genesis of this notion of what I call Track Your Plaque. Plaque meaning atherosclerotic plaque and tracking it. Then it gives you a whole new perspective on this disease when you think of it as something you can follow, measure, track and even manipulate. And in the years I’ve been doing this, if you set your sights on achieving a goal, I can tell you that in the first few years we did not achieve it. But as time has gone on, I’ve gotten better and better at it and through this online process called Track Your Plaque as well as what I do in practice and the concepts I articulate, we’re getting a lot better at it. Our current record by the way for reversal of plaque is 64% reduction.
Ben: Now it’s my understanding I guess that couldn’t you already test for plaque? Isn’t that something that people have always been able to do?
Dr. William Davis: No, it’s only something that’s been possible in the last decade or so. Before then you had to have a heart catheritization or have something obvious happen like a heart attack or a bypass in order to have heart disease detected. Stress testing is kind of a mainstream means of detecting coronary disease, but it only detects coronary disease at its advanced stages. In other words is the blockage sufficient to block flow in one of the coronary arteries. For an abnormality to be detected in a stress test. So the vast majority of people walking around have plaque yet have no knowledge of it, so what you and I really need is a real easy low risk test that we can use to identify plaque. Additionally, cholesterol testing has been the means to tell people whether or not they have plaque. Unfortunately, cholesterol fails more often than not and too often it leads to nothing more than cholesterol drugs as you probably know. So we need a test of the disease itself and the disease is plaque, cholesterol is only one small item, Ben, in a long list of causes that leads to plaque. So one of the ideal I try to pass on is that there are many, many things that cause you and me to have plaque. Cholesterol is one little item on the list, there are many others. There’s no doubt that cholesterol is the most profitable cause of plaque. It’s not the most important cause. And if you and I set our sights on achieving control over plaque, perhaps even tipping the scales in our favor to reduce plaque then we need to identify all the causes and correct all of them and it may or may not involve cholesterol.
Ben: I see. So if you can paint a picture for me and for the audience. If someone in the past was concerned that they might have cardiovascular disease or wanted to screen themselves prior to say preparing for a triathlon, then contrast for me what they would have done in the past to discover heart disease versus how they would actually look at heart disease risk using this Track Your Plaque method.
Dr. William Davis: A triathlon might be a special situation in that this person is going to push themselves to very high levels of effort, that person may still need a conventional stress test because the question may not just be the presence of plaque but may be the safety of exercise. That question still is answered by this traditional standard test called the stress test. If the stress test is abnormal, it means there’s plenty of plaque and that person does indeed have coronary disease. Now let’s assume we have a triathlete who’s fit obviously and has no symptoms and maybe has a very bland cholesterol pattern. And that person just wants to know if they have plaque or risk for long term heart disease, then a plaque measurement that is a heart scan would tell that person whether or not they have plaque or not. It’s a very easy test. We’re talking about literally a 30 second test that does involve a small quantity of radiation and some expense because the insurers don’t like to pay for this test just as they balk at paying for mammograms for the first 30 years of its history. But it’s money well invested because it tells that person if they have plaque or not, so if a triathlete feels well, he can do his Ironman, no problem, but he has say a heart scan score… that is how the result is reported, let’s say of 300 at age 52. We know that person has long term potential over the next several years for having heart attack, development of symptoms and those kinds of things.
Ben: Interesting, can you explain just to the people – because this is something I discovered recently, I wasn’t aware of – the concept of silent plaque?
Dr. William Davis: Well virtually all plaque – I should say most plaque is silent. That is for all the people who are (inaudible) have a heart attack or bypass or stints or something like that, at some point for many years will have silent plaque. So if John Smith has a heart attack at age 55, he has silent plaque for the preceding 30 years. So it’s those years or decades of this disease for atherosclerosis that it accumulates and risk accumulates with it. So most plaque is silent plaque until it finally expresses itself as chest pain or angina or heart attack or some other catastrophe.
