LCHF 15 years, Coronary Artery Calcium Score ZERO!

Let’s talk about an important cardiovascular (CV) endpoint, specifically atherosclerosis or plaque, that usually appears before ever having a heart attack, stroke or sudden cardiac death. This is the case of a 54 year old male who’s been on a whole foods, low carb high fat diet for over 15 years.  Because his lipid profile and all biomarkers had improved, he decided it was time for a heart scan to see if this matched the biomarkers. It turns out the result was a perfect calcium score of ZERO! You may know this man, as he’s yours truly Dr. Jeff Gerber and is not to be confused with that ‘Lobby Boy‘ from the Grand Budapest! 😛 Have a look at these beautiful images:

Dr. Jeff's ZERO calcium score image (left) - High calcium score image for comparison (right)

Dr. Jeff’s ZERO calcium score image (left) – High calcium score image (different person) for comparison (right)

 

Vascular imaging of any kind provides invaluable information relating to CV risk. Atherosclerosis, plaque (hardening of the arteries) or inflammation of the arteries is the new endpoint and visualizing plaque’s presence or not using tools like coronary artery calcium scoring can provide powerful and useful information that will motivate individuals to make change.

Normal, non-inflamed arteries do not contain calcium. As plaque develops (first soft plaque, then hard), calcium builds within the inflamed blood vessel wall, and this can be detected using high speed computerized tomography (CT) imaging. Although no test is perfect and radiation exposure (equivalent to a mammogram or slightly greater) is an important consideration, coronary artery calcium scoring is a great direct method to estimate plaque burden and cardiac risk. The more calcium that you have (especially if you’re in the unlucky ≥75th percentile for age and sex), along with calcium progression (≥15% per year,) the greater your risk. Even with a positive calcium score, stabilizing that score greatly reduces your risk.

Calcium Score Presence of Plaque
0 No evidence of plaque
1-10 Minimal evidence of plaque
11-100 Mild evidence of plaque
101-400 Moderate evidence of plaque
>400 Extensive evidence of plaque

Adapted from Rumberger JA et al. Mayo Clinic Proceedings March 1999: 74:243-252

To illustrate, with a score of zero your likelihood of having a cardiac event is <1% yearly compared to a high score of >300 making you at least 8 times more likely to suffer from a cardiac event. Progression of ≥15% per year for any given score is particularly ominous as this can cause one to be 17.2 times more likely to have a cardiac event and 3 times more likely to die from any cause. Halting progression is most imperative and will greatly reduce risk.

Calcium Score FRS Equivalent 10-Year Event Rate, %
0 Very low 1.1-1.7
1-100 Low 2.3-5.9
101-400 Intermediate 12.8-16.4
>400 High 22.5-28.6
>1000 Very high 37

J Am Coll Cardiol Img. 2015;8(5):579-596 FRS=Framingham Risk Score

What’s really important is that calcium scoring actually surpasses Framingham risk assessment that traditionally uses age, sex, cholesterol, HTN, smoking, diabetes and history of previous MI to determine risk. Calcium scoring does truly excel at predicting CV risk better than any other non-invasive tool available today.

Vascular ultrasound (performed in our office) is another useful technology to look for plaque burden in larger vessels like the carotids and the aorta. Because coronary arteries (supplying blood to the heart muscle) are relatively small and always in motion, other technologies beyond standard ultrasound had to be developed to properly visualize these small vessels. There are several competing technologies including CT angiogram, heart catherization and intravascular ultrasound, but they are all invasive and expensive relative to CT calcium scoring.

Just to clarify, I don’t own a CT scanner nor do I get compensation to refer people for testing. After further study and peripheral involvement with The Widomaker movie (a must watch) it’s clear to me how powerful and important cardiovascular imaging is especially for anyone who wishes to know their risk.

patrick-forbes-jefffry-gerber-bill-blanchet-lindsay-woods-the-widowmaker-movie

Dr. Jeffry Gerber – Director Patrick Forbes – Lindsay Woods – Dr. Bill Blanchet – The Widowmaker movie premier Boulder Colorado

 

Regarding proper prevention, it’s different for everyone, but I am not the only one who can boast of a ZERO calcium score while being on a LCHF diet. Jimmy Moore, Ivor Cummins, Gearóid Ó Laoi, and some of our patients are just a few examples of people who have been lucky when it comes to achieving that perfect calcium score of ZERO. Others have been able to stabilize and improve their calcium scores. Certainly there are many factors to consider including genetics, but we have all chosen the low carb high fat dietary approach to address CV risk and health, and so far this approach appears to be working. I find it important to monitor all CV markers when it comes to addressing any lifestyle approach.

Unfortunately, calcium scoring has been underutilized for reasons spelled out in The Widomaker movie and mostly ignored by primary care doctors. I am, however, optimistic that CV imaging will gain momentum in the next several years, thanks to the movie and the various medical institutions that have finally endorsed the test. Most hospitals and other outpatient facilities actually do offer the test. In Denver, Front Range Preventive Imaging is by far my favorite because my trusted colleague, Dr. Bill Blanchet is the medical director. They do calcium scoring testing accurately, reliably and using minimal radiation. What’s difficult is finding the right doctor who knows how to interpret the results and provide proper advice, addressing prevention as it relates to diet, exercise and medication. That’s where our office comes into the equation.

Do you have a story related to lifestyle and CV imaging? Please share it with us.

So what’s Lobby Boy characters real name?

Is Coronary Calcium Scanning The Mammography of the Heart?

Zero CAC Score Confers 15-Year “Warranty” Against CAD related mortality

Dr. Matthew J. Budoff review article: Screening for Ischemic Heart Disease with Cardiac CT: Current Recommendations

Budoff et al.: Long-Term Prognosis Associated With Coronary Calcification

Long-Term Prognosis After Coronary Artery Calcification Testing in Asymptomatic Patients: A Cohort Study

Zero Calcium Score, No Statin?

IHDA: What is Calcification?

Updated 09/07/2015: Added another table, references and links.

  • blade78

    so how do I get a 0 calcium score?

