Here’s the story of John Lorscheider.
John was a patient of mine and a moderator in PrevMed’s forum. He also used to contribute videos to our YouTube channel.
John narrated how he decreased his calcium score by 59% within 16 months in this video:
John got several genetic risks based on his family background.
His relatives on his mother’s side suffered from carotid artery disease; all of them had strokes. His relatives on his father’s side had coronary artery disease, and they suffered previous cardiac events.
John himself had both carotid and coronary artery diseases.
He worked with a pretty progressive doctor in Illinois whom he credited for discovering a lot of his risk factors. One particular risk was his fast plaque growth, as seen through calcium scans.
However, John was quite frustrated not being able to pinpoint the causes of his plaque growth, more so, how to treat it.
He did the things traditionally recommended by mainstream doctors—statin, niacin, fish oil, diets. None of those seem to work, as John’s coronary calcium score kept rising year after year.
Inflammation and insulin resistance
In 2016, John stumbled upon my YouTube channel. (My channel just started then, with only 30 to 40 videos so far.)
John contacted my office/clinic to make an appointment. And that was the start of our 2 years of our journey together, discovering and managing his cardiovascular risks.
John said this episode piqued his interest.
In this video, I talked about Bradley Bale and Amy Doneen’s book “Beat the Heart Attack Gene.” The book tackled many issues close to John’s situation.
The book’s most crucial point is this: Inflammation is the leading cause of heart disease, stroke, dementia, and a range of other illnesses.
So if inflammation is the number 1 cause of cardiovascular disease, what’s the number 1 cause of inflammation?
It’s prediabetes (which we also refer to as insulin resistance).
So when I first met John, I immediately set him up for tests not only for inflammation tests but also lab tests for insulin resistance.
The first tests I ordered for John are for inflammation. Here are his results:
CRP (C-reactive protein) is an inflammation marker. It is produced by the liver whenever there’s inflammation.
However, a CRP test can give a false-positive result. An injury, infection, autoimmune dysfunction, even a flu vaccination can elevate CRP.
Thus, it’s best to combine CRP with other inflammation tests.
John’s CRP: 0.5. A normal CRP is below 1 mg/L, so John had a normal CRP. He got 1.9 6 months earlier, but he got a back injury that time.
Lp-PLA2 (lipoprotein-associated phospholipase A2) is another inflammation marker that shows plaque formation.
Lp-PLA2 is an enzyme produced by monocytes (a type of immune cell). It targets and dissolves plaque.
John’s Lp-PLA2: 92. Normal Lp-PLA2 must be less than 123 nmol/min/mL. 92 is an excellent result, as John used to have values way over 200.
Like Lp-PLA2, MPO (myeloperoxidase) is also an enzyme.
It’s produced by neutrophils. It also targets and dissolves existing plaque in the artery.
When MPO and Lp-PLA2 do their actions, unfortunately, they make plaque soft and less stable. Hence, MPO and Lp-PLA2 should be below the acceptable limit to show that there’s no inflammation.
John’s MPO: 285. Normal MPO should be below 470 pmol/L.
Insulin resistance tests
With inflammation as the leading contributor to heart attack and stroke, and insulin resistance as the leading contributor of inflammation, I ordered the OGTT and Kraft insulin survey for John.
These 2 tests help determine if one person has insulin resistance or already has full-blown diabetes.
OGTT (oral glucose tolerance test)
OGTT measures a person’s glucose levels after the person drinks a 75-g glucose solution. Blood samples are drawn and tested 3 times.
Here are John’s OGTT results and interpretations.
- Fasting blood glucose: According to the ADA (American Diabetes Association), normal values should be below 100 mg/dL. John’s value is 81, which is good.
- 1 hour after drinking the glucose solution: John’s result is 142. ADA has no established limits for this one-hour test.
- 2 hours after drinking the glucose solution: John’s result is 182. ADA’s range for prediabetes is 140-199 mg/dL; for type 2 diabetes, the range is 200 and above.
While John meets the qualification for prediabetes, his 2-hour result is already borderline high, he can be labeled a diabetic already.
Moreover, his 2-hour blood glucose was higher than the 1-hour value. Ideally, the 2-hour value should be lower.
Kraft insulin survey
The Kraft insulin survey builds on the information provided by OGTT.
