Book Review: Don’t Die Early

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Lying on the gurney in the emergency room, I shielded my eyes from the glaring overhead lights and tried to remember exactly when my heart went wacko. I remember being anxious and out of sorts all evening. Looking back, I realized that during dinner my chest felt fluttery and strange inside, and I recall snapping at my wife, Laura, over nothing as I left the kitchen to go upstairs.

By the time I reached the top of the stairs, I knew something was very wrong— I could barely breathe and when I placed my fingers to the side of my neck, my pulse felt very unusual. Not the rhythmic beating I would have expected, but more like an indistinct, squishy fluttering. Walking into our spare bedroom, I retrieved the pulse meter from the shelf next to the treadmill. I slipped the meter on my finger and looked at the readout. The effort seemed exhausting. Sitting on the edge of the bed, I called for Laura. When she arrived a moment later, I handed her the pulse meter.

The display read 195 beats per minute and I knew my life had just changed forever. The old carefree way of taking care of my body that had worked fine in my youth and young adulthood wasn’t working anymore. I now had to become a conscious advocate of my own health.

That’s the opening from Don’t Die Early, an educational and very well-written book by Rocky Angelucci – who did nearly die early.  Finding yourself lying on a gurney should certainly put a scare into you, but unfortunately many people respond to that scare by following their well-meaning doctor’s orders … you know, cut back on the eggs and saturated fats, eat your hearthealthywholegrains, etc.

Rocky didn’t go that route, partly (and I’m delighted to say this) because of Fat Head.  As he explained in an email some months ago:

I have been a fan of yours since discovering a snippet of Fat Head on YouTube the evening I returned home from the hospital following a life-changing episode of atrial fibrillation. I was only 45 years old at the time, but had just been rudely awakened by the realization that the carefree lifestyle of my youth had become increasingly harmful. Fat Head’s discussion of insulin resistance and fat storage resonated very well with my pre-med college days studying life sciences and my experiences with the Zone diet and the hormonal implications of foods. Fat Head also catalyzed my growing displeasure at a procedure-driven medical system and gave substance to my vague feeling that politics, not science, has infiltrated medical care.

Because my underlying cardiac problem ultimately turned out to be an alarming plaque burden, my research quickly lead me to Dr. William Davis’ Track Your Plaque forum, where I have been a very active member for the past two years. I became so impressed with Dr. Davis that he has been my cardiologist for the past year.  His warmth and prevention-minded attitude makes the journey from Dallas to Wisconsin entirely worthwhile. Thanks to my radical lifestyle changes, most of them flying in the face of conventional wisdom, I’m fortunate to be one of the TYP members who has shown dramatic plaque reversal, recently showing a 24% six-month decrease immediately following a horrific 83% increase the year before.

If I had heart disease, there’s no one in the world I’d rather have treating me than Dr. Davis.  Rocky’s in good hands.

His email continued:

Emboldened by a background as a technical writer in the fields of software, nanotechnology, and medical devices, I’ve spent the past year writing a book on preventive health that captures what I’ve learned and applied to my own condition.

I read the book before it was published and again last week, and it’s excellent.  When I consider recommending a book (publishers send me books I don’t recommend, by the way), I ask myself two questions:  1) Is the information useful to people who want to lose weight or become healthier?  2) Does it pass my “Aunt Martha” test … that is, could your Aunt Martha read it and understand it?

The answer to both questions in this case is an enthusiastic yes.  Rocky has a gift for taking the science of nutrition and health and explaining it clearly, and it’s obvious from the many topics he covers and how well he covers them that he jumped into that science head-first.  I learned more from this book than I thought I would, which is always a pleasure.

As the title indicates, Don’t Die Early isn’t about weight loss.  It’s about how to live to a ripe old age and remain healthy along the way.  Weight loss is covered in a section about dietary fallacies, but Rocky’s goals for the reader are the same goals he set for himself:  1) understand the true causes of heart disease, diabetes and inflammation; 2) learn how to reliably measure and track the instigators or markers of those diseases, such as LDL particle size and A1C; and 3) take specific actions to reverse disease or prevent it from developing in the first place.

That’s what Rocky did, and was rewarded with excellent results:

In the first six months after embracing a preventive lifestyle, I accomplished the following:

  • Lowered my body fat percentage from 20% to 11%
  • Lowered my inflammatory markers by as much as 75% (you’ll learn about inflammation later)
  • Reduced my triglycerides by more than 90% (this happened in the first 30 days)
  • Improved every measurable aspect of my cholesterol
  • Improved my fasting glucose by 25%
  • Improved my muscle tone and stamina
  • Lowered my blood pressure from an average of 145/90 to an average of 115/70
  • Reduced my resting heart rate by more than 13 points

As impressive as these results might appear, I’m not revealing them so that you’ll invite me to your next party. They are to show you what is very attainable for anyone who makes the proper lifestyle changes.

The book is divided into two parts.  Part One, titled The Major Players, provides in-depth explanations of heart disease, diabetes and inflammation.  The message Rocky pounds home in these chapters is that it’s important not only to understand what these diseases actually are and what causes them, but to know specifically what to measure so you can tell if you’re developing them.  Sadly (but not surprisingly), the tests your doctor orders often add up to too little, too late:

Imagine having the following conversation with your child’s teacher:

You: How is my daughter doing in school this semester? Is she learning the required material?

Teacher: Based upon her age, and what we infer her socioeconomic status to be, as well as her assertions that she does homework on a regular basis, we believe she has a very high likelihood of having mastered this semester’s materials acceptably.

You: Excuse me? What does this mean? Have you tested her on the material?

Teacher: No, we compared her socioeconomic status, apparent nutritional health, and her testimony that she does her homework regularly to a statistical model we have and there’s a strong correlation between your daughter’s parameters and students who mastered the coursework. Oh, and we measured the callouses on her writing fingers and they indicate that she’s likely doing quite a bit of writing, which our statistical model shows increases by 22% her chances of having mastered the material. Overall, we feel very confident that she has mastered this semester’s material.

You: I don’t understand why you’re comparing her to a statistical model instead of testing her. Do you ever plan on testing her?

Teacher: Only if she shows clear signs of having failed to master the material would we test her. As long as her parameters correlate acceptably to the statistical models of a successful population, we will assume that she is mastering the material.

Does this sound like a school you would like your child to attend? Does estimating your child’s performance by comparing indirect parameters to a statistical model sound like an ideal way to gauge her mastery of the subject matter? It certainly doesn’t to me.

Yet this is how our medical culture typically measures the risk of coronary artery disease during routine preventive exams.

That’s why Rocky didn’t know he was developing plaque in his arteries.  He quotes Dr. William Davis, who says that the traditional methods of identifying people at risk for heart disease miss 90 percent of the people who eventually have a heart attack.  If you want to know if you’re developing plaque, you should (surprise!) measure plaque.

The standard test for measuring diabetes often misses those who are developing it as well:

Many of the clinical guidelines in use today encourage a physician to use fasting glucose as the sole indicator of one’s diabetic health. Seeing a fasting glucose level within the laboratory “normal” range, both patient and physician are satisfied that the patient is at low risk of Type 2 diabetes.

Now that you know more about how diabetes progresses, you can see that gauging the risk of Type 2 diabetes solely on fasting glucose is terribly ineffective. An abnormal fasting glucose is typically the last commonly used indicator to show the presence of diabetes. In fact, by the time your fasting glucose is no longer in the normal range, you are already diabetic.

Throughout these chapters, Rocky explains which health markers you should be actually measuring and which specific tests you can request from your doctor or order online and perform at home.

Fat Head fans will be familiar with much of material on heart disease and diabetes, including how much of the standard advice from so-called experts is wrong.  But even though I’ve read quite a bit on those topics, I kept coming across information in Don’t Die Early that was either new to me or struck me as particularly well-explained.  Here are a couple of sample bits:

Perhaps the biggest problem with insulin being a growth hormone is that not all of the tissues in the body become desensitized to increasing levels of insulin at the same rate. As a person becomes more and more insulin-resistant, cells that are much less affected continue to respond to the ever-increasing levels of insulin, growing and multiplying more rapidly as insulin levels increase. What cells exhibit this behavior? The endothelial cells that form the lining of your arteries, for one. As these arterial cells multiply more rapidly, the lining of an insulin-resistant person’s arteries thicken and grow inward, hastening coronary artery disease. This is one of the reasons why so many diabetics die from heart disease.

A typical cell membrane is composed of a lipid bilayer, which is just what it sounds like: two layers of fatty acid molecules, sandwiched together to give cell membranes their much-needed strength. This bilayer also forms an effective barrier to foreign substances, through the use of embedded receptors that are designed to transfer only specific things into and out of the cell. The impermeable lipid layers and their receptors serve as gatekeepers to help ensure the health of a cell by transferring only what the cell needs, in the right amounts, into the cell and removing unwanted substances from within the cell. Virtually anything that the cell consumes or produces is transported this way, ensuring that only the proper substances ever reach the interior of the cell.

As with most structures of the body, the cell’s lipid bilayer needs to be constantly maintained, which the body does by constantly replenishing the crucial fatty acids that comprise the cell membranes. What happens if a person eats a trivial amount of healthy omega-3 fatty acids and an abundance of unhealthy omega-6 fatty acid? Simple, the body does its best with what you give it and will use the omega-6 fatty acids instead.

What this means is that in addition to their role in promoting inflammatory chemical messengers, omega-6 fatty acids become incorporated into virtually every cell in your body.

Part two of the book, Lifestyle Changes, includes chapters on dietary truths and fallacies, setting goals, and taking action.  Again, the chapter on diet covers ground that’s largely familiar for Fat Heads (Gary Taubes and Dr. William Davis are quoted several times), but it’s well written and worth the read.

In the final two chapters, Rocky urges the reader to do enough testing to establish several baseline measurements (blood sugar, fasting insulin, vitamin D concentration, LDL particle size, etc.), set specific and attainable goals for improving those markers, then work  to meet them.  If you’ve ever wondered what your fasting insulin level or vitamin D concentration should be (ideally, anyway) this chapter will tell you.   Rocky also gives advice on how to improve your odds of meeting each goal.  For example, to achieve optimum triglyceride levels:

In summary, the best approach to reducing one’s triglycerides is

  • Eliminate grains, replacing them with vegetables, nuts, and berries.
  • Minimize carbohydrates (especially fructose), eating them in sufficient moderation so as to never cause unfavorable glucose levels.
  • Consider supplementing your diet with omega-3 fatty acids from fish oil.
  • Speak to your physician about supplementing with niacin to help optimize your triglycerides.
  • All of the above steps will very effectively control your fasting triglycerides. To really take it to the next level, buy a Cardio-Chek triglyceride meter to measure your body’s response to different types of meals to identify exactly how sensitive your body is to specific types and quantities of fats. If you perform a small series of these carefully controlled tests, you’ll have infinitely more clarity on how to optimize your diet for the best possible postprandial triglyceride production (this will be especially valuable in determining whether saturated fat is good for you and at what level).

Near the very end of the book, there’s a section I’m sure many of you will relate to … the sub-chapter heading is Prepare To Be An Outcast. Here’s chunk of that section:

You may find yourself biting your tongue every time you see a friend, colleague, or loved one wolf down a low-fat, grain-based meal, laden with vegetable oil, as they complain about having acid reflux or autoimmune disorders.

You may see friends and loved ones struggle with weight problems while they eat low-fat foods that constantly elevate their blood glucose level, ensuring that they live life as the “walking starving,” trying unsuccessfully to lose weight.

Even your more health-conscious friends may not appreciate your one-upping them on matters of health and nutrition. Responding to their enthusiasm for fish oil with “Yes, but do you track your daily intake of omega-3 and omega-6 fatty acids and have you ever checked your Omega-3 Index?” will make you sound like a know-it-all.

It’s painful to realize that some people just don’t want to hear that there’s a better future available to them if they just abandon the current thinking on what’s healthy and what’s not. Many refuse to believe that they could ever get bad advice from a physician or from a “trusted” source like the USDA, the American Dietetic Association, or the American Diabetes Association. In such cases, you may just need to silently watch them continue on their path.

Sadly, that’s true.  But for people who are open to trying a new path to health, Don’t Die Early is an excellent guidebook.

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56 thoughts on “Book Review: Don’t Die Early

  1. Jose Marti

    Very interesting.However I still see too much emphasis put on constant medical tests(which I never do).If we follow the proper diet and feels ok I just don’t see the need for this obsessive testing.On the other hand, the bylayer of fats in the cells membranes are mostly saturated fats as well as in the linings of the heart(which feeds on palmitic and stearic acids,both saturated),so I don’t see the recommendation on Omega 3 pertinent since this comes mostly from polysunsaturated fats which are proven to be highly unstable as Jake pointed out and easily degraded in the body unless they are protected by a healthy dose of saturated fats.I offer myself willingly to a diet of saturated fats and then,what else?, being tetsted.

    Reply
  2. Jose Marti

    Very interesting.However I still see too much emphasis put on constant medical tests(which I never do).If we follow the proper diet and feels ok I just don’t see the need for this obsessive testing.On the other hand, the bylayer of fats in the cells membranes are mostly saturated fats as well as in the linings of the heart(which feeds on palmitic and stearic acids,both saturated),so I don’t see the recommendation on Omega 3 pertinent since this comes mostly from polysunsaturated fats which are proven to be highly unstable as Jake pointed out and easily degraded in the body unless they are protected by a healthy dose of saturated fats.I offer myself willingly to a diet of saturated fats and then,what else?, being tetsted.

    Reply
  3. Rocky Angelucci

    Hello, Jose!

