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



 
 
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  #1  
Old October 27th, 2003, 03:33 PM
Mineral Mu_n
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On 26 Oct 2003 19:12:40 -0800, (Patrick Blanchard,
M.D., A.B.F.P.) wrote:

I have spent a good deal of time reading the excellent threads on this
forum and would like to add comments regarding CIMT, or carotid artery
intimal thickness measurements.


What are the reasons that a carotid measurement is used? Is it because
of the common association with carotid artery dissection and strokes?

As you already know, atherosclerosis is the number one cause of death
and number one cause of disabilty for industrialized countries; more
than all accidents and cancers combined.

CIMT provides a wonderful window into the burden of atherosclerosis an
individual has, and has been proven in clinical trials to be a
terrific tool to quantify risk for heart attack and stroke as baseline
and in a serial fashion. It is endorsed by the American Heart
Association writing group in 2002 (whereas EBCT is not).

When I began performing CIMT evaluations in my office after a
mini-fellowship at Wake Forest University dept of neurosonology, it
has transformed my management of atherosclerosis. LDL levels are no
longer set in stone, but differ for almost everyone whom I have taken
CIMT readings. For example, a 35 year old with critical CIMT should
undergo aggressive atherosclerosis therapy (using non-prescription and
prescription regimens; statin-like drugs, ACEI, beta-blockers, asa,
niacin, fish oil, red-yeast rice, policosanol, flavanoids - my
favorite is a healthy serving of soy, exercise, tobacco cessation...)
regardless of LDL levels. A 94 year old with a low CIMT should not
undergo LDL reduction unless it is unbearably high (over 200), but
should be treated conservatively.

How often have we seen normal angiograms fail to quantify acute
coronary syndromes in individuals without traditional risk factor
exposure? Atherosclerosis begins in infancy with intimal thickening,


All atherosclerosis? Or in some it begins in infancy?

and progresses at various rates depending upon the individual. There
are nearly 300 known risk factors for atherosclerosis, and some of
these vary almost daily (fast food on the weekends and salads during
the week for example).


Are you relating sat fat intakes with (advancing) atherosclerosis?

Tomorrow holds the discovery for even more risk
factors. CIMT is a global measure of all risk factors however, both
known and unknown.


Exactly how is this procedure performed?

CIMT in association with high sensitivity C-reactive protien may
revolutionize atherosclerosis management in your practice as it has in
mine. Especially when it comes to the patient with metabolic syndrome
or multiple 'difficult' to manage risk factors for atherosclerosis.

Looking forward to your comments. pubmed has many references on CIMT.


Thank you for your time.

http://antwrp.gsfc.nasa.gov/apod/ap030829.html
Lift well, Eat less, Walk fast, Live long.
  #2  
Old October 27th, 2003, 07:04 PM
Patrick Blanchard, M.D.
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On Mon, 27 Oct 2003 09:33:58 -0500, Mineral Mu_n wrote:


What are the reasons that a carotid measurement is used? Is it because
of the common association with carotid artery dissection and strokes?

carotid dissection is a rare event really. CIMT is better at predicting
heart attack risk than for stroke risk because there are more heart attacks
than strokes. however, it emphasizes that atherosclerosis is a global
process with a predilection to certain sites in the arterial beds.
exposure? Atherosclerosis begins in infancy with intimal thickening,


All atherosclerosis? Or in some it begins in infancy?

All.

and progresses at various rates depending upon the individual. There
are nearly 300 known risk factors for atherosclerosis, and some of
these vary almost daily (fast food on the weekends and salads during
the week for example).


Are you relating sat fat intakes with (advancing) atherosclerosis?

no, but more important is a 'toxic' diet high in trans fats. I am not
opposed to saturated fats if trans fats are avoided like the plague.
Tomorrow holds the discovery for even more risk
factors. CIMT is a global measure of all risk factors however, both
known and unknown.


Exactly how is this procedure performed?

There are many many 'protocols' followed across the globe for this
procedure. Some are better than others, but it uses high resolution
ultrasound to measure the thickness of the carotid intima-media interface
(down to .01 mm in various segments - common, bifucation, internal and
external. In my office the evaluation takes about 30 minutes and then takes
me about another 30 minutes to process over 50 images on the computer.