It is done like OGTT, but this time, insulin levels are also tested. After the patient drank the glucose solution, blood samples will be drawn and tested for both glucose and insulin levels up to the 5-hour mark.
Let’s look at John’s Kraft test results, focusing on fasting and the 2-hour values:
- Fasting: John’s fasting blood glucose is 88; insulin level is below 2. Normal fasting glucose must be below 100 mg/dL, so like in OGTT, John’s result here is good. The insulin level must be below 10 mU/L, so John’s finding here is also good.
- After drinking the glucose solution: John’s blood glucose and insulin levels went up. At the 2-hour mark, his insulin level is 81, while his glucose level is 291. John has high glucose here, and he now fell into the “type 2 diabetes” range of ADA. Moreover, his insulin at the 2-hour mark should be below 50, and John was over that limit with 80.9.
John’s Kraft test results were pretty consistent with his OGTT results, confirming that he has diabetes.
Whether it’s full-blown diabetes or insulin resistance, both conditions are critical for one’s health. They can damage your arteries, subsequently setting them up for plaque formation, atherosclerosis, and inflammation.
If not for the OGTT and Kraft insulin survey, John would not have discovered that he is diabetic. Ask your doctor to order an OGTT and/or Kraft insulin survey for you. If not, one way to get it yourself is through PrevMed’s webinar program.
Aside from OGTT, Kraft insulin survey, and inflammation tests, John also took CIMT to gauge his plaque.
CIMT is short for “carotid intima-media thickness.” It is a non-invasive, non-radiation test.
CIMT looks at the carotid area where the main carotid artery splits into internal and external branches. This is an area where plaque usually builds up.
If plaque is detected in this area, there’s a high chance that there is also plaque in arteries in other parts of the body.
Moreover, CIMT detects both calcified plaques as well as soft plaques.
In 2017, John’s plaque burden was at 5.9 mm.
In 2018, to his surprise, his result jumped to 7.3, up by 20%. We were both puzzled about the increase, so we contacted Todd Eldredge, the owner of CardioRisk (the lab which performed John’s CIMT).
To our relief, Todd assured us that John had not increased his plaque thickness, and that the increase was because of an equipment upgrade. Being more sensitive, the ultrasound equipment could pick up a higher degree of plaque in 2018 than in 2017.
To get things settled, John decided to confirm his CIMT results by doing a test that he had always done for years—the calcium scan.
The coronary artery calcium score (calcium score for short) is a measure of the amount of calcified plaque in the coronary arteries. It’s done using CT (computed tomography).
As the calcium score only looks for calcified plaque, it won’t provide you any information about blockage or soft plaque. Many people would be worried about calcified plaque. But it’s soft plaque that causes trouble as it’s prone to inflammation.
John was already familiar with the calcium score. He already had several calcium scans before he became my patient in 2016. He had a low score from 2010 to 2012.
However, his score started to go up in 2013. That time, he quit taking a statin as per his doctor’s recommendation, although stopping statin may not be the only reason. That time, he had not discovered his diabetes yet. His weight and lipoprotein(a) were also going up.
Then his score appeared to level off from 2014 to 2015, so he decided not to take one in 2016. In 2016, we met, and we both found out about his diabetes (again, thanks to OGTT and Kraft insulin survey).
In 2017, he took another calcium scan. To his surprise, his score almost doubled within 2 years, from around 70 in 2015 to 123 in 2017. That means he got a moderate amount of calcified plaque and a moderate chance of developing coronary artery disease and blockage development.
If a patient has a calcium score of 0, it means there’s a low risk of having a cardiovascular event in the next 5 years. Though 123 is not bad for a 65-year-old man, John wanted to flatten his curve a bit.
Here’s a reference table of calcium scores:
Remember John’s supposed “increase” in plaque based on his 2018 CIMT results?
I mentioned in the previous section that Todd of CardioRisk assured us that John’s “increase” in plaque was because of an equipment upgrade.
Still, John got a calcium scan to dispel his doubts. This time, after 16 months, he got a calcium score of around 51 in 2018.
The decrease supports Todd’s statement. And for John, he felt good that he had somewhat in the right direction in managing his plaque.
John found out about his diabetes with OGTT and Kraft insulin survey. He measured his plaque with CIMT and calcium scan. John also took inflammation tests to give him an overall profile of his cardiovascular risk.
