Cardiovascular Disease is Not Just About the Heart

I listened to another great podcast on Dr. Mark Hyman’s Farmacy – Longevity Roadmap series.  He and his guests from The Ultrawellness Center where they focus on a functional medicine approach to treat patients, talk about drivers of heart disease and what we can do to prevent it.

Here are the highlights:

Cardiovascular disease (CVD) is not just about the heart

You need to look at the whole vascular, endothelial and lymphatic system.

• The endothelial layer is the cell layer that lines inside of our arteries and this needs to relax to allow blood to get to all the tissues in the body. If this does not relax, blood pressure will go up. It can take years of endothelial dysfunction before one can develop hypertension.
• Oxidative stress and inflammation can damage the endothelium.
• Visceral fat (weight around the belly) actually secretes IL6 and tumor necrosis factors which cause inflammation of the body. So when men gain weight around the belly, they also have a higher risk of erectile dysfunction.
• Did you know that blueberries are rich in anthocyanins that contribute to the improvement of your endothelium? One cup of blueberries twice a day can drop systolic BP as much as blood pressure medication.

Insulin resistance is the enemy

• Insulin takes the food we ingest and gets it into cells to use for energy.
• However, the poor diet we eat forces our bodies to become insulin resistant which means more insulin is produced to get the energy into the cells. High levels of insulin cause you to gain weight around the belly and have been associated with heart disease, stroke, cancer and dementia.   
• Everyone should get their fasting insulin measured – why isn’t this standard practice?
• Fasting insulin of less than 12 is considered normal BUT ideal should be closer to 5! So if your insulin is between 7-12, you could be pre-diabetic. A high fasting insulin means you have insulin resistance. My levels vary between 5-9 so I check them regularly.

CVD is NOT about cholesterol

Rather, it’s about inflammation and how cholesterol responds.

• Cholesterol is not water soluble so it must be carried by lipoproteins (HDL/LDL). 
• LDL carries cholesterol from the liver to parts of the body where it’s needed.
• HDL carries it from the periphery of the body back to the liver for disposal. Like giant dump trucks taking away the trash, HDL carries cholesterol away to dispose of it so it is considered “good cholesterol.”
• Cholesterol has an affinity for inflammation. When the endothelial lining of the blood vessel wall gets inflamed, it creates an opening in the protective lining. When this happens, the immune system recognizes it as a foreign body and initiates an immune response – which makes the LDL flood to the inflamed area to cover it. This grows and turns into plaque which eventually prevents blood flow, leading to ischemic heart disease. That’s why cholesterol gets a bad rap even though it’s inflammation that’s causing it.
• Standard American diet staples like refined carbohydrates, processed vegetable fats (corn, soy, sunflower) and sugar all cause inflammation. It’s no surprise why heart disease is the number one killer in the US.  
• Statins for primary prevention have no role. