CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On Tue, 28 Oct 2003 07:42:31 -0600, Patrick Blanchard, M.D. wrote:
You are very insightful with this question!
Unfortunately, aging is an unmodifiable risk factor for atherosclerosis. To
some degree, yes, everyone is atherogenic (atherosclerotic). It is the
acceleration (or lack of it) that results in a wide variance of
atherosclerotic burden among individuals. However, I am concerned of your
term 'accumulation' and want to clarify something very important regarding
atherosclerosis. The process is not a deposition of gunk ON the inside
lining of arteries, but is a complex cascading set of reactions INSIDE THE
ARTERIAL WALL itself called the intima-media complex that begins in the
very young years of life. This process is also reversible with proper
therapy. Many people, including some physicians, hold an antiquated view
that is not correct, still believing that atherosclerosis is deposition ON
the inner lining, and that once you have it, it cannot be reversed. Not so!
Many web sites, including one site from the American Heart Association,
reveals the antiquated view of gunk deposition ON the inner wall lining.

here's my question. Where do the deposits come from? Do they
come from the blood in the artery, or from outside the artery (capillaries?)
going inward?

Where exactly is the source of the problem whereby the LDL/HDL ratio
contributes to fast or slow (or reversible?) depositions and
inflammation?

This is where we leave "tierra firma", or firm grounding in clinical
science, and I don't want to debate ketogenic diets on this thread, except
to say that I believe non-diabetic ketosis is metabolically sound. It was
the introduction of agriculture many thousands of years ago that was simply
too hard for civilizations to resist. Our bodies, however, were designed to
respond favorably in chronic ketosis and was probably the main metabolic
state which our ancestors were in for millions of years before agriculture.

True, but evolution of paleolithic ancestors was driven by deaths
from childbirth, accidents and infectious disease, and probably
not atherosclerosis. In addition the high physical activity
probably made any diet reasonably OK as long as they got enough to eat.

Modern therapies can reverse atherosclerosis AT ALL STAGES, and should be
initiated on individuals identified as having it.

what specifically can people do to reverse atherosclerosis, as opposed
to slowing rate of increasing disease?

Are you related to a Prof. Daniel Blanchard at UCSD? His
statement of research interests is:

'My research interests include echocardiography, transesophageal
echocardiography, contrast echocardiography, stress/exercise
echocardiography, smoking and cardiac remodeling post-MI, and new
antithrombotic agents for hypercoagulable states.'

:I see. Ornish called his diet "proper therapy". Would you agree on a
:low to no sat fat regimen for those with serious, perhaps surgically
:qualified, atherosclerosis?

On Tue, 28 Oct 2003 10:30:02 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

I think it is important to ask yourself just what you are attempting to
accomplish with any nutrition program. Is it to boost energy, or to have
ESP, or to lose weight, or to have stronger bones, or to .... you get the
point.

Sure do and multiple agendas are most common. Ime, if you are not
focused on your health first, then you will have a major problem
losing weight and a much more difficult problem than losing it, that
is, maintaining ideal weight for a lifetime.

My 10 years of private practice has been focused on 1 issue however,
and that is to reduce death and disability caused by atherosclerosis.

Good pick. Wish there were more like you..

Pseudoscience is rampant even in established medical communities (last
century we were giving Mercury for hyptertension, a few decades ago smoking
was "healthy" in some expert circles, the recent smallpox fiasco...), and I
cannot accurately comment on no or low sat fats in general.There are simply
too many variables. Personally I believe genetic phenotyping will help
individuals understand where they came from and what foods they should
concentrate on, but it will be decades until such testing is well
validated.

I'm afraid I agree with your timetable.

An individual knocking on the door of a vascular surgeon or a
cardiothoracic surgeon with critical levels of atherosclerosis should
undergo an aggressive therapy consisting of higher dose statins, tissue
ACEI like lisinopril, 81 mg asa, clopidrogel, beta-blocker, fish oil,
fibrates, niacin,

In what dosages and only for critical levels of atherosclerosis?

no tobacco, no trans fats and moderate servings of
naturally occuring saturated fats and protiens and complex carbohydrates
for a minimum of 6 weeks before undergoing surgery if possible.

Do you expect to see significant changes in pathology in six weeks or
is this more a preparation for positive surgical results?

Finding the
best surgeon and technique for intervention is a completely different
topic.

Yes it is and thanks again.

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.

How often would you get a result from CIMT that you would consider to
be inaccurate? How would you now if a result is accurate or not?

On Tue, 28 Oct 2003 11:09:57 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

This is a question about protocol. Annual CIMT evaluations will give you
the earliest information about trending, or the progression or regression
of global atherosclerosis (including coronary arteries), as long as the
protocol is performed exactly the same way, with the same high resolution
ultrasound. An accurate protocol is difficult, time consuming, and surveys
3 major flow segments of the carotid system that mimic remote arterial beds
(like coronary, brain, aorta, renal, extremities) : low flow, low pressure
(internal), vortex regions (bifurcation), high flow high pressure
(external), medium flow medium pressure (common), each at near and far
walls, and 4 different scanning angles 15 degrees apart. You can find other
CIMT protocols (like Univ. of Wisconsin, Loma Linda to name 2 of them) but
they are lesser quality in my opinion, and do not focus on trending.