Thank you for your time.

you are welcome

Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
--
Using M2, Opera's revolutionary e-mail client: http://www.opera.com/m2/
  #3  
Old October 28th, 2003, 01:11 PM
Mars at the Mu_n's Edge
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"


All atherosclerosis? Or in some it begins in infancy?


On Mon, 27 Oct 2003 12:04:19 -0600, "Patrick Blanchard, M.D."
wrote:


All.


Is this because everyone, to some degree, is atherosclerotic or is
this only the beginning point for those who are atherosclerotic. If
the former, is it the acceleration and or the accumulation of
atherosclerosis that is the problem?

Are you relating sat fat intakes with (advancing) atherosclerosis?

no, but more important is a 'toxic' diet high in trans fats. I am not
opposed to saturated fats if trans fats are avoided like the plague.


Is it the combination of fats that is issue to you? Do you see any
direct links from high sat fat intake and atherosclerosis?

Exactly how is this procedure CIMT performed?



There are many many 'protocols' followed across the globe for this
procedure. Some are better than others, but it uses high resolution
ultrasound to measure the thickness of the carotid intima-media interface
(down to .01 mm in various segments - common, bifucation, internal and
external. In my office the evaluation takes about 30 minutes and then takes
me about another 30 minutes to process over 50 images on the computer.


Typically, is this cost covered by insurance and what pre-testing or
diagnosis or pathologies would need to be present to qualify the
procedure for insurance?

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.
  #4  
Old October 28th, 2003, 02:42 PM
Patrick Blanchard, M.D.
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On Tue, 28 Oct 2003 07:11:14 -0500, Mars at the Mu_n's Edge
wrote:


All atherosclerosis? Or in some it begins in infancy?


On Mon, 27 Oct 2003 12:04:19 -0600, "Patrick Blanchard, M.D."
wrote:


All.


Is this because everyone, to some degree, is atherosclerotic or is
this only the beginning point for those who are atherosclerotic. If
the former, is it the acceleration and or the accumulation of
atherosclerosis that is the problem?

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.

It is not accumulation and obstruction, but accumulation and rupture of a
vulnerable plaque that kills and cripples more people every year than any
other cause - and has done so since 1900 (except 1918, the year of the last
great flu epidemic - did you get your flu shot yet?). Vulnerable plaques do
not give you symptoms unless you are having TIAs or Acute Coronary Syndroms
and cannot be detected by heart catherizations.

Are you relating sat fat intakes with (advancing) atherosclerosis?

no, but more important is a 'toxic' diet high in trans fats. I am not
opposed to saturated fats if trans fats are avoided like the plague.


Is it the combination of fats that is issue to you? Do you see any
direct links from high sat fat intake and atherosclerosis?


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.
Paleolithic diets will promote atherosclerosis if you follow them
haphazardly, intermixing the standard american diet (SAD) when convienient
(known as the Atkins spousal abuse - on the Atkins site). Combining modern
atherosclerosis therapy with strictly followed paleolithic diets is not an
idea to discard. Agriculture, when originally discovered, provided nutrient
dense alimentation. It has been *******ized into higher yields economically
and into nutrient poor alimentation. Amarynth, spelt wheat and soy are the
only grains I have found to have closely retained their original form.

Exactly how is this procedure CIMT performed?



There are many many 'protocols' followed across the globe for this
procedure. Some are better than others, but it uses high resolution
ultrasound to measure the thickness of the carotid intima-media
interface (down to .01 mm in various segments - common, bifucation,
internal and external. In my office the evaluation takes about 30
minutes and then takes me about another 30 minutes to process over 50
images on the computer.


Typically, is this cost covered by insurance and what pre-testing or
diagnosis or pathologies would need to be present to qualify the
procedure for insurance?


This is not covered by insurance. Do not confuse insurance coverage with
cost effective and scientifically sound medicine however.

Because the majority of heart attacks and strokes are from clinically
evident atherosclerosis, and because there are decades of preceeding
clinically silent atherosclerosis, I recommend CIMT for people age 30 and
above. The American Heart endorses CIMT for people identified as
'intermediate' risk by Framingham data and want to know if they are 'high
risk' (in other words, the Framingham risk profile may not have identified
high risk). Framingham data (age, smoking, cholesterol, blood-pressure,
family history, diet, exercise... is terribly inaccurate for assesing risk
and has been shown to miss over 50% of individuals at risk for heart attack
and stroke. CIMT takes the guesswork out of atherosclerosis management.
Also a lesser well known problem with Framingham data is how it is often it
is improperly used to calculate risk after intervention. For example, if
you have a high risk score on the Framingham questionaires because you
smoke and have high cholesterol, and you undergo treatment, Framingham data
is no longer valid and never will be valid for you again. Framingham data
is used for initial pre-treatment assesment only, and becomes invalid the
moment you change your risk factors with therapy. Therefore, if you have
taken statins a few years ago and then quit, the Framingham data is
inaccurate. CIMT however, delivers global assesment of your risk, and takes
into account all of your past risk factors and can then asses your progress
in therapy (of lack of) like no other tool!

Modern therapies can reverse atherosclerosis AT ALL STAGES, and should be
initiated on individuals identified as having it. Children with
hypercholesterolemia have been shown to have increased CIMT readings that
improve with proper therapy, and I recomend the evaluation to children and
adolescents with strong risk factors (using the Framingham data). High
resolution ultrasound has 40 years of proven safety in all age groups. I
refer you to www.pubmed.gov for references. Simply search "carotid intima
media" as a starting point.
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
  #5  
Old October 28th, 2003, 04:18 PM
Mars at the Mu_n's Edge
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

Is this because everyone, to some degree, is atherosclerotic or is
this only the beginning point for those who are atherosclerotic. If
the former, is it the acceleration and or the accumulation of
atherosclerosis that is the problem?


On Tue, 28 Oct 2003 07:42:31 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

You are very insightful with this question!


You make me blush, lol.

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.


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?

It is not accumulation and obstruction, but accumulation and rupture of a
vulnerable plaque that kills and cripples more people every year than any
other cause - and has done so since 1900 (except 1918, the year of the last
great flu epidemic - did you get your flu shot yet?).


Eeeeks, should I?

Vulnerable plaques do
not give you symptoms unless you are having TIAs or Acute Coronary Syndroms
and cannot be detected by heart catherizations.


Yes, I understand that piece.

Is it the combination of fats that is issue to you? Do you see any
direct links from high sat fat intake and atherosclerosis?


On Tue, 28 Oct 2003 07:42:31 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

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.


As you said, this is for another time and place but thank you for your
POV.

Paleolithic diets will promote atherosclerosis if you follow them
haphazardly, intermixing the standard american diet (SAD) when convienient
(known as the Atkins spousal abuse - on the Atkins site).


Didn't see it in the glossary, find it on a search of Usenet either.
This is what?

CIMT is not covered by insurance. Do not confuse insurance coverage with
cost effective and scientifically sound medicine however.


I understand managed care all too well. However, there are instances
where proactive measures can be covered by insurances.

Because the majority of heart attacks and strokes are from clinically
evident atherosclerosis, and because there are decades of preceeding
clinically silent atherosclerosis, I recommend CIMT for people age 30 and
above.


Cost?

The American Heart endorses CIMT for people identified as
'intermediate' risk by Framingham data and want to know if they are 'high
risk' (in other words, the Framingham risk profile may not have identified
high risk). Framingham data (age, smoking, cholesterol, blood-pressure,
family history, diet, exercise... is terribly inaccurate for assesing risk
and has been shown to miss over 50% of individuals at risk for heart attack
and stroke.


Or you could say it is successful 50% of the time.

CIMT takes the guesswork out of atherosclerosis management.


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?

Also a lesser well known problem with Framingham data is how it is often it
is improperly used to calculate risk after intervention. For example, if
you have a high risk score on the Framingham questionaires because you
smoke and have high cholesterol, and you undergo treatment, Framingham data
is no longer valid and never will be valid for you again. Framingham data
is used for initial pre-treatment assesment only, and becomes invalid the
moment you change your risk factors with therapy.


I see the point.

Therefore, if you have
taken statins a few years ago and then quit, the Framingham data is
inaccurate. CIMT however, delivers global assesment of your risk, and takes
into account all of your past risk factors and can then asses your progress
in therapy (of lack of) like no other tool!


Is there cheap stock available?

