Welcome to Doc’s Opinion.
The blog is written and edited by Axel F. Sigurdsson MD, Ph.D., FACC.
Dr. Sigurdsson is a cardiologist at the Department of Cardiology at The Landspitali University Hospital in Reykjavik Iceland. He also practices cardiology at Hjartamidstodin (The Heart Center) which is a private heart clinic in the Reykjavik area. He is a Fellow of the American College of Cardiology (ACC), The Icelandic Society of Cardiology and the Swedish Society of Cardiology. He is a past president of the Icelandic Cardiac Society.
Dr. Sigurdsson is also a licensed Aviation Medical Examiner. He held the position of Medical Director at Icelandair from September 2004 to August 2019.
Axel F. Sigurdsson MD, PhD
I studied medicine at the University of Iceland between 1978-1984. Upon receiving my medical license, I went to Sweden at the beginning of 1988 for further education and training.
I spent the next eight years at the Sahlgrenska/Östra University Hospital in Gothenburg, Sweden, specializing in internal medicine and cardiology.
In October 1993, I defended my doctoral thesis at the University of Gothenburg, termed “Neurohormonal Activation in Patients with Acute Myocardial Infarction or Chronic Congestive Heart Failure – With Special Reference to Treatment with Angiotensin Converting Enzyme Inhibitors”
In 1995-1996 I was a clinical fellow at the Royal Jubilee Hospital in Victoria BC, Canada. The primary purpose of my fellowship was training in interventional cardiology, mainly coronary angiography and percutaneous coronary interventions (PCI’s).
I have published more than 100 scientific abstracts, articles, and book chapters in international journals and textbooks.
Since 1996 I have worked as a clinical cardiologist at the Landspitali University Hospital in Reykjavik Iceland as well as practicing internal medicine and cardiology at Hjartamidstodin (The Heart Center) in Kopavogur, Iceland.
Doc’s Opinion
I started writing Doc’s Opinion in the spring of 2012.
My aim is to write informative high quality articles based on medical science. Evidence based medicine is at the core of my writing.
The main purpose of this website is to provide up to date information on preventive medicine, healthy lifestyle, and nutrition, and to provide reliable and practical information about different medical conditions. Although heart disease plays a central role, I also focus on many other areas of medicine.
My goal has always been to write articles that can be read and appreciated by health professionals as well as the general public. Of course, this is a difficult challenge because the gap between the medical literature and what ordinary people can read and understand may sometimes be difficult to overpass.
Bringing medical science to the masses is my mission.
This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
A List of Some of my Published Scientific Papers
Evidence, Not Evangelism, for Dietary Recommendations
Outcome of myocardial revascularisation in patients fifty years old and younger.
Benefits of Statins in Healthy Elderly Subjects What Is the Number Needed to Treat?
Screening for risk factors of sudden cardiac death in young athletes
A comparison of all coronary angiographies (CA) performed in 2008 in Iceland and Sweden
Angiographic in-stent restenosis is not related to the inflammatory markers hs-CRP and MPO
Diagnostic accuracy of 64-MSCT for detection of in-stent restenosis
The effect of physical training in chronic heart failure
Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths
Results of percutaneous coronary interventions in Iceland during 1987-1998.
In-hospital heart failure – epidemiology, prognosis and treatment
The role of neurohormonal activation in chronic HF and postmyocardial infarction
ACE inhibitors in patients with minimal or asymptomatic left ventricular dysfunction
Short- and long-term neurohormonal activation following myocardial infarction
Enalaprilat in acute myocardial infarction: Tolerability and effects on the reninangiotensin system
Anti-arrhythmia agents after myocardial infarction should be used with caution
The Etiology of Bacterial Cellulitis as Determined by Fine-Needle Aspiration
Dear Dr. Sigurdsson: I was directed to your statin link by a correspondent in StoppedOurStatins, a yahoo group I belong to. Thank you for the kind and accurate review of my book, The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs. Indeed, I have no product line, or anything else to sell, except my expertise after more than 35 years as a cardiologist who has also been involved in clinical trials of cholesterol lowering drugs. I am very concerned about the long term risks of statins, particularly on the nervous system. I spent one memorable day in Iceland in… Read more »
Dear Doctor Roberts. Thanks for your interest in my blog.