The next question is: What are the things John does to manage his risks:
Before rounding up all the things John did and still doing, let’s cover first his medications and supplements, as these 2 things are usually interesting to people.
Medications and supplements
John doesn’t take as many meds as he used to, though he still takes some. As for supplements, John used to take some but stopped those that gave zero to little benefit to him.
John takes a low dose of 5 mg a day. Fortunately, he experienced no side effects.
While we know statins for their cholesterol-lowering effects, low-dose rosuvastatin has a pleiotropic effect of inhibiting inflammation.
This is a blood pressure-lowering drug. It’s an ACE inhibitor (angiotensin-converting enzyme inhibitor) that also reduces inflammation (Kortekaas, 2014).
John’s diabetic, so he takes a moderate dose of metformin—500 mg of the extended-release form 2x a day.
Medicines, however, won’t do the work alone for managing diabetes. People have to do other things (like changing their lifestyles) for the best effects.
John used to follow the Linus Pauling protocol—he took 5,500 milligrams of vitamin C per day. But he got bowel intolerance, so that’s something that may work better for other people.
Here’s the irony of the Linus Pauling protocol. Pauling died 5 years before the birth of the Linus Pauling Foundation. The foundation discovered sodium-dependent vitamin C transporter proteins.
These proteins take vitamin C to where vitamin C needs to go. The protein, however, becomes saturated at 250 mg of vitamin C per day; the amount beyond that is excreted in the urine.
So by taking 5,500 mg per day, over 95% will just go down the toilet.
John uses ubiquinone. He used to take the supposedly more bioavailable ubiquinol.
However, not only is ubiquinol more expensive, but it’s also converted instantly to ubiquinone once ingested. So there’s no benefit to taking ubiquinol, and many studies support this.
John used to take high doses and good brands of vitamin E (mixed tocopherols and tocotrienols).
Vitamin E is supposed to stabilize plaque and reduce plaque, but none of that happened. Some studies have showed that high-dose vitamin E could do more harm than good.
John takes the extended-release form of niacin at 2,000 milligrams per day. It appears to work well for him.
His HDL used to be in the 30s, but it went down to 8.
His lipoprotein(a) is also down by close to 75%. Reports say that niacin reduces lipoprotein(a) by 20 to 30%, so a 75% reduction appears to be an excellent benefit.
With certain studies showing that people shouldn’t be tinkering with their plaque, then trying to pull calcium out might destabilize calcified plaque that’s already stable.
Other medications and supplements
John used to take aspirin. But he replaced it with Eliquis for his atrial fib (and Flecainide if he is having an episode). He also takes Levothyroxine for his thyroid.
John also took soluble fiber, policosanol, and plant sterols. These things supposedly reduce cholesterol absorption.
However, in cardiovascular health, cholesterol is not the issue; it’s inflammation.
How John lowered his calcium score: The summary
It’s a combination of different things.
His fasting blood glucose is in the low 80s. His postprandial (after a meal) glucose is below 120. He keeps those numbers low.
He monitors his inflammation markers. His MPO and CRP values are low, both are a good thing. His Lp-PLA2 has improved.
He eats a strictly low-carb diet to get into an area called “ketosis.” His HbA1c is 4.7 (below 5 is the acceptable range).
He also adopted a high-fat, moderate-protein diet. Not just any fats, though.
He eats a lot of avocados. He eats cheese, nuts, fish, and other forms of good seafood.
He’s not a vegan or a vegetarian, but he has significantly reduced the amount of red meat in his diet. He eats a little chicken and a few turkeys.
He does intermittent daily fasting, too.
He does high-intensity interval training, which he credits as one of the most beneficial things that worked for him. The exercise highly sensitizes insulin receptors into getting more glucose into the body.
His blood pressure dropped to below 120 over 80, even without the meds.
Still, he takes his BP med (Lisinopril) despite a drop in his blood pressure. He takes a low dose, though, to target inflammation.
He takes niacin to manage his lipoprotein(a).
He takes a moderate dosage of metformin for diabetes.
He takes low-dose Crestor (rosuvastatin). The purpose of low-dose rosuvastatin is to inhibit inflammation.
So that’s John’s story.
While he takes supplements and medications, those are not the only reason for his improved calcium score.