Modern therapies can reverse atherosclerosis AT ALL STAGES, and should be
initiated on individuals identified as having it. Children with
hypercholesterolemia have been shown to have increased CIMT readings that
improve with proper therapy, and I recomend the evaluation to children and
adolescents with strong risk factors (using the Framingham data). High
resolution ultrasound has 40 years of proven safety in all age groups. I
refer you to www.pubmed.gov for references. Simply search "carotid intima
media" as a starting point.


Thanks again.

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.
  #6  
Old October 28th, 2003, 04:38 PM
Patrick Blanchard, M.D.
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

Paleolithic diets will promote atherosclerosis if you follow them
haphazardly, intermixing the standard american diet (SAD) when
convienient (known as the Atkins spousal abuse - on the Atkins site).


Didn't see it in the glossary, find it on a search of Usenet either.
This is what?


I am sorry, it is from the Wall Street Journal... here it is.

The Atkins Spousal Syndrome:
Partners of Low-Carb Dieters
Suffer, Without the Benefits
By KATY MCLAUGHLIN
Staff Reporter of THE WALL STREET JOURNAL
Alfred Gingold, a 56-year-old writer in Brooklyn, has never been on
the Atkins diet. Nevertheless, his doctor blames Atkins for the
uptick in Mr. Gingold's cholesterol level.
The culprit: Mr. Gingold's wife, Helen Rogan -- who was on Atkins for
several months this summer.
She followed the high-protein, low-carbohydrate diet, and as a result the
family dinner table groaned
under the weight of dishes like fried pork chops and "beer can chicken"
with lots of crispy skin. Though
Mr. Gingold wasn't on Atkins, he was eating all that additional meat and
fat -- and still chowing down
on items the diet forbids, like spaghetti and bread. As a result, his
cholesterol jumped about 10 points.
Add a new complaint to the various beefs about the controversial low-carb
diet: Atkins Spousal
Syndrome. With Atkins and similar plans gaining adherents, doctors and
nutritionists say the diets are
having an unintended, and often unpleasant, impact on people who live with
a dieter but who aren't
dieting themselves. The problems range from rising blood pressure to
halitosis, a common side effect of
low-carb diets. "This diet is the best form of birth control," says Dayna
Zizis of Bay Shore, N.Y., who
says her dieting husband's breath can be a turnoff.
But while a major recent study showed that a strictly low-carb diet can be
healthy, spouses of dieters
sometimes find themselves eating the new foods that are appearing on the
table -- like more beef, cheese
and butter -- and also eating the potatoes, bread and snack food that their
significant other is avoiding.
Atkins itself warns people not to do the diet halfway by continuing to eat
carbohydrates while also
adding in more meat and fat. "That's the deadliest combination," says
Colette Heimowitz, education and
research director at Atkins Nutritionals, the company that markets the
Atkins diet.
For a nondieting family member, this spells trouble. "It's kind of like
second-hand smoke," says Amy
Lanou of Physicians Committee for Responsible Medicine, a group that
recommends a vegetarian diet.
Pork-Rind Dip, Anyone?
WSJ.com - The Atkins Spousal Syndrome:
http://online.wsj.com/article_print/...321800,00.html (1 of
3)9/21/2003 3:24:44 AM
WSJ.com - The Atkins Spousal Syndrome:
While any diet of course can bring tensions into the home, Atkins can have
a particularly big impact
because it inspires such fervor. It has spawned hundreds of low-carb Web
sites, where passionate fans
sometimes praise the diet in what might be called low-carb-speak. An
excerpt from Atkinsfriends.com:
"LC is the best WOE for me. Even my BF says I am sweeter when I LC."
Translation: "A low-carb diet
is the best way of eating for me. Even my boyfriend says I am sweeter when
I low-carb."