I do think that you have written an important book. I deal with the question of statin therapy almost every day in my practice. These drugs have certainly given us the opportunity to affect the progression of cardiovascular disease and they have improved prognosis for many patients. However, the side-effects during long-term treatment have not been entirely clarified. Millions of people worldwide are taking statin drugs. Therefore it is so important for medical professionals and people in general to have knowledge about these drugs, both the positives and the negatives.
Hello Dr. Roberts.
I am a student at UC Berkeley working on a project that is exploring statin alternatives to reduce high cholesterol. I would love if I could have a couple of minutes of your time to talk about the high cholesterol problem and learn more about it.
Thank you!
Cecilia
Dear Dr Sigurdsson… I am a physician practicing in the Boston area…. I recently read your comments regarding LDL-C and LDL-P..and their relation to CVD risk factors…You did a wonderful job of elucidating a very complex subject…I too believe that atherosclerosis is an inflammatory disease rather than a lipid disorder as are many of the degenerative disease so prevalent in the USA today. I believe there is enough solid peer reviewed evidence to say in the USA that these diseases are caused by our American diet which is too high in Omega-6s and too high in high glycemic index (fast… Read more »
I am sorry if I missed the link of where to contact you off screen…. I am wondering if you have managed to read this rather lengthy paper which is wonderfully (historically) informative and seriously challenging to the current Diet Heart Hypothesis? https://qjmed.oxfordjournals.org/content/105/6/509.full.pdf
Clare McHarris
Clare. Thanks for providing the reference. I hadn’t seen this paper by Dr. Grimes before. Really looking forward to read it.
I read it. Not a particularly interesting nor informative paper. Grimes really has quite a few problems in his argumentation: 1) His claim that CHD isn’t a multifactorial disease and that its cause is a “mystery”. Err, not exactly. He provides no evidence supporting this, apart from anecdotes (“I recently saw a man …”) and abundant use of a logical fallacy called “false dilemma”. The evidence pointing to a multitude of risk factors behind CHD is – to put it mildly – enormous. To deny this is practically the same as to make a religious statement in scientific discussion. 2)… Read more »
Mie. I disagree with you about this paper. Of course this is not a scientific study. It is an opinionated review. I found it very intersting. Dr. Grimes challenges many of the current beliefs of the medical community. But if nobody does that, there won’t be any progress. Dr. Grimes argues that coronary heart disease is an epidemic, likely caused by an unknown environmental biologic factor, possibly a microorganism. Of course I´m not able to say whether he is right or wrong. However, he makes an interesting case. I enjoyed the historical prespective. I don’t know whether Dr. Grimes is… Read more »
“Mie. I disagree with you about this paper. Of course this is not a scientific study. It is an opinionated review.” Indeed. Nor did I claim otherwise. And I did recommend the paper, remember? 🙂 “Dr. Grimes challenges many of the current beliefs of the medical community. But if nobody does that, there won’t be any progress.” Axel, a mere challenge means NOTHING. It’s the content & argumentation & new data that is the key. Grimes’ points are neither new nor convincing. “Dr. Grimes arguments that coronary heart disease is an epidemic, likely caused by an unknown environmental biologic factor,… Read more »
Dr. Grimes conclusion could also imply that risk factors may not important anymore, because the epidemic is almost over. That could be a dangerous assumption, not least if it is based on pure speculation. Anyhow, I enjoyed reading the article. Reminded me about how little we know, and how much we don’t know.
After reading the paper I wrote to Dr. Grimes. In his reply he said, “I do not believe that coronary heart disease is anything to do with diet…The rise of the epidemic and the fall of the epidemic could not possibly have been due to a dietary factor.” I felt inclined to disagree at first. But upon further reflection I decided he may have a valid point. It may be that dietary choices have an impact on vulnerability. In other words, food choices may either furnish protection or accelerate the onset of the disease. Regarding the Kitava Study he noted,… Read more »
David, he doesn’t have a valid point. IF he had stated that CHD isn’t just about diet, then yes, the point would’ve been valid.
But to state that diet has NOTHING whatsoever to do with CHD is simply false given the amount of evidence.
Mie, My take on what he said is that the CHD epidemic has nothing to do with diet. I suggest you write to him for clarification.
“This bacterial infection -thing as all the rage back in the 90s. You do know why it died away, don’t you? No evidence” WHAAAAAAAT? Here are some Pubmed refs for you: Microbe/MI: 24001883 9244203 10550273 10738358 11221586 10695364 16441448 9859707 11136684 24820983 A-biotx/MI: 25752357 25667617 25737169 25704525 25681693 25703120 11927522 9244203 9952202 12045171 10550273 12045171 9259655 27346378
You are most welcome. It is very well written, easy for non scientific people like myself to follow too. It does not answer questions such as particle size ApoA – ApoB etc., but certainly gives much stimulus for thought. Professor Uffe Ravnskov has (for a long time) theorised that heart disease has a bacterial underpinning, and this paper would seem to perhaps hint at a similar model. Looking forward to your thoughts once you have had time to read it and comment.
Patients have been indoctrinated that the cause of their heart disease/artery disease is from consuming fats… those bad ones which are portrayed as building up inside of arteries, causing blockages and heart attacks/strokes. To say that this has been simply a marketing ploy to scare people into taking drugs is an over simplification. However there is new work being done now to attempt to identify, early, when insulin spikes are doing damage to the body (? vascular system) – not only for diabetes diagnosis. Fats, per se (excluding trans-fats) are not responsible for insulin/sugar spikes – however carbohydrates are….. this… Read more »
hi doc. I am 47, non smoker, no family history but i have subclinical hypothyroidism. Due to high LDL of 211 and cholesterol 253, I run extra tests my self. Here are the results, HDL 59.5, I am homozygous C677T mutation, APO P 115, LpA 9.2, HSCRP 0,7, LP-PLA2 293, homocystein3 18 but lowered to 13 in one month with vitamins, HBA 1 C 5,3, interleukin 1 below 5 and interleukin 6 below 1.5, fasting gloucose 100, MPO < 1:10, BNP 21, CoQ10 1510, small LDL-P 482, LDL size 21.9, HDL-P total 23.3, LDL-P 2146, LP-IR 42, LDL-C 174, Carotides… Read more »
Is coconut oil(virgin cold pressed) good to take…a tablespoon a day for heart health or is it too much saturated fat?
Is virgin cold pressed coconut oils safe to take by mouth…one tablespoon a day…for heart health?
I’m not aware of any studies suggesting that coconut oils will improve heart health or reduce the risk of heart disease. I also don’t know of any evidence indicating that coconut oils are harmful. So, like so much else in the world of diet and nutrition we really don’t know. Sometimes other factors have to be taken into account, such as body weight, family history, metabolic status and blood lipids. So, my honest answer to your honest question is: “I don’t know” 🙂
Thanks for the quick reply Doctor…I appreciate the info you provide here…
Dear Dr. Sigurdsson, I am a 50 year old female, 5’5″ 144 pounds. Father had a heart attack at 60, Paternal grandfather died from heart attack at 63, Maternal grandfather from heart attack at 43. No history of heart disease in any females. January of last year my total cholesterol was 278. LDL 103, HDL 146, Triglycerides 54. My Apo B was 77, LDL-P was 1554. Lp(a) Mass 63. My doctor started me on a statin. Labs 9 months later show total cholesterol 252, LDL 56, HDL 171, Triglycerides 57, Apo B 51, LDL-P 793 and Lp(a) Mass 78. Unfortunately… Read more »
Dear Dr Sigurdsson, I am female, 61 years old, and quite confused about whether or not to take statins. Two out of three cardiologists have strongly recommended them for me but I do not like the idea of taking them and have not taken any yet. My father had CVD and died at 82 (after back surgery). My mother is 83, quite healthy. She and I both have Mitral valve Prolapse. Mine is mild. Her bloodwork results and mine are very similar and always have been. My blood pressure is always on the low/low normal side, never elevated. I have… Read more »
Dear Dr Sigurdsson,
Just wanted to thank you for taking the time to write the blogs. Truly interesting stuff to read.
Thanks
Andrew
Thanks Andrew. Appreciate your kind words and interest.
Axel
Hello – how can I contacct you with an important update to one of the links on this page https://www.docsopinion.com/health-and-nutrition/high-blood-pressure/
[email protected]
Dr. Sigurdsson,
I am currently studying to become a dietitian. I love your objective, yet honest posts regarding many controversial/confusing nutrition topics. I have subscribed and look forward to reading you future posts.
Ashley
Thank you Ashley. Appreciate your interest. I’m glad you find the site useful, and thanks for taking the time to mention it.