    Your comments illustrate very well some of the reasons I wrote the book. How closely one chooses to test various things will depend heavily upon the individual condition. For example, I don’t know a single 20-year old man whom I would encourage to have a coronary calcium scan to detect cardiac plaque. That same person at age 40, however, may be an entirely different matter. A 40-year old man whose cardiac health has only been assessed using indirect indicators like standard cholesterol tests or a stress test, can have a very false sense of security regarding his cardiac health. In such a case, a calcium scan can provide inexpensive, highly valuable insight. Then what? It depends. If the scan showed no plaque there would probably be no reason to test again in a year. Maybe scan again five or 10 years, depending on a bunch of other individual factors, as discussed in the book.

    Similarly, testing one’s lipids using advanced subfraction analysis is far more critical for a person who already has heart disease and who is attempting to reduce the cardiac plaque that their calcium scan revealed. Such a person, in the face of a rapidly increasing plaque level, may need to test his lipid subfractions “obsessively” for six months or a year while he’s making careful adjustments in his diet and lifestyle to zero in on the perfect combination that results in plaque regression. On the other hand, a 25-year old low-carber would probably have little concern for such careful monitoring, possibly just doing so once a year at an annual physical, just for the bragging rights.

    For some things, however, anyone could benefit. Virtually everyone in modern society is severely magnesium deficient, for example. A simple blood test to identify RBC magnesium levels would reveal the need for adding a very inexpensive magnesium supplement to one’s diet (and/or increase foods containing magnesium). Vitamin D? Most are deficient in vitamin D and the metabolism of vitamin D is so highly variable that it’s virtually impossible to make a generic recommendation for supplementing with vitamin D. A vitamin D blood test once a year would avoid speculation. Having ideal vitamin D and magnesium levels would pay great long-term dividends, especially to people in their 20’s. Even if I were in my 20s and eating very well and feeling great, I wouldn’t want to wait until I was 40 years old to find out that some quirk in my metabolism caused my vitamin D level to be needlessly low for the past 20 years.

    We don’t want to test or worry needlessly but nor do we want to overlook a silent killer like heart disease, which is predicted so poorly by traditional medical testing.

    Don’t Die Early replaces today’s generic advice with specifics, so that every individual, no matter their age or condition, will have the understanding necessary to chart their own individual path towards optimal preventive health.

    Reply
  4. Rocky Angelucci

    Hello, Jose!

    Your comments illustrate very well some of the reasons I wrote the book. How closely one chooses to test various things will depend heavily upon the individual condition. For example, I don’t know a single 20-year old man whom I would encourage to have a coronary calcium scan to detect cardiac plaque. That same person at age 40, however, may be an entirely different matter. A 40-year old man whose cardiac health has only been assessed using indirect indicators like standard cholesterol tests or a stress test, can have a very false sense of security regarding his cardiac health. In such a case, a calcium scan can provide inexpensive, highly valuable insight. Then what? It depends. If the scan showed no plaque there would probably be no reason to test again in a year. Maybe scan again five or 10 years, depending on a bunch of other individual factors, as discussed in the book.

    Similarly, testing one’s lipids using advanced subfraction analysis is far more critical for a person who already has heart disease and who is attempting to reduce the cardiac plaque that their calcium scan revealed. Such a person, in the face of a rapidly increasing plaque level, may need to test his lipid subfractions “obsessively” for six months or a year while he’s making careful adjustments in his diet and lifestyle to zero in on the perfect combination that results in plaque regression. On the other hand, a 25-year old low-carber would probably have little concern for such careful monitoring, possibly just doing so once a year at an annual physical, just for the bragging rights.

    For some things, however, anyone could benefit. Virtually everyone in modern society is severely magnesium deficient, for example. A simple blood test to identify RBC magnesium levels would reveal the need for adding a very inexpensive magnesium supplement to one’s diet (and/or increase foods containing magnesium). Vitamin D? Most are deficient in vitamin D and the metabolism of vitamin D is so highly variable that it’s virtually impossible to make a generic recommendation for supplementing with vitamin D. A vitamin D blood test once a year would avoid speculation. Having ideal vitamin D and magnesium levels would pay great long-term dividends, especially to people in their 20’s. Even if I were in my 20s and eating very well and feeling great, I wouldn’t want to wait until I was 40 years old to find out that some quirk in my metabolism caused my vitamin D level to be needlessly low for the past 20 years.

    We don’t want to test or worry needlessly but nor do we want to overlook a silent killer like heart disease, which is predicted so poorly by traditional medical testing.

    Don’t Die Early replaces today’s generic advice with specifics, so that every individual, no matter their age or condition, will have the understanding necessary to chart their own individual path towards optimal preventive health.

    Reply

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