Diet, exercise, and continuous monitoring with tests also played a part in why he found success in managing his cardiovascular risk.
My name is Ford Brewer. My team and I work to prevent heart attack, stroke, cancer, and dementia. Our goal is to help you understand how to prevent major killers and disablers. Most of them are driven by the process of cardiovascular inflammation.
If you’d like to learn about the basics of heart attack & stroke prevention for free, complete this form, and get access to our CV inflammation course. If you’re interested in how we can help you, check out our services page.
American Diabetes Association (ADA). Diagnosis. ADA website. https://www.diabetes.org/a1c/diagnosis. Accessed March 1, 2021.
Brewer F. 15 Rules to Prevent Heart Attack and Stroke Risk. PrevMed website. https://prevmedhealth.com/15-rules-to-prevent-heart-attack-and-stroke-risk. Accessed March 1, 2021.
Brewer F. Can Metformin Help You Lose Weight? PrevMed website. https://prevmedhealth.com/can-metformin-help-you-lose-weight. Accessed March 1, 2021.
Brewer F. CoQ10: Does It Work? Is Ubiquinol Better Than Ubiquinone? PrevMed website. https://prevmedhealth.com/coq10-does-it-work-is-ubiquinol-better-than-ubiquinone. Accessed March 1, 2021.
Brewer F. Coronary Calcium Score: Under-Utilized But Still A Great Test. PrevMed website. https://prevmedhealth.com/coronary-calcium-score-under-utilized-but-still-a-great-test. Accessed March 1, 2021.
Brewer F. Does Niacin Work? The Great Niacin Debate. PrevMed website. https://prevmedhealth.com/does-niacin-work-the-great-niacin-debate. Accessed March 1, 2021.
Brewer F. How Does Inflammation Cause Cardiovascular Disease? PrevMed website. https://prevmedhealth.com/cardiovascular-inflammation-and-plaque-formation. Accessed March 1, 2021.
Brewer F. How To Prevent Stroke & Manage Atrial Fibrillation. PrevMed website. https://prevmedhealth.com/how-to-prevent-stroke-manage-atrial-fibrillation. Accessed March 1, 2021.
Brewer F. How to Test for Cardiovascular Inflammation. PrevMed website. https://prevmedhealth.com/how-to-test-for-cardiovascular-inflammation. Accessed March 1, 2021.
Brewer F. Prediabetes: A Risk for Heart Attack & Stroke? PrevMed website. https://prevmedhealth.com/prediabetes-a-risk-for-heart-attack-stroke. Accessed March 1, 2021.
Brewer F. Reducing Arterial Plaque – Is It Possible? PrevMed website. https://prevmedhealth.com/reducing-arterial-plaque-is-it-possible. Accessed March 1, 2021.
Brewer F. Stopping Statins: Is It Safe? PrevMed website. https://prevmedhealth.com/stopping-statins-is-it-safe. Accessed March 1, 2021.
Brewer F. Vitamin K2 & Cardiovascular Health – What’s the Real Score? PrevMed website. https://prevmedhealth.com/vitamin-k2-cardiovascular-health-whats-the-real-score. Accessed March 1, 2021.
Brewer F. What is Carotid Intima-Media Thickness Test (CIMT)? PrevMed website. https://prevmedhealth.com/what-is-carotid-intima-media-thickness-test-cimt. Accessed March 1, 2021.
Brewer F. What is Vitamin K2? Can It Remove Arterial Plaque? PrevMed website. https://prevmedhealth.com/vitamin-k2-can-it-remove-plaque. Accessed March 1, 2021.
Diabetes.co.uk. HbA1c Test for Diabetes. Diabetes.co.uk website. https://www.diabetes.co.uk/hba1c-test.html. Accessed March 1, 2021.
Kortekaas KE, Meijer CA, Hinnen JW, et al. ACE inhibitors potently reduce vascular inflammation, results of an open proof-of-concept study in the abdominal aortic aneurysm. PLoS One. 2014;9(12):e111952. Published 2014 Dec 4. doi:10.1371/journal.pone.0111952
WebMD. Do I Need an Oral Glucose Tolerance Test? WebMD website. https://www.webmd.com/diabetes/guide/oral-glucose-tolerance-test#1. Reviewed November 6, 2020. Accessed March 1, 2021.