Wish you all the best with your studies.
Hi Dr. Sigurdsson, This is a great piece. I would greatly appreciate if you included a mention of my book, which is the source of your arguments. The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet (Simon & Schuster) 2014. My book was the first to make this case for rehabilitating saturated fats. I’m so glad to see that these ideas are getting out there, and would really appreciate your citing the source! thank you.
Hi Nina.
I have responded to you by e-mail.
Best regards
Axel
hello i am 48 in good health female dontsmoke or drink unable to ecercise due to back pain and unable to tolerate statins. my recent chol 273,tri 212,hdl66,ldl 165.risk ldl/hdl is 2.4. what is my option. thanks
Dr. Sigurdsson,
I have been informally studying nutrition and fitness for the past five years or so and only today stumbled upon your blog while researching ways to lower LDL-P. You have a way of making difficult concepts easy to understand, and I look forward to reading more of your posts.
I am not a physician, but my wife is Swedish, and I studied law at the University of Victoria during your tenure at Royal Jubilee, so there are a couple of oblique connections between us 🙂
Wishing you a healthy and prosperous 2015.
With warm regards,
Richard
Hi Richard
Thanks for the comment and your interest in my blog.
Nice to hear about our “oblique connections”. Sometimes I get the sensation that the world is smaller than we think.
By the way, may son will finish his Master’s degree in law from the University of Iceland next spring.
Hope you continue to visit Doc’s Opinion.
Wish you all the best for 2015
Hello, I have really enjoyed reading your blogs. I have been getting an NMR profile for the past 3 years I am so confused by the results and what effects the numbers. I had read that increasing cardiovascular and weight training exercise will increase HDL but NOTHING seems to raise my HDL. I tried prescription Omega 3’s also. My HDL at it’s highest was 31 at age 38 and at it’s lowest at age 28 at (13).. YES!!! 13!!!!! Here is my latest NMR profile results. I currently weigh 150 lbs and I’m 5’9 and female. This is the most… Read more »
HI Doc, I love your website! I was hoping I could get your opinion on my numbers. I finally got my family Doc to give me script for a fractional lipid panel, as well as a CBC. I am not sure that he really comprehend all of this, as he didn’t know I could even get a fractionated lipid panel. Some background: I am a 52 year old male 6’5″, lost weight last year from 246 to 227, Father is 86 and has some of the same type number as me- low HDL, elevated LDL,. Mother is 82 and has… Read more »
Several months ago I had some routine blood work done. At the time my total cholesterol was a whooping 314 even though I have been a vegetarian for over 35 years, exercised, and fasted two days a week. My triglycerides were very good and both the LDL and HDL needed improvement although not esp.bad. My doctor said he was not willing to prescribe a statin for me yet and with his okay I started to take red yeast rice. A few days ago I had blood work done again (at a different facility) and now my total cholesterol is 211…an… Read more »
Susan
This is not surprising. Red yeast rice is known to lower cholesterol.
Hello. I agree with the doctor’s opinion that LDL-P might be a greater indicator for CVD. However, the question really is about what role cholesterol plays in the body and cholesterol is a supportive one. The higher number of LDL is just a symptom of your body repairing damage caused by other factors. Sending multiple ambulances to a bad accident scene doesn’t make the ambulances bad ambulances. The problem isn’t the ambulances. The problem, theoretically was the drunk driver. LDL, whether small particles or not treats systemic inflammatory conditions in the endothelium of the arteries The contents of the LDL… Read more »
I received a call from my doctor office my LDL was a 5 and my HDL was 79. asked me to come back in something is wrong they are gone to redo the test. My mother had a heart attack at 28 years old and has Mitro Valve prolapse since. Someone please let me know what the low LDL level means. i’m googling things and it’s making me scared. I just turned 40 years old and have a severe anxiety disorder so the constant pain in my heart i just think it’s my anxiety
thanks colleen
Colleen,
Her’s some info https://www.docsopinion.com/health-and-nutrition/lipids/ldl-c/
Dear Dr. Sigurdsson
Do you know about institutions/courses in the US or Europe, directed to physicians/dietitians who want to formally specialize in low-carb diets as treatment to diabetes ?
Low-carb is still not recognized officially as a sound treatment in Brazil, so I’m searching for a foreign institution which can provide training – brazilians in general trust a lot on anything that comes from US/Europe…
Best regards!