Also common online: Snapshots of brides cutting low-carb wedding cakes, and
recipes for treats like
pork-rind dip. "They're like a cult," says Ms. Zizis, who adds that her
husband follows her around the
kitchen gabbing about carbs. "It's pretty annoying."
Low-carb diets can have other side effects on loved ones above and beyond
bad breath (which is caused
by certain chemicals being released in the breath, as well as the urine, as
the body burns fat). They
include constipation (due to a lack of fiber in the diet's early stages)
and even a full-blown case of the
grumps. Judith Wurtman, who studies the link between diet and emotion at
the Massachusetts Institute
of Technology, says her research shows that a lack of carbohydrates can
create a depressed mood.
Credibility Boost
The Atkins diet, invented in the 1970s, got a major boost in May, when the
New England Journal of
Medicine published a study showing that strict adherence to it can be quite
effective for weight loss and
doesn't have a significant effect on bad cholesterol. Since then, Atkins-
type diets have enjoyed meteoric
success. Today, nearly 2% of the U.S. population is on some kind of low-
carb diet, according to NPD
Group. The diet is so ubiquitous that fast-food restaurants are putting
"protein meals" on the menu, and
supermarkets are rolling out contradictory-sounding foods like "low carb"
pasta.
Much of the medical establishment believes that the Atkins diet and others
like it are dangerous even
when properly followed. The American Heart Association and the American
Dietetic Association warn
against adopting the diet, saying that there hasn't been enough long-term
study proving that it is safe and
effective.
Breath Mints
Atkins Nutritionals says studies show that mood can actually improve on the
diet, and that cholesterol
and blood pressure don't go up when carb intake is controlled. It also says
bad breath and constipation
are likely to occur only during the first two weeks, when carb intake is
strictly limited; the solution is to
use a sugar-free breath mint, drink plenty of water and eat fiber-rich
vegetables. After the diet's initial
phase, a spokeswoman says, it becomes completely healthy even for
nondieting members of a
household, since it includes many whole grains and vegetables.
Doctors point out that many people get into trouble when they jump on the
bandwagon without really
understanding how the diet works. "They seem to think that the Atkins
approach legitimizes eating
unlimited sausage and bacon," says Tom Barnard, a general internist in
Leamington, Ontario.
In spite of the potential for marital distress, the Atkins diet remains
wildly popular mostly for one
http://online.wsj.com/article_print/...321800,00.html (2 of
3)9/21/2003 3:24:44 AM
WSJ.com - The Atkins Spousal Syndrome:
reason: Lots of people lose lots of weight on it. But that, too, can be
hard on some spouses. For Sharon
Stine, a homemaker in Conowingo, Md., Atkins Spousal Syndrome kicked in
when her husband lost
weight on a low-carb plan while she remained overweight and pregnant, to
boot. "It really made me feel
like I was this giant cow," says Ms. Stine. By contrast, her husband had
suddenly become "kind of a
hottie," she says.
--Jane Spencer contributed to this article.
Write to Katy McLaughlin at 3
URL for this article:
http://online.wsj.com/article/0,,SB1...321800,00.html
Hyperlinks in this Article:
(1) http://online.wsj.com/article/0,,SB1...858300,00.html
(2) http://online.wsj.com/article/0,,SB1...219304,00.html
(3)
Updated September 18, 2003
Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved
Printing, distribution, and use of this material is governed by your
Subscription agreement and Copyright laws.
For information about subscribing go to http://www.wsj.com
http://online.wsj.com/article_print/...321800,00.html (3 of
3)9/21/2003 3:24:44 AM
  #7  
Old October 28th, 2003, 05:09 PM
Mars at the Mu_n's Edge
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