Ben: Ok, so let’s say I want to know if I actually have plaque build up going on in my arteries whether it be… I personally am a pretty healthy guy but I’m interested in finding out from just a genetic standpoint if perhaps it’s something that I’m at risk for. Can you walk me through the process of what’s involved with actually getting one of these heart CT scans from the point where do I find out where to get one and what process do I go through once I show up at the scanning center?
Dr. William Davis: Well it’s a little bit different in every stage. More or less, you’ll see ads for heart scans, you can call your local hospital and see if they can form a heart scan for you. Up to a few years ago, there were only a handful of scanning centers nationwide. About 200 of them. Now there’s many of them because the newest scanners called multidetectors 64 slice scan have been adopted by hospitals. So hospitals oddly have become the centers of heart disease prevention for heart scan purposes. And so it really just boils down to calling your hospital or watching the ads or calling the scan center in your area. There are listings for these places on our website www.trackyourplaque.com. Regrettably we haven’t been very good about keeping that up to date. There’s another website called – I believe it’s called scancenter.com or something like that. That lists nationwide scanners. The scan centers have changed so rapidly that all of us have had a difficult time keeping track nationwide with scan centers. But those websites or just some phone calls in your area should uncover most centers that are capable of doing a scan. Now the best scanners are the electron beam scanner and 64 slice CT scanners are better. Those two are the most accurate, least radiation scanners. And by the way I should mention that there’s a lot of confusion about the fuss about radiation exposure made by the media. What the media has been fussing about, that is the test that introduces a radiation exposure of several hundred chest x-rays is not a heart scan. That’s another test called CT coronary angiograms for angiography. And those tests, while they do generate wonderful images, do require a lot of radiation and that is not a heart scan though some newspapers and magazines and TV shows have called them heart scans. The simple heart scan you and I want as a means of measuring plaque is a low radiation test.
Ben: Ok. Gotcha.
Dr. William Davis: So you can schedule your heart scan. It’s a process… paperwork takes 10, 15 minutes. The scan itself is literally just a minute or so. And then you’re done, and then you get your result usually in a few days after the physician reads over the scan and you get a score, and the score is nothing more than the quantity of calcium in the arteries. That’s the tripping point, most people have a hard time understanding but it’s very simple. You’re given a score. For example 250. That’s a calcium score and the reason why we measure calcium is because it’s easy to see and it’s very easy to precisely quantify. Now a lot of critics say, but calcium is not the disease. The curious thing is calcium occupies 20% of the volume of all… 20% of total plaque volume. So in other words, if for instance I have two cubic ml of calcium, I’ve got 10 cubic mls of total plaque. So using that relationship which by the way holds true in men and women and older people and younger people, I can know how much plaque I have in my heart’s arteries. So the calcium score you get from a heart scan is nothing more than an indirect gauge of the total amount of plaque you have in your arteries. If I know how much plaque I have today, I can track that over time. And we make it our goal to stop it from growing or to reduce it. Interestingly, Ben, in the studies I’ve examined, what happens to these heart scan scores – if in other words, if you have a heart scan today and you have it again in a year or two, the average rate of growth of these scores is 30% per year.
Dr. William Davis: When I saw that data several years ago, that was an eye opener. In other words if we know that the score is going to increase 30% per year if we do nothing, we should do something and we should try to manipulate that score. I can tell you I haven’t seen this in people who’ve not made the effort to stop plaque growth. It does indeed grow at that rate. It’s a very frightening… if you don’t stop it.
Ben: Interesting. So when I go in to get this scan done, they’re simply going to do an injection, run the scan and then do I get instant feedback or do you actually get feedback later on after the test?
Dr. William Davis: It varies from scan center to scan center, but by the way there’s no IV, there’s no injection. You wear your own clothes, you lie down, hold your breath once and the scan time varies between 12 seconds and about 40 seconds depending on the scanner used. Very, very easy. There might be some confusion with the CT artery angiogram where there is indeed an IV and X-ray done, all that stuff. But for heart scan, this little kind of mammogram of the heart, you and I don’t need an IV. Don’t even have to change our clothes. Now some scan centers have a very nice policy of having the CT technologist sit down with you and go over the scanner because the physician is usually not there. Occasional centers do indeed do that where the cardiologist or the doc is sitting right there. In most centers it will just be a technologist who then points out some of the features of your heart scan. And then you generally get the results several days later after the interpretation of the cardiologist or radiologist.
Ben: So with as many triathletes, athletes and active individuals who listen to our show, should they care about this? Are there certain individuals who should be worried about the early detection or the prevention of heart disease or is this something that’s pretty much limited to the people who are eating hamburgers and living sedentary lives?
Dr. William Davis: No, no you know there’s a very interesting conversation in your question, and that is elite athletes have an unusual propensity – contrary to popular opinion, there is a subgroup of people who are elite athletes who are in fact at high risk for heart disease. You probably heard those stories. You’ll hear about the marathon runner, for instance, who has a very high heart scan score. Or the guy who finished 25 marathons yet ends up with a bypass operation. Unfortunately, media often puts it like “Does marathon running cause heart disease?” which that’s simply not true. The question here is there’s something hidden in this person genetically that drives the risk for heart disease. And that risk can be easily uncovered by a simple heart scan. So if a marathon runner finished a 26.2 mile run last Tuesday but has a heart scan score of 400 today, we know that person has long term risk. It doesn’t mean they should stop their marathon efforts, it means a very serious effort to control the risk needs to be undertaken.
Ben: Sorry to interrupt, but in your experience, do those types of people have any symptoms prior to having something like a cardiovascular episode during an event or a training session?
Dr. William Davis: Many do not. And that’s the dilemma, that people who are elite athletes tend to be fearless and often simply don’t want to accept that there really is risk but I’ve seen it happen. In fact I take care of several triathlon runners and athletes. Now interestingly – this is a little bit complicated but there’s a subset of causes of heart disease. It’s a genetic cause called lipoprotein A. This is peculiar to people who have high aerobic capacity. It’s a very unique and very fascinating by the way, genetic pattern. And it’s passed on very cleanly from parents to children. So if your father for instance had a heart attack at 42 and you’re 42, it’s a very good time to think about being screened for heart disease. And this lipoprotein A genetic pattern is very cleanly passed on and it seems to be passed on mostly in people who have high aerobic capacity. So I tell my patients with lipoprotein A, if you want to see a whole bunch of other people with a similar pattern, go to a marathon or a triathlon and you’ll see a bunch of people who share your pattern. Now the wonderful thing about lipoprotein A is that while it’s a high risk for heart disease, it is something that can be corrected. It’s a bit more difficult than say giving a person a drug for high cholesterol. It takes a little bit more effort, a little bit more insight but it is something that can be controlled in the majority of people. You just have to know whether you have it or not. But the first issue to settle is whether or not there’s plaque. Because if you’re a marathoner and you have a heart scan score of 0, your risk for heart attack and those kinds of catastrophic things in the next five to 10 years is close to 0.
Ben: So if you actually worry that you have plaque or find out that you have plaque via one of these scans, what type of things can you do aside from I guess surgery to actually reduce your risk or increase the chance that you’re going to survive even with the plaque?
Dr. William Davis: There’s plenty, Ben. And one thing I’d like to stress is heart scans have sometimes been used by some of my colleagues as a means to get people to go through procedures. I’d like to make clear, that is a misuse of this test. In other words, if the only aim of a heart scan is to find out who needs a stent or a bypass, that is a misuse of the test. In other words, there is no doubt some people who are so far along the process of heart disease that they have their heart disease uncovered by a heart scan, but the vast majority of people – in other words, people who are well, who feel fine and just want to know if they have long term risk and they happen to have a score – these people do not need a procedure. They might need a stress test at most but the vast majority of people who feel fine and just want to know if they have long term risk of having a positive score do not need procedures. Unfortunately, I still see these stories of so and so has a heart scan and his heart was saved. And he had a bypass surgery. A good many of those procedures never need to be done. So, I don’t want to give anybody the impression that a heart scan is a means to identify procedures. A heart scan is a wonderful tool for prevention. What can you do to put a stop to the risk posed by plaque? Well first order of business, identify the causes. And so everybody’s cause may be unique. So if it’s a marathon runner whose dad had a heart attack in his 50s, one of the things to think about is lipoprotein A and so someone needs to take the effort to identify the causes. Vitamin D deficiency – a big, big cause, Ben. If there’s one nutrient that your audience pays attention to it’s vitamin D.
Ben: We’ve heard that from so many physicians on this show and yeah we’ll chalk another one up to vitamin D based off what you just said.
Dr. William Davis: Fish oil, omega 3 fatty acids is a widespread deficiency and correction of omega 3 fatty acids is a wonderful tool. That alone reduces risk for cardiovascular events substantially. One of the things we pay attention to is thyroid health. We’re seeing… I’m in Wisconsin and we’re in the part of the country often called the goiter belt, that is large thyroids from lack of iodine but Ben we’re seeing it come back. Goiters that are coming back and the iodine deficiency is not as bad as it was in 1923, but it’s coming back and one of the consequences is thyroid dysfunction which can then express itself as accelerated plaque and so one of the things we pay attention to is normalization of thyroid measures. So those are the basic things. Identify the cause, correct some of the common deficiencies and that simple formula achieves stopping of the increase in heart scan scores or a reduction in scores.
Ben: Should people be thinking about magnesium based off of the relationship between plaque formation and calcium?
Dr. William Davis: Magnesium is yet another supplement that we use to address the deficiencies of modern life. So magnesium as you know has been taken out of most municipal drinking water and most bottled water so magnesium deficiency is becoming almost an epidemic nationwide and that has implications because if your magnesium is low, your blood pressure is a little bit higher, blood sugar is a little bit higher. Insulin responses are distorted and you have more potential for heart rhythm disorders. So magnesium, you’re absolutely right. Magnesium is becoming a larger issue as time passes.
Ben: Interesting, so the impression I’m getting from you is that not only do you have the general population who could be walking around with plaque not knowing it and maybe even getting stress tested aren’t necessarily going to identify their risks, but we’ve also got this subset of athletes, marathoners and triathletes who would also be considered at high risk based off of their high levels of lipoprotein A, their genetic predisposition to a heart attack during exercise. Is that correct?
Dr. William Davis: Absolutely. I think the easiest way to sift through the uncertainty is what I’ve been preaching all along which is for everyone, a male over 40, females over 50 to get a heart scan. And you’ll know with great confidence if there’s risk long term for heart disease.
Ben: Is there a certain age at which one should begin to track their plaque?
Dr. William Davis: Yeah, I think the age cutoffs we generally use is a male 40 and over, females 50 and over. Unless there’s something in your past or your family’s history that suggests that heart disease starts sooner. For instance if my dad had a heart attack at age 38, I should probably think about it 5 to 10 years earlier than 40. So I might get my heart scanned as early as 30 or 35 because of my family history. But speaking, 40 over males, 50 for females. And that’s worked out pretty well. That’s based on, by the way, the data that asks the question at what point do men and women begin to show signs of positive scores?
Ben: Right, well interesting. This has been really good information and I’m looking forward to getting this out to our audience. Did you have any other resources to which you’d like to direct the audience? I’m going to put a link to www.trackyourplaque.com. I’ll put a link to your book as well about the heart disease prevention program there on the website. Anything else you’d like to mention?
Dr. William Davis: Of all the things I do, Ben, ironically my blog seems to draw the most fire and the most traffic.
Ben: Ok, and your blog address is?
Dr. William Davis: The easiest way to find me without having to give you a lengthy URL is just to put the phrase “heart scan” into the Google search. I usually come up in the first few choices.
Ben: I’ll find it and link to it in the Shownotes as well. Alright, well thank you for coming on the show and sharing this information today Dr. Davis.
Dr. William Davis: Oh thank you Ben, it was a pleasure.
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