Hilton
Dear Dr. Sigurdsson
I really appreciate your blog. This might be a weird question but I’am a young nurse from Scandinavia who for is highly interested in critical errorfinding in scientific papers especially in the field of medicin and nursing. If you were me what “path” or education choice would you go for.
I really hope you can help me with this different kind of question.
Yours sincerely Sean Jobe.
@docsopinion:disqus – My name is Vet and I work for Sovrn Holdings- The third largest ad exhange in the world. Id love to talk to you about your monetization strategy for this site. please email me at [email protected]
I live in the UK where doctors haven’t heard of the Try/HDL ratio.
So I have an important query about mention of a conversion factor mentioned for those in Canada & Europe. https://www.drsinatra.com/the-most-important-cholesterol-ratio-to-watch/
Whether both numbers are in m.mol/L (as in Europe), or, in mg/dL (as in US) it is a RATIO!
A ratio of two (mass-per-unit-volume) density-units is surely the same (across measurement systems) as long as the two are consistent with each other within their own system???
Please can someone clarify, I speak to the doc. tomorrow.
The molecular weight for TG and HDL-C is not the same. Therefore, the conversion factor for these two is not the same. Hence, the reference ratio for the TG/HDL-C ratio changes when you convert.
This is what you should use in the UK
TG/HDL-C ratio less than 0.87 is ideal
TG/HDL-C ratio above 1.74 is too high
TG/HDL-C ratio above 2.62 is much too high
Thank you for those parameters but can I just divide the two mmol/L measures directly
1.6 (TG) over 1.36 (HDL) to get ratio 1.17 ? (fairly good?)
I ask because, due to TC to HDL ratio of 4.6, my doc wants me to take a statin & I’m resisting a bit.
Reading your assertions about Dr. Perlmutter, I’m wondering if you may have missed a crucial detail in his book. The book talks about how grains themselves have changed. In is own acknowledgement of the Mediterranean diet’s inclusion of grains, he talks about how not only wheat has changed but how the processing of it has changed. It has a ton more gluten in it than it used to, and my own research indicates that it’s processed more quickly and shipped when green.
You may have a point here and this is certainly something we should take into consideration when talking about the health effecst of grains. However, although I’m generally in favor of carbohydrate restriction and eating more healthy fats, I still miss the scientific evidence for most of Perlmutter’s claims. Don’t misunderstand me, I’m absolutely not promoting grains, at least not for those who are insulin resistant. Is there any study that you know of that has compared the health effects of grains as the used to be and the “modern” typre of grains?
Curious how they would get a hold of “paleo” grains to do the study. However, the studies that Pelmutter reference go back to the 60s and before. It’s not like they were published in Yoga Journal. They were published in the Journal of Neurology and other notable publications. Just hasn’t trickled down to the glyphosate-loving citizens yet. Whatever the issue, it’s without a doubt that all attention must be focused on inflammation.
Pardon my post as I am quite new to this and maybe off subject bit. Could you help me understand the Coronary Calcium Scan, the test that ranges from 0 to 401 but can get scores upward to 1000. Is there a way you can help me understand how score interpretation relates back to actual CAD disease as this is an invasive test and not always a direct correlation to occluded artery percentage. My wife is a pillar of health, eats right, no fat, vegetarian and never smoked or drank etc. She has been on Crestor for years which appears… Read more »
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Hello Dr. Sigurdsson
I am a student at UC Berkeley working on a project that is exploring statin alternatives to reduce high cholesterol. I would love if I could have a couple of minutes of your time to talk about the high cholesterol problem and learn more about it. I can also send you an email with questions if that works better
Thank you!
Cecilia
Dear Dr. Sigurdsson: I am a 60 year old female (5’7′ , 118 lb.) recently diagnosed with PVD and AFIB. I have had 5 angioplasties (3 on one leg and 2 on the other) in the last 6 mo. I do not have diabetes, do not smoke have normal blood pressure and LDL (although now down to 63 with statins). I eat a healthy (Mediterranean-style) diet and, until claudication, exercised regularly (still do, but leg pain prevents me from getting a real work out). I take 81 mg asa, 75 mg Clopidogrel, 25 mg Metoprolol, 40 mg Atorvastatin, Gabapentin 600… Read more »