Much thanks for the links.

================================================== ======

On Tue, 28 Oct 2003 09:38:10 -0600, "Patrick Blanchard, M.D." tag"
***remove wrote:

The Atkins Spousal Syndrome:
Partners of Low-Carb Dieters
Suffer, Without the Benefits
By KATY MCLAUGHLIN
Staff Reporter of THE WALL STREET JOURNAL
Alfred Gingold, a 56-year-old writer in Brooklyn, has never been on
the Atkins diet. Nevertheless, his doctor blames Atkins for the
uptick in Mr. Gingold's cholesterol level.
The culprit: Mr. Gingold's wife, Helen Rogan -- who was on Atkins for
several months this summer.
She followed the high-protein, low-carbohydrate diet, and as a result the
family dinner table groaned
under the weight of dishes like fried pork chops and "beer can chicken"
with lots of crispy skin. Though
Mr. Gingold wasn't on Atkins, he was eating all that additional meat and
fat -- and still chowing down
on items the diet forbids, like spaghetti and bread. As a result, his
cholesterol jumped about 10 points.
Add a new complaint to the various beefs about the controversial low-carb
diet: Atkins Spousal
Syndrome. With Atkins and similar plans gaining adherents, doctors and
nutritionists say the diets are
having an unintended, and often unpleasant, impact on people who live with
a dieter but who aren't
dieting themselves. The problems range from rising blood pressure to
halitosis, a common side effect of
low-carb diets. "This diet is the best form of birth control," says Dayna
Zizis of Bay Shore, N.Y., who
says her dieting husband's breath can be a turnoff.
But while a major recent study showed that a strictly low-carb diet can be
healthy, spouses of dieters
sometimes find themselves eating the new foods that are appearing on the
table -- like more beef, cheese
and butter -- and also eating the potatoes, bread and snack food that their
significant other is avoiding.
Atkins itself warns people not to do the diet halfway by continuing to eat
carbohydrates while also
adding in more meat and fat. "That's the deadliest combination," says
Colette Heimowitz, education and
research director at Atkins Nutritionals, the company that markets the
Atkins diet.
For a nondieting family member, this spells trouble. "It's kind of like
second-hand smoke," says Amy
Lanou of Physicians Committee for Responsible Medicine, a group that
recommends a vegetarian diet.
Pork-Rind Dip, Anyone?
WSJ.com - The Atkins Spousal Syndrome:
http://online.wsj.com/article_print/...321800,00.html (1 of
3)9/21/2003 3:24:44 AM
WSJ.com - The Atkins Spousal Syndrome:
While any diet of course can bring tensions into the home, Atkins can have
a particularly big impact
because it inspires such fervor. It has spawned hundreds of low-carb Web
sites, where passionate fans
sometimes praise the diet in what might be called low-carb-speak. An
excerpt from Atkinsfriends.com:
"LC is the best WOE for me. Even my BF says I am sweeter when I LC."
Translation: "A low-carb diet
is the best way of eating for me. Even my boyfriend says I am sweeter when
I low-carb."
Also common online: Snapshots of brides cutting low-carb wedding cakes, and
recipes for treats like
pork-rind dip. "They're like a cult," says Ms. Zizis, who adds that her
husband follows her around the
kitchen gabbing about carbs. "It's pretty annoying."
Low-carb diets can have other side effects on loved ones above and beyond
bad breath (which is caused
by certain chemicals being released in the breath, as well as the urine, as
the body burns fat). They
include constipation (due to a lack of fiber in the diet's early stages)
and even a full-blown case of the
grumps. Judith Wurtman, who studies the link between diet and emotion at
the Massachusetts Institute
of Technology, says her research shows that a lack of carbohydrates can
create a depressed mood.
Credibility Boost
The Atkins diet, invented in the 1970s, got a major boost in May, when the
New England Journal of
Medicine published a study showing that strict adherence to it can be quite
effective for weight loss and
doesn't have a significant effect on bad cholesterol. Since then, Atkins-
type diets have enjoyed meteoric
success. Today, nearly 2% of the U.S. population is on some kind of low-
carb diet, according to NPD
Group. The diet is so ubiquitous that fast-food restaurants are putting
"protein meals" on the menu, and
supermarkets are rolling out contradictory-sounding foods like "low carb"
pasta.
Much of the medical establishment believes that the Atkins diet and others
like it are dangerous even
when properly followed. The American Heart Association and the American
Dietetic Association warn
against adopting the diet, saying that there hasn't been enough long-term
study proving that it is safe and
effective.
Breath Mints
Atkins Nutritionals says studies show that mood can actually improve on the
diet, and that cholesterol
and blood pressure don't go up when carb intake is controlled. It also says
bad breath and constipation
are likely to occur only during the first two weeks, when carb intake is
strictly limited; the solution is to
use a sugar-free breath mint, drink plenty of water and eat fiber-rich
vegetables. After the diet's initial
phase, a spokeswoman says, it becomes completely healthy even for
nondieting members of a
household, since it includes many whole grains and vegetables.
Doctors point out that many people get into trouble when they jump on the
bandwagon without really
understanding how the diet works. "They seem to think that the Atkins
approach legitimizes eating
unlimited sausage and bacon," says Tom Barnard, a general internist in
Leamington, Ontario.
In spite of the potential for marital distress, the Atkins diet remains
wildly popular mostly for one
http://online.wsj.com/article_print/...321800,00.html (2 of
3)9/21/2003 3:24:44 AM
WSJ.com - The Atkins Spousal Syndrome:
reason: Lots of people lose lots of weight on it. But that, too, can be
hard on some spouses. For Sharon
Stine, a homemaker in Conowingo, Md., Atkins Spousal Syndrome kicked in
when her husband lost
weight on a low-carb plan while she remained overweight and pregnant, to
boot. "It really made me feel
like I was this giant cow," says Ms. Stine. By contrast, her husband had
suddenly become "kind of a
hottie," she says.
--Jane Spencer contributed to this article.
Write to Katy McLaughlin at 3
URL for this article:
http://online.wsj.com/article/0,,SB1...321800,00.html
Hyperlinks in this Article:
(1) http://online.wsj.com/article/0,,SB1...858300,00.html
(2) http://online.wsj.com/article/0,,SB1...219304,00.html
(3)
Updated September 18, 2003
Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved
Printing, distribution, and use of this material is governed by your
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For information about subscribing go to http://www.wsj.com
http://online.wsj.com/article_print/...321800,00.html (3 of
3)9/21/2003 3:24:44 AM