Thank you for your detailed answer.

Thanks for the workout!

It's one of the things I do.

I am a strength and power trainer for elite athletes and counsel many
individuals, privately, on their diets. Not just athletic types but
diabetics, morbidly obese, thin, you get the idea.

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.

Patrick Blanchard, M.D. at tag" ***remove talked on ....

the last great flu epidemic - did you get your flu shot yet?).

Eeeeks, should I?

yes! ( and it won't give you the flu!)

**raise hand!!! I did!! and so did my son ..

I have to because I'm asthmatic and my asthma is induced by illness or
stress ..

--
Kitty =^..^=
168/161.6/130
Start: September 2003

On Tue, 28 Oct 2003 13:31:39 -0500, Mars at the Mu_n's Edge
wrote:



:I see. Ornish called his diet "proper therapy". Would you agree on a
:low to no sat fat regimen for those with serious, perhaps surgically
:qualified, atherosclerosis?

On Tue, 28 Oct 2003 10:30:02 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

I think it is important to ask yourself just what you are attempting to
accomplish with any nutrition program. Is it to boost energy, or to have
ESP, or to lose weight, or to have stronger bones, or to .... you get
the point.

Sure do and multiple agendas are most common. Ime, if you are not
focused on your health first, then you will have a major problem
losing weight and a much more difficult problem than losing it, that
is, maintaining ideal weight for a lifetime.

My 10 years of private practice has been focused on 1 issue however, and
that is to reduce death and disability caused by atherosclerosis.

Good pick. Wish there were more like you..

Pseudoscience is rampant even in established medical communities (last
century we were giving Mercury for hyptertension, a few decades ago
smoking was "healthy" in some expert circles, the recent smallpox
fiasco...), and I cannot accurately comment on no or low sat fats in
general.There are simply too many variables. Personally I believe
genetic phenotyping will help individuals understand where they came
from and what foods they should concentrate on, but it will be decades
until such testing is well validated.

I'm afraid I agree with your timetable.

An individual knocking on the door of a vascular surgeon or a
cardiothoracic surgeon with critical levels of atherosclerosis should
undergo an aggressive therapy consisting of higher dose statins, tissue
ACEI like lisinopril, 81 mg asa, clopidrogel, beta-blocker, fish oil,
fibrates, niacin,

In what dosages and only for critical levels of atherosclerosis?

you might look at Dr. Chaos's questions about statins for a discussion on
hs.CRP and MPO and CIMT.


no tobacco, no trans fats and moderate servings of naturally occuring
saturated fats and protiens and complex carbohydrates for a minimum of 6
weeks before undergoing surgery if possible.

Do you expect to see significant changes in pathology in six weeks or
is this more a preparation for positive surgical results?

plaque stability can develop within 6 weeks. plaque regression takes up to
a year and beyond.


Finding the best surgeon and technique for intervention is a completely
different topic.

Yes it is and thanks again.

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.




--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

On Wed, 29 Oct 2003 14:30:39 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

ummm, could you take this outside please?

You will have to excuse Troll Chef Pastorio. He's a little ****ed off
since he ate, drank and refused to exercise. Then had a quad bypass
when he knew better.

Oh well.

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.

Mars at the Mu_n's Edge wrote:

On Wed, 29 Oct 2003 14:30:39 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

ummm, could you take this outside please?

You will have to excuse Troll Chef Pastorio. He's a little ****ed off
since he ate, drank and refused to exercise. Then had a quad bypass
when he knew better.

Oh well.

Well, Patrick, it would be good not to have it at all, as you imply.
But the fraud who calls himself Mu (in all its incarnations to evade
the myriad killfiles he's been in) is a notorious liar, troll, spammer
and crossposter with the sole intent to stir up anger and animosity.
He has appeared in the diet, fitness and cardiology groups trolling
and denigrating people for a good while. He has used the names Roose,
SUT, arete, Mu and others, changing often while never giving a real
name or identity. He claims many skills and many accomplishments but
shows them to be mere braggadocio with further contradictory posts.

The characterization he offers about me above is utterly fraudulent
and he can't seem to recall that it was a triple and he can't seem to
recall that his assertions about my lifestyle have been asked and
answered and shown to be false. He simply lies about it because he
can. And because nothing more ethical will ever come from him, if
history is any predictor. Here's one of the times I dealt with his
spurious "facts." http://tinyurl.com/qs7t

It is customary for Mu to follow Chung and mock the intelligent and
knowledgeable people who either ask questions about or criticize Chung
for his "information" or tactics. They're like ventriloquist and dummy
with identities that change back and forth making it hard to
distinguish one from the other. Pity, that.

Pastorio