  • Joe Santerama

    I have a quick question…..im 45 years old. 3 years ago I had a CT done and had a calcium score of 7. Had it redone just recently (3 years later), and my score is 22. Is that a big jump in 3 years time? I know percentage wise its a big jump. But in absolute #’s its an increase of 15. So not sure which way to look at it.
    My lipid profile is good. Total cholesterol: 173…..LDL: 102…..HDL: 41….Triglycerides: 125…..Blood pressure normal.
    I eat a balanced diet of protein, good fats and plant based carbs (beans, brown rice, quinoa, fruits, veggies). Workout a lot.
    Doctor wants to put me on a statin. But I don’t know if my situation calls for it. Any advice or insight on the stats I posted would be greatly appreciated.

    • @joesanterama:disqus the absolute scores are not terrible although the rate is increasing at 71%/yr. Are those your Agatston/AJ scores? Most reports highlight the Agatston/AJ density score. Do you see calcium a VOLUME score? This is what is used to measure progression risk and goal is to keep progression of <15%/yr.

      • Joe Santerama

        No there is no Volume Score. Just one number, that says Calcium score 22. What does that mean in the grand scheme of things

        • Wonderer

          Joe:
          IMHO I feel you could be underestimating some potential risks that few docs/cardiologists would have anything specific to say…leave alone tests.

          I had a heart-attack – despite a very healthy lifestyle – LCHF(LowCarb HiFat) and exercising/swimming. “no” traces of any plaques (6 months prior to heart attack carotid duplex ultrasound came out extremely good !!! In fact, the analyst physician mentioned my arteries(neck) were 15 years younger than my age (i.e., no plaque deposits).

          Also during the angio everywhere else heart was clean but for that one LAD spot. Todate only reasonable explanation has been – my intense weight lifting (despite used to) caused a soft-plaque (25%ish) to rupture and form a 90% block due to the clot.
          (yes the clot is what causes the bigger block & and not the cholesterol deposits’ pipe-clogging mechanism I had been naively led to believe until then.

          Shame on AHA and the entire heart care experts out there. I still can’t find a clear definition of “heart-attack”. Much less so from a prevention perspective).

          Either way…
          1) Do stay away from heavy intense (anaerobic) exercise – anything really strenuous actually. (high rep low weights ok but not the other way around anerobic the real exercise) I can’t tell you how much depressed I get for being unable to exercise intensely for life. A month before the heart attack I could swim for 3 hours at a stretch.
          I can hardly motivate myself to go for a walk these days.

          I naively believed, given my less than 4.8% A1C values (mainly LCHF driven), excellent adaptation to LCHF diet over the years, exercising, no stress, no family history of any disease, heart-disease was the last thing I thought I would worry about. But, that’s life.
          (& Never ever wondered the often heard quote “healthy fit guy/runner etc…dropped dead after exercising…How surreal…)

          2) I hated statins too. But, I got no choice now. (Believe it stabilizes the ruptured plaque and prevents re-stenosis of the stents that’s relevant for me & you don’t have to worry about).

          After 80 mg/day of Statins – FDA’s cap – along with 5mg/day Ezetimibe for 5 months had my LDL-C(=37mg/dL) , LDL-P(=563nmol/L), Trig(52mg/dL) moved further in the good direction docs lowered Statins to 40 mg/day. I also have toned down saturated fat a little bit.

          Still Statin messes up with my fat metabolism (especially with LCHF diet as liver’s cholesterol production is literally shutoff by Statin cutting off a crucial energy supply in LCHF diets. But fat absorption gets amped up, to compensate, as measured by Sterol absorption markers ) and causes muscle aches and does reduce muscle strength.

          Long term side-effects I don’t know yet. (My physician says he’s taking it for more than a decade and is ok but, it’s a sample of 1)

          3) pls. also do NMR profile of lipids (along with LP(a) – a key driver of heart disease that can NOT be controlled by life style changes/meds ). They do provide an excellent full picture unlike the standard lipid panel – which many consider of much less diagnostic value.

          4) Consult a Lipidologist. They know a lot more about the underlying mechanisms/diet than primary care/cardios.

          5) and I’m sure you know LAD is the second most serious location you can get a plaque build up (nicknamed the “widow maker”).

          Trust me …I can never forget the concerning/sigh-of-relief words from my cardio’s mouth after stent surgery (You ARE a lucky MANNN….!). It took me a bit of reading before I realized the full gravity of that sentence.
          (Fortunately, I got medical care without delay – that causes heart muscle/brain damage or worse. That’s my luck.
          My heart attack happened at the gym, next-door to a major hospital, in a series escalating achy episodes – particularly the left jaw pain along with throwing-up, hyper-ventilation. By the time the final one struck, that ripped thro me , I was right at the ER, about to be sent home, after 90 mins of the initial onset…Glad I decided to call the ambulance without delay)

          My Cardio summarized it beautifully:
          ————————————————
          When I asked him “How the heck this happened to me? and why no tests detected anything”…
          “Would a Calcium score have showed something useful?”

          He said…”There really is no good test…If you suspect physician quality or access to tests… think of Bill Clinton and Bush. Both had heart attacks. No early warnings despite the best medical care one can think of. And in the case of Clinton re-occurred and Bush does work-out and eats healthy.

          I guess it’s as logical (or Illogical really) as it gets…

          Not trying to scare you in anyway….but trying to pass on some of the experiences, realities that I’m happy to live to write…and hopefully helpful from a “formerly healthy” (another heavily loaded word I learnt during my hospital stay) fellow blogger who had gone the additional miles down (:-)…

          Best wishes to you in your search for the difficult questions…

        • Wonderer

          Joe:
          IMHO I feel you could be underestimating some potential risks that few docs/cardiologists would have anything specific to say…leave alone tests.

          I had a heart-attack – despite a very healthy lifestyle – LCHF(LowCarb HiFat) and exercising/swimming. “no” traces of any plaques (6 months prior to heart attack carotid duplex ultrasound came out extremely good !!! In fact, the analyst physician mentioned my arteries(neck) were 15 years younger than my age (i.e., no plaque deposits).

          Also during the angio everywhere else heart was clean but for that one LAD spot. Todate only reasonable explanation has been – my intense weight lifting (despite used to) caused a soft-plaque (25%ish) to rupture and form a 90% block due to the clot.
          (yes the clot is what causes the bigger block & and not the cholesterol deposits’ pipe-clogging mechanism I had been naively led to believe until then.
          Shame on AHA and the entire heart care experts out there. I still can’t find a clear definition of “heart-attack”. Much less so from a prevention perspective).

          Either way…
          1) Do stay away from heavy intense (anaerobic) exercise – anything really strenuous actually. (high rep low weights ok but not the other way around anerobic the real exercise) I can’t tell you how much depressed I get for being unable to exercise intensely for life. A month before the heart attack I could swim for 3 hours at a stretch.

          I can hardly motivate myself to go for a walk these days.

          I naively believed, given my less than 4.8% A1C values (mainly LCHF driven), excellent adaptation to LCHF diet over the years, exercising, no stress, no family history of any disease, heart-disease was the last thing I thought I would worry about. But, that’s life.

          (& Never ever wondered the often heard quote “healthy fit guy/runner etc…dropped dead after exercising…How surreal…)

          2) I hated statins too. But, I got no choice now. (Believe it stabilizes the ruptured plaque and prevents re-stenosis of the stents that’s relevant for me & you don’t have to worry about).

          After 80 mg/day of Statins – FDA’s cap – along with 5mg/day Ezetimibe for 5 months my LDL-C(=37mg/dL) , LDL-P(=563nmol/L), Trig(52mg/dL) moved further in the good direction & Docs lowered Statins to 40 mg/day. I also have toned down saturated fat a little bit.

          Still Statin messes up with my fat metabolism (especially with LCHF diet as liver’s cholesterol production is literally shutoff by Statin cutting off a crucial energy supply in LCHF diets. But fat absorption gets amped up, to compensate, as measured by my Sterol absorption markers ) and causes muscle aches and does reduce muscle strength.

          Long term side-effects I don’t know yet. (My physician says he’s taking it for more than a decade and is ok but, it’s a sample of 1)

          3) pls. also do NMR profile of lipids (along with LP(a) – a key driver of heart disease that can NOT be controlled by life style changes/meds ). They do provide an excellent full picture unlike the standard lipid panel – which many consider of much less diagnostic value.

          4) Consult a Lipidologist. They know a lot more about the underlying mechanisms/diet than primary care/cardios.

          5) and I’m sure you know LAD is the second most serious location you can get a plaque build up (nicknamed the “widow maker”).

          Trust me …I can never forget the concerning/sigh-of-relief words from my cardio’s mouth after stent surgery (You ARE a lucky MANNN….!). It took me a bit of reading before I realized the full gravity of that sentence.

          (Fortunately, I got medical care without delay – that causes heart muscle/brain damage or worse. That’s my good luck.

          My heart attack happened at the gym, next-door to a major hospital, in a series escalating achy episodes – particularly the left jaw pain along with throwing-up, hyper-ventilation. By the time the final one struck, that ripped thro me , I was right at the ER, about to be sent home, after 90 mins of the initial onset…Glad I decided to call the ambulance without delay)

          My Cardio summarized it beautifully:
          ————————————————
          When I asked him “How the heck this happened to me? and why no tests detected anything”…

          “Would a Calcium score have showed something useful?”

          He said…”There really is no good test…If you suspect physician quality or access to tests… think of Bill Clinton and Bush. Both had heart attacks. No early warnings despite the best medical care one can think of. And in the case of Clinton re-occurred and Bush does work-out and eats healthy.

          I guess it’s as logical (or Illogical really) as it gets…

          Not trying to scare you in anyway….but trying to pass on some of the experiences, realities that I’m happy to live to write…and hopefully helpful from a “formerly healthy” (another heavily loaded word I learnt during my hospital stay) fellow blogger who had gone the additional miles down (:-)…

          Best wishes to you in your search for the difficult questions…

          • @disqus_SqplNK7wpE:disqus thanks for sharing and I wish you the best. I wonder if you were ever tested for hypercoagulopathy? Your case is unusual and I actually have one or two patients like you. They suffered embolic events that had very little to do with plaque formation. CV imaging won’t be able to detect this as you mention, but then again 90% of events are related to atherosclerosis and rupture of vulnerable plaque, therefore CV imaging can be helpful for the majority.

            Also just for the record, I believe that Bill Clinton never had a calcium heart scan prior to his quadruple bypass. A scan might have changed the approached to his care.

          • Wonderer

            Much Appreciate your kind reply Dr. Jeffry…
            Really amazed at your thoughtful reply and how much you care. (Your patients are lucky).
            Thanks also for more info. on Bill Clinton…

            Intrigued by your embolic event idea.
            Though I’d never know for sure, I doubt it given
            (i) my mildly sclerotic aeortic valve (from the Transthoracic ultrasound day after the Cath procedure) and
            (ii) ultra high carb life-style several years ago that led to elevated lipids for a few years before I found the wonders of LCHF for the past 3 years.

            HyperCoagulopathy:
            Have to look into this.
            The closest I had was the following for Coagulation Genetics 3 months ago.
            (i) Factor V Leiden (G1691A) did show high risk, “Arg/Gln”
            (ii) Prothrombin Mutation (G2021DA) was G/G hence no carrier.

            Thanks again…

          • Joe Santerama

            Thank you all for the great advice and personal experiences you’ve shared so far. I have one more quick question…..I know your stance on Statins for the most part. But what are your thoughts on baby aspirin? Do you think the benefits are worth it to take a daily baby aspirin? Or are there cons to it that doctors don’t really tell us?

      • Joe Santerama

        actually I just looked at my results again to be sure….it says my score is 22 Agatston Units

      • Joe Santerama

        This is what the exact report says…..My Calcium score is 22 Agatston Units.
        Left Main Coronary Artery is Patent without obstructive disease
        Left Anterior Decending Artery contains mixed plaque in the mid segment with mild (Approximately 30%) luminal stenosis. The remainder of the LAD appears patent without obstructive disease.
        LCX appears patent without obstructive disease
        RCA appears patent without obstructive disease

    • Interesting wording “stenosis” and “obstructive disease”. CAC score only measures plaque burden, not lumenal dimensions. They might be inferring. Regardless, some facilities don’t report volume scores. You should ask them for it as they should have it. Again, serial volume scores are the best way to access progression.

      • Joe Santerama

        hmmmm, thank you for that insight. I did think the wording was somewhat confusing.
        Based on my full profile of what they provided me with…..A calcium score of 22…….with very good lipid profile, where do i stand in your opinion as compared to most people? I was under the assumption that everyone as you age develops some arterial plaque. So im just confused as to am i a Code Red, societal outcast here? Or from your experience, is my profile quite common? My doctor initially said my calcium score of 22 was a good # and that he would basically throw that in the garbage. But then went on to say i should be on a statin. So im just confused.

        • Based on the chart in the post your 10 yr event rate risk is 2.3-5.9%. Risk is significantly increased with a score >400. Appropriate diet (low carb) still is the 1st line of treatment IMO. 🙂

    • In some, volume score remains stable while density increases. This represents plaque consolidation and is protective.

      • Joe Santerama

        oh ok, how do i find out what the volume is thou? I dont think they measured it, or they probably would have put it on the report. Or do you think they would have that number available? The whole reason i had gotten the test to begin with 3 years ago was because i had some chest pains and it turns out i had a bout of Pericarditis, which lasted a few days and went away with meds, but when i went to the hospital for it they ran a CT scan to rule out anything else. And thats when i had shown a calcium score of 7

      • Joe Santerama

        I have one more quick question Dr Gerber…..The whole diet thing is confusing to me. Because I hear such opposite schools of thought. Lot of readings make it seem like a plant based/vegan type diet is best for heart health and reversing plaque. But a diet like that would be fairly high in carbs. Even thou they are good carbs, its still high carbs. But im also seeing much reading on High Protein /High Fat /Low carb diets being best for heart health. Im confused because these are such polar opposites, yet each claim it is best for heart health, while claiming the other is terrible.
        Which is it??

        • @joesanterama:disqus, I absolutely share in your frustration as it only confuses people. There are some common themes when it comes to nutrition and heart disease, yet the various factions are at war with one another in defense. We should be sharing the platform. Sugar and ‘processed food’ are bad. Not much there, but it’s a start.

          • Joe Santerama

            Thanks Dr Gerber. I made a appt with a new cardiologist for a consultation, because im unsure of my doctors advice to put me on a statin. Still kinda confused about the whole calcium score thing and whether my score of 22 at age 45 is a reason to overly worry

  • Craig

    There are claims that vitamin K2 can prevent or even reduce calcification of plaque. The heart scan CT picks up the calcium (which is approx 20% of plaque volume) and uses this to determine the calcium score. If something like K2 MK-7 reduces calcium score by removing calcium from the plaque, is it really removing the plaque or just removing the calcium from the plaque leaving the other 80% of the plaque intact just invisible to the CT scanner? So it seems to me that having a reduced calcium score does NOT mean there is not any plaque, just no calcified plaque. Couldn’t one have bunch of uncalcified plaque (because the K2 worked) and have a false sense of security from a good calcium score when in fact they are high risk? I think that’s where the CCTA test comes in because it can see all plaque not just calcified plaques.

  • bonnie

    If you don’t have a zero score , but go on lchf diet can you reduce your score in time or does that score always stay the same even on the lchf diet?

  • Jeanie Miller

    I do have a story and a question. I’m a 62 yr old female. I’ve been on LCHF for 3 years now. Lost 30 lbs. Currently about 20 lbs over weight. I had to select a new Primary Care Giver and after having a full blood panel done he pointed out my LDL Cholesterol was 142. This is about 10 points higher than the previous year. So I told him I’d been LCHF for a few years and drinking Bulletproof Coffee (coffee w/grass fed butter and coconut oil added) and I would cut out the coconut oil and cut back on cheese and come back in 6 weeks. Well when I went back 6 weeks later my LDL had climbed to 166!? I refused his statins and he insisted on a Heart Scan which came back zero. I’ve added all the right foods to my diet to try and lower my LDL and not gain back the weight I lost. My question is If my Calcium Score is Zero is there any need for statins? I have a sluggish thyroid and arthritis, otherwise Im perfectly healthy.

    • Scott Morgan

      Jeanie: No benefit has ever been shown for women taking statins. You should ask your doctor for the basis of your prescription. There is very little correlation between LDL and heart disease. Those with the lowest LDL have the worst outcomes. In terms of odds ratio, the best predictor of heart disease is triglycerides/HDL ratio, and LCHF is by far the best for minimizing that ratio. You should read some of the excellent books on cholesterol: The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease-and the Statin-Free Plan That Will by Jonny Bowden and Stephen Sinatra, The Great Cholesterol Con by Malcolm Kendrick, Cholesterol Clarity by Jimmy Moore, and Fat and Cholesterol Don’t Cause Heart Attacks and Statins Are Not The Solution by several authors. All of these are available on Amazon.

    • Amy

      Jeanie,
      I’ve been eating a zero carb (meat and eggs only) diet for almost 2 years. I am 42, 5’7″, 125 Lbs. I had blood work done in Dec 2015 (9 months after starting ZC). At that time my LDL was around 150, but my HDL was 85 and my trigs were 55. I had an NMR particle test, and I had NO evidence of small dense particles–only large fluffy ones.
      Fast forward to Dec 2016…..my LDL is now 500 (total chol 600), HDL is 93, trigs are 93 (it’s common for trigs to increase when LDL increases). I had another NMR test….all VERY large fluffy particles this time, still no evidence of small dense particles.
      With perfect NMR results and a trig/HDL ratio at or below 1, I feel very comfortable with my lipid panel. Total cholesterol and even LDL chol is completely irrelevant in assessing cardiac health/risks. Your trig/HDL ratio and particle size is more relevant, as is your coronary calcium score (which I haven’t had done yet). Incidentally, my doctor didn’t even mention statins to me…..she knows I will NEVER take them. High cholesterol is actually associated with longevity in women. I feel very healthy.

      • Jeanie Miller

        Hi Amy, Thanks for sharing. I also have no intention of taking statins. Everything else in my blood work is great, except my D which I have now brought back up. I have recently made a connection between my Thyroid medication and my LDL. I had requested my Dr. replace my Armour thyroid with a synthetic since the Armour has gotten so expensive. Being a by the numbers man he had to fool with it and started lower the dosage each time I came in to have my cholesterol checked. EVERY time he lowered the Synthroid dose my LDL went up 20 points. I pointed this out to him last time I was in and he kind of blew me off. Needless to say I’m on my way to a new doctor next month for a second opinion.

  • Rebecca

    Hello Dr Gerber. First and foremost, I want to thank you and Ivor for sharing all this information. After watching the Widowmaker movie I convinced my doc to order a Calcium test for my husband age 61. My father in-law had quintuple bypass at 70 and his father dropped dead of a heart attack at 55. So on Sept. 15 my husband had the test. His results indicate a calcium score of 16 mild plaque burden and moderate CVD desease risk. The location of the plaque was in the Left Anterior Descending Volume 130 was 12 and AJ-130 was 16. All additional findings for were within normal. My husband eats a relatively low carb diet certainly at home as we have no processed foods, all meat grassfed and organic, I make everything froms scratch including mayo dressings etc. to avoid added sugars. But he does sometimes cheat at work, drinks read wine every night and he definitely has a sweet tooth. My first question to you is why does the report say: “These calcium deposits usually begin to form years before any symptoms develop. Early detection and modification of risk factors such as smoking and cholesterol intake, can slow the progression of coronary disease, Really cholesterol intake? His apolipoprotien E genotype is 3/3 which means he should be able to consume lots of healthy fats like butter, avacados marbled red meat and fatty fish is that correct? His MTHFR isC677T/A1298C for which he takes PoDiaPn. Lab test in march alarmed the doc and she told him to cut the saturated fat because his total cholesterol went from 204 to 243, Additionally his small LDL-P went from 684 to 890. His ApoB-A-1 Ratio (calculated) also went up from .79 to .96. But what the doctor said was so urgent was his Lp-PLA inflammation marker that went from 325 to 390! She told him to cut the fats, red meat, and stick to nuts, avacados and lean meats and fish. By the way he exercises regularly, is very lean and has no abdominal fat, His Glucose was 89, A1C 5.6 and insulin 4, omega 3 was 7.3, ferrtin 60, vitamin D 41.
    Fast forward to July after following the doctor’s advice and numbers look better. Hos total cholesterol is down from 243 to 192, his small LDL-P is down from 890 to 669, his ApoB-ApoA ration is down from .96 to .71 and the inflammation marker Lp-PLA is down from 390 to 355. Fasting glucose down from 89 to 81 A1C down from 5.6 to 5.3 and insulin was 2!! His ferritin is still 60 his vitamin D went up from 40 to 49 but his omega 3’s went down a bit from 7.8 to 7.3, So here is my next question did cutting the saturated fat really help that much in particular with the inflammation or could it have been something else. Moving forward what should he be doing to reverse the calcium score or at the very least maintain it where it is? He doesn’t like taking many supplements but I have tried to explain that certain supplements are essential as you age because your body just is not that efficient at producing those things, So basically if you had to recommend a few supplements and steps to take to help further lowering his risk of CVD what would they be?

    • @Beca123:disqus A Volume 130 was 12 and AJ-130 was 16 is not such a bad score. And yes it’s historical as it takes years do build up calcium and plaque. I would check a score in another 2-3 years and see if all that your husband is doing will stabilize his score. A diet addressing inflammation and oxidative stress such as low carb, Vit D3, K2, Magnesium and artisan salt.

      • Rebecca

        Thank you Dr Gerber, I will share your response with him and hopefully he will pay more attention to inflammation and oxidative stress.

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  • Julie Berry Clark

    Magnesium is also a very important mineral, which is a calcium antagonist. They balance each other, and most all of us are deficient in magnesium. The mainstream pushes calcium like candy, neglecting the very important magnesium.
    But great to see your scan after being on a high fat, low carb diet for 15 years! I am doing the same, but not for so long.

  • Mark

    I am nearly 53 and follow a daily healthy diet and life style. I have had all my blood tests done religiously each of the previous 10 years and currently have a LDL of 2.5 and HDL of 1.5 with excellent liver function etc. I exercise both by cycle and weight program nearly daily. My BMI is normal, my blood pressure is 80/120 and I do not believe I suffer from stress. I have never had any symptoms of heart disease even during 10 to 21 km jogs or 120 km cycle rides. My father had both a stent and eventually a triple bypass in his 60’s and died from a stroke at 71.
    Recently I have found my calcium score is 2400 (LM 0.0, LAD 368, LCX 404 & RCA 1536). I have since had a stress test to a heart rate of 158 (after riding 13 kms to clinic). The report was blood pressure and heart operation normal. I have had an ECG which noted an extremely dilated Left atrial of 51 ml/m vs normal 29 ml/m with all other areas normal. I have also had a scan of my left and right carotid arteries which was reported as “no significant stenoses identified”. My cardiologist has put me on a stantin and daily aspirin and advised me to continue my daily exercise activities and “don’t change my life”.
    I am happy with my very experienced Cardiologist, but I am interested in anyone else with similar conditions as I appear to be outside all other of the key causes i.e. obese, diabetic, smoker, high blood press high cholesterol and inactivity.
    Can anyone advise of other treatments or any ability to reverse the plaque build-up.
    Thanks Mark

    • Hi Mark. The goal would be to stabilize your plaque, regression is not typical. Although your way above the 90th percentile for total score, keeping the progression of calcium <15%/yr will greatly increase your odds. Certainly there are genetic factors to consider, but your healthy lifestyle and perhaps collateral circulation has been helping. I would stick to a diet that addresses inflammation and oxidative stress. Grains, sugars and the industrial vegetable oils are especially bad. Get another scan in a few years.

    • David

      k-vitamins.com/ Go here and read, read, read. Although Dr. Gerber is correct that regression is not typical, it is for reasons that you will learn by doing research. You can easily reverse you artierial plaque. I am on this therapy, more or less. I’m not sure which scoring system was used on you, but my score was 71. At my age (almost 53) that puts me at higher risk than normal, for my age. I was already 8 months into my own prescribed treatment plan before I found out about the product he sells and had my first scoring done. My score before my teatment plan might well have been much higher. I may go for another scan at 6 month interval, or wait until a full year. I expect to have much lower numbers. For you to have a score of 0 on your left main is odd based on my own score and reading scores of other scores. Usally I see the left main as having the most buildup. But everybody is different. Good luck.

  • Penny Olivier

    I have been following lchf for over 6 years now.My blood profile improved, I lost 15kg in 2 months, & have been at goal weight ever since.My hubby is a medical practitioner, & still not convinced re long term effects! I am a long distance athlete, & have found even more benefits of lchf here.But I am now more worried about AGE’s being produced because of heavy endurance exercise….Comrades marathon (90 km run), cycling races over 200km, full Ironman etc.Also the long term effects on the heart? ( enlarged ventricles etc).I am 51 years old……& love my endurance events, especially with the positive contribution of lchf, boundless energy,
    & no insulin spikes

  • William Blanchet

    We have the ability to take heart disease off of its pedestal as the leading cause of death and disability in this country. Find out what your risk really is with a coronary calcium score and treat until the calcium score stabilizes. This can usually be done with diet, supplements, great dental hygiene, adequate sleep, treatment of BP and diabetes and perhaps a generic medication or two.

  • JDavidP

    I’ve lived right for decades. (As far as what’s been assumed as “living right”.) Mediterranean diet, daily exercise, good sleep, good outlook on life. Not much I can do about age or gender, but everything else on your risk list is fine. Except my total cholesterol has gotten a bit high. I wanted to prove to my cardiologist that I was fine and didn’t need a statin, so I got tests. Passed the stress test with flying colors – better than expectation for age, no ECG abnormality. My hsCRP came back at .5. (Point five.) But then I was quite surprised when my CAC came back with an Agatston total of 1,609. (One thousand six hundred and nine!)
    I have to wonder where that came from. I’m told there MUST be plaque. There’s no other cause for such calcification?

    • @JDavidP:disqus, there are always genetic factors to consider. I allpaud your effort to improve your lifestyle. What’s important is to prevent calcium score progression (<15%)/yr as this will stabilize your risk. Keep On Keepin' On!

      • JDavidP

        But these prospective genetic factors must involve a particular process, no? If I knew the process I’d have a clue as to how to counter it specifically.
        Matrix GLA protein not behaving properly? Some such? I’ve been taking my MK-7.
        What specialty would know about this sort of thing?

        • @JDavidP:disqus We do recommend K2, D3, Magnesium, artisan salts and methylfolate along with proper diet to decrease CV risk. I wish there was more to say about the relation to genetic factors but we’re all still learning. The goal would be to address inflammation and oxidative stress from all angles.

  • Jeanna

    I’m still trying to figure out why at age 50, I have a 0 score! I have high blood pressure, high cholesterol…about 285…high stress life, I have an autoimmune disorder called Hashimotos which makes it virtually IMPOSSIBLE to lose weight (and pls don’t give me friendly advice about how to lose weight or tell me I’m a fatty because I either eat too much or I don’t exercise…I walk a few miles a day, strength train a bit and I am mostly a veggie eater…I’ve also eliminated the following from my diet: soy, chocolate, ALL grains, ALL night shades, caffeine, dairy, etc. I eat mainly veggies, a bit of protein and a couple pieces of low glycemic fruit a day…I’m still a fatty…) so…I don’t understand why it is with all of the issues I have, a calcium score of 0! I am blessed, I suppose. I also have a long line of women on my mothers side who died between the ages of 23 and 56…I’m not that far off. I’m a bit concerned there is soft calcification lurking in my heart, ready to rear its ugly head in a few years…

    • @jeanna, I’m not sure where to start but simply to say that you could get a CT angio if your really worried about soft plaque.

    • Carl Hedberg

      Jeanna, no mention of FAT: MCT, coconut, olive oil, etc? % of daily intake.

  • 48 years old, Ketosis for 6 months. Zero calcium score; TG reduced 70%; HDL increased 70%. Just completed the mother of all stress tests: 45Km marathon run fasted on water only.

    • @drsimonthompson:disqus, What an awesome story. Yet another fat adapted endurance athlete. You make Dr. Phinney, Volek and Noakes proud, and your heart hasn’t exploded yet!

      • Thanks for the encouragement Jeffry, but I am no athlete- a G.P. who until 10 weeks ago did a walk most days. Prior to last Sunday, I had never run in any event other than a 5 Km fun run 15 years ago.I will get to meet Dr Volek in 3 weeks time when he visits Melbourne- I am very excited. My ketone level for the run got up to 5.1 ! Makes interesting conversations about the energy that one gets when Keto adapted. I did the run Sunday, Karate training Monday (and Wednesday), and two light recovery runs 8 Km Tuesday and Thursday. I did all my running training fasted and on water- switch off the gut/parasympathetic/insulin and let the fatty acids/ketones fly!

        • @drsimonthompson:disqus Looking good and yes you are now a fat adapted endurance athlete. Tell Dr Volek and Dr. Rod Tayler I said hello. I hope Dr. Rod invites me down under soon.

  • PJkrt

    Another issue for some may be the exposure to radiation from the CT scan. The typical heart scan using 64k-slice technology is supposedly equal to a few thousand chest x-rays. The newest CT-technology is 256k-slice – it supposedly is equal to a 100 chest x-rays.

    If so, that’s a large reduction in radiation exposure. Plus the 256k-slice technology delivers much better resolution. I would assume that means that previously undetected calcification using the old technology can now be detected by this newer technology.

    And it takes less time to do the actual heart scan – it’s faster.

    I am under the impression that not a lot of medical centers have this newer technology yet.

    • I had my test performed using the original 64 slice EBCT scanner. Radiation exposure is about 0.7 mSv and Dr. Blanchet refers to it as a mammogram of the heart partly because of equivalent radiation exposure. If a CXR is 0.1 mSv its only 7 times more.

      The newer mechanical scanners previously used more radiation say 3 mSv (30 times a CXR) but they have improved with less radiation and better quality. Motion artifact has been the issue with these newer scanners and it has been overcome using the 256 slice technology.

  • charles grashow

    Are there any published studies which show stabilization/reversal of arterial plaque on a LCHF diet?

    Add this person to your list
    https://twitter.com/RimasVJanusonis/status/576004021539975168

    • PJkrt

      Hmmm…I think someone is going to ask you about your LDL…b/c of all that LDL-causing low carb and keto stuff. 😉

      • charles grashow

        Well since I do not follow a ketogenic diet what would you have me say?

  • Remigio Garcia

    I know nobody is going to believe this but in 2012 i pegged at a score of 3200. Yes, 3200, you read right. I wrote myself off at that time but still seem to be ticking. What gives? I didn’t have a repeat test, didn’t want to spend money on more bad news.

    • @remigio_garcia:disqus, you should definitely get a repeat test and see if your plaque is stable. Even though your risk is high (some like you have scores in the thousands), if your calcium score remains stable that is favorable and would suggest that whatever you have been doing since 2012 has been helping.

      • Remigio Garcia

        Thank you, I’ll get one scheduled.

        • sasoon1

          Did you get results?

  • charles grashow

    Dr. Gerber and Dr. Patel

    What would you recommend if a patient had a CAC score >30 on a LCHF diet?

  • PJkrt

    Is it true that one’s CT calcium score is not a measurement of arterial blockage, stenosis and/or occlusion? If so, maybe someone can add a layperson clarification of exactly what is being measured by the CT imaging.

    My own impression is that the ‘score’ is better understood as the total coronary arterial area that is affected by the calcification (versus being a measurement of narrowing and/or bulges into the artery).

    • HI @PJkrt. You’re spot on with your interpretation of calcium scoring. Calcium ‘area’ volume and density are all that can be measured and it’s associated with plaque burden, not necessarily blockage. However, its presence or not has been used to stratify CV risk (events) in literally thousands of people and the results are reproducible.

      Plaque or blood vessel inflammation develops as a response to blood vessel ‘injury’. All the mechanisms are still not fully understand but plaque starts as soft and later hard (calcium laden). Acute events occur mostly from plaque rupture and thrombus formation. The greater the plaque burden (as measured via CAC scoring) the greater the risk. Risk has little to do with the degree of stenosis.

      Rocky mentioned a small study showing that 20% of people with a ZERO calcium score actually had soft plaque. True, but the small study did not have enough power to predict risk based on these findings. It only observed that soft plaque was present.

      Bottom line, a calcium score of ZERO still means that your risk remains <1% regardless. I hope that helps.

      • PJkrt

        Thanks, Dr. Gerber.

        Following up with another question(s). You used the word ‘density.’ Does that mean the imaging is measuring both the the calcification on surface of the artery wall and the calcification behind the artery wall?

        Also, my understanding is that the ‘score’ is the total calcification of all the coronary arteries. So, if someone has calcification of ’99’ across 3 arteries, then that person may have one artery that is a ’79’ and the other two each at ’10.’ Correct understanding?

        • kanor74

          True..my score of 67 showed 65 of it being one artery and the remaining 2 in another.

          • Nice explanation @kanor74:disqus , the areas are added together. Density describes areas on on CT with bright signals that identify a greater density of calcium.

          • PJkrt

            Let me ask another way…does the ‘score’ represent only the surface of the arterial wall calcification? Or does the CT imaging also measure calcification behind the surface of artery wall (behind the layer of endothelial cells)?

          • Ok. The test cannot identify the depth (lumen, endothelium, itima, etc…) of the calcium.

          • PJkrt

            Thanks. Well, my guess on that one was wrong. I thought it measured the compete artery calcification.

            Or is the reality that there is usually no calcification behind the endothelial cells? Instead, behind those cells are only the foam cells, excess lipids and etc. ready to rupture if surface calcification cap is too thin?

          • Might need a pathologist or cardiac surgeon to answer your question as to where the the hard plaque 1st forms.
            @pjkrt:disqus

  • Rakesh Patel, MD

    Jeffrey,

    That’s amazing that you reversed your calcium score. But a correction to your blog: a zero calcium score does not mean “no evidence of plaque”. It just means no presence of calcified plaque, a very important distinction.

    Several studies in the literature demonstrate that very high risk CVD patients (those that fail myocardial perfusion testing) can often have a calcium score of zero, despite having obstructive coronary disease at time of anigogram. It was 20% percent of the peeps in this one study! http://www.ncbi.nlm.nih.gov/pubmed/20170786

    I think if you are going to do the calcium scoring, a CT coronary angiogram is a much better assessment. I am goona assume the carotids are clean as well 😉

    cheers, rocky

    • Hi Rocky, Thanks for having a look. The chart I used is a standard oversimplified version from this source: http://www.ncbi.nlm.nih.gov/pubmed/11397349. There are other versions that provide more detail.

      I am familiar with the paper you quoted above and indeed soft plaque lesions will not be detected. I agree it’s not a perfect test but still many more will benefit from testing than not. A ZERO score still means that your risk for and event is <1% based on different sources.

      I see you are arguing for CT angiogram because it will detect all obstructions arising from either soft or hard plaque. Ok, but this has to be weighted against the invasiveness (IV contrast, more radiation) and expense vs. calcium scoring. I'm not sure asymptomatic people would want such a test.

      BTW, this was my 1st calcium score so I have no data showing regression, only that it is ZERO. The bio-markers have improved.

    • @rakeshpatelmd:disqus, I wanted to include some more sources for the table I used: Adapted from Rumberger JA et al. Mayo Clinic Proceedings March 1999: 74:243-252. http://www.mayoclinicproceedings.org/article/S0025-6196(11)63860-3/abstract

      Here is a more detailed version: https://www.adrad.com/hs_heart_faq.htm

  • Eric

    I believe weight is a consequence and a risk factor. We can blame people for there weight while in fact it is one of the consequence. Takes years to turn this around. Same thing I believe there are many unhealty skinny people eating absolute crap. As lucky they can be… they don’t gain weight. Does this mean they should continue? I think everybody deserve a minimum respect, including overweight people.

  • charles grashow

    What would you do if your CT scan shows plaque on a LCHF diet?

    • LLVLCBlog

      The point is it didn’t.

      • charles grashow

        My question is what would you advise a patient to do if it did?

        • LLVLCBlog

          Mine is 0 eating 80% fat.

          • charles grashow

            How’s your weight BTW?

          • LLVLCBlog

            I’ve not hidden that I’ve gained weight. Reveal my numbers often on social media and my blog. Thanks for your concern.

          • Charles please behave yourself.

          • Charles is presumably a slim Jim, however calcified he managed to get himself 🙂

    • kanor74

      Dr. Bill Davis (Wheat Belly) is a cardiologist who also uses the CT scan as part of his practice. He told me that if one is following all his protocols, one can hope to stop the progression of plaque growth or even reverse it to a degree. Following Wheat Belly or another LCHF way of eating, taking good fish oil supplements (EPA + DHA intake of 3600 mg per day ), optimizing vitamin D3, correcting bowel flora, normalizing thyroid function, and getting some exercise are all in the plan. I am a little over 3 years LCHF, 64 y/o, and got a low minimal score. My hope is to stop it or reverse it…..

      • charles grashow

        What was your score and where were the plaque(s) located?

        • kanor74

          67 almost all of which is in the left main coronary artery.

          • charles grashow

            Mine is 48 – 47 in the LAD (the widowmaker). I’ve drastically slowed the rate of progression – it’s gone from 30 in 12/07 to 48 in 2/14. My next goal is reversal which I believe is possible.

          • kanor74

            Very good! Dr. Davis told me that for folks who eat a standard diet of low fat, high carb…they can expect an increase in plaque upwards of 30% per year. So, following his protocols and eating LCHF, or in my case, Wheat Belly, I hope to stop this dead in its tracks.

          • charles grashow

            EXCEPT – I’m NOT eating Wheat Belly or LCHF. He also published a paper prior to Wheat Belly

            Effect of a Combined Therapeutic Approach of Intensive Lipid Management, Omega-3 Fatty Acid Supplementation, and Increased Serum 25 (OH) Vitamin D on Coronary Calcium Scores in Asymptomatic Adults

            Abstract

            The impact of intensive lipid management, omega-3 fatty acid, and vitamin D3 supplementation on atherosclerotic plaque was assessed through serial computed tomography coronary calcium scoring (CCS). Low-density lipoprotein cholesterol reduction with statin therapy has not been shown to reduce or slow progression of serial CCS in several recent studies, casting doubt on the usefulness of this approach for tracking atherosclerotic progression. In an open-label study, 45 male and female subjects with CCS of > or = 50 without symptoms of heart disease were treated with statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides or = 60 mg/dL; and vitamin D3 supplementation to achieve serum levels of > or = 50 ng/mL 25(OH) vitamin D, in addition to diet advice. Lipid profiles of subjects were significantly changed as follows: total cholesterol -24%, low-density lipoprotein -41%; triglycerides -42%, high-density lipoprotein +19%, and mean serum 25(OH) vitamin D levels +83%. After a mean of 18 months, 20 subjects experienced decrease in CCS with mean change of -14.5% (range 0% to -64%); 22 subjects experienced no change or slow annual rate of CCS increase of +12% (range 1%-29%). Only 3 subjects experienced annual CCS progression exceeding 29% (44%-71%). Despite wide variation in response, substantial reduction of CCS was achieved in 44% of subjects and slowed plaque growth in 49% of the subjects applying a broad treatment program.

            Notice the use of statins.

          • kanor74

            Dr. D is adamantly opposed to statin use. I’d recommend his newest book, Wheat Belly Total Health which is up-to-date on the latest research and science. I highly recommend the WB way of eating…. visit his website/blog or the official Wheat Belly Facebook page. Tons of info and happy, healthy folks who follow him.

          • charles grashow

            The paper referenced above was PUBLISHED by Dr Davis based on patient records. If he still recommends HDL>60, TG<60 and LDL<60 for reversal, please explain how LDL<60 is possible on LCHF.

          • Easy. Suppress Insulin, turn off lipogenesis, turn up lipolysis and BOOM LDL is reduced along with TG: eat your carbs and the opposite is true!

          • Davis luckily saw the error of his earlier approach Charles – he’s one of the few who has the big picture now. LDL is only a bit-player in the atherosclerosis game – respect thine Insulin and the LDL will look after itself. As nature intended it to – soon everyone will realize that evolution did not create Lipoproteins to kill us off quickly… http://www.thefatemperor.com/blog/2015/4/25/lchf-motherlode-paper-ldlp-my-butt-insulin-and-c-peptide-rules-atheroscleosis http://www.thefatemperor.com/blog/2015/5/3/cholesterol-lchf-whats-the-only-thing-that-matters-for-repeat-heart-attacks http://www.thefatemperor.com/blog/2014/11/12/ldl-its-not-the-bad-cholesterol-thats-simplistic-foolery

          • @charlesgrashow:disqus, different strokes for different folks.

          • Hey Charles – a good stint on ultra-high-fat with some intermittent fasting & sun / K2 / Mg etc. should get your score sorted – best of luck with it !

          • charles grashow

            Let’s see – I practice IF, eat food sources of + supplemental K2, I take supplemental D3 and get sunshine when I can.

            However, when I tried a VLCHF diet it sent my LDL-P soaring so that’s not a viable option

      • @kanor74:disqus best of luck with slowing your progression

      • Duff Watkins

        Can I enquire about this? I just received a calcium score of 533 (Agatston test) out of the blue, which surprises me greatly as I’ve been low-carb for years, supplement with fish oil (plus many others), train regularly (one glance at me would tell you I’m an athlete), had a pre-shoulder surgery pulse of 56 bpm several months ago, only to find that I’m a high risk candidate for CVD. How can this be?! All insights gratefully received.