http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.
  #8  
Old October 28th, 2003, 05:30 PM
Patrick Blanchard, M.D.
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On Tue, 28 Oct 2003 10:18:21 -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?

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

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

~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
  #9  
Old October 28th, 2003, 05:53 PM
Patrick Blanchard, M.D.
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On Tue, 28 Oct 2003 10:18:21 -0500, Mars at the Mu_n's Edge


It is not accumulation and obstruction, but accumulation and rupture of
a vulnerable plaque that kills and cripples more people every year than
any other cause - and has done so since 1900 (except 1918, the year of
the last great flu epidemic - did you get your flu shot yet?).


Eeeeks, should I?

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

~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
  #10  
Old October 28th, 2003, 06:09 PM
Patrick Blanchard, M.D.
external usenet poster
 
Posts: n/a
Default CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"

On Tue, 28 Oct 2003 10:18:21 -0500, Mars at the Mu_n's Edge
wrote:

CIMT is not covered by insurance. Do not confuse insurance coverage with
cost effective and scientifically sound medicine however.


I understand managed care all too well. However, there are instances
where proactive measures can be covered by insurances.

Because the majority of heart attacks and strokes are from clinically
evident atherosclerosis, and because there are decades of preceeding
clinically silent atherosclerosis, I recommend CIMT for people age 30
and above.


Cost?


375.00 USD for the test itself, performed by me currently.


The American Heart endorses CIMT for people identified as 'intermediate'
risk by Framingham data and want to know if they are 'high risk' (in
other words, the Framingham risk profile may not have identified high
risk). Framingham data (age, smoking, cholesterol, blood-pressure,
family history, diet, exercise... is terribly inaccurate for assesing
risk and has been shown to miss over 50% of individuals at risk for
heart attack and stroke.


Or you could say it is successful 50% of the time.


you are an optimist!


CIMT takes the guesswork out of atherosclerosis management.


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?


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.


Also a lesser well known problem with Framingham data is how it is often
it is improperly used to calculate risk after intervention. For example,
if you have a high risk score on the Framingham questionaires because
you smoke and have high cholesterol, and you undergo treatment,
Framingham data is no longer valid and never will be valid for you
again. Framingham data is used for initial pre-treatment assesment only,
and becomes invalid the moment you change your risk factors with
therapy.


I see the point.

Therefore, if you have taken statins a few years ago and then quit, the
Framingham data is inaccurate. CIMT however, delivers global assesment
of your risk, and takes into account all of your past risk factors and
can then asses your progress in therapy (of lack of) like no other tool!


Is there cheap stock available?

let me know if you find some, but I don't own stock anyway.

Modern therapies can reverse atherosclerosis AT ALL STAGES, and should
be initiated on individuals identified as having it. Children with
hypercholesterolemia have been shown to have increased CIMT readings
that improve with proper therapy, and I recomend the evaluation to
children and adolescents with strong risk factors (using the Framingham
data). High resolution ultrasound has 40 years of proven safety in all
age groups. I refer you to www.pubmed.gov for references. Simply search
"carotid intima media" as a starting point.


Thanks again.

Thanks for the workout!


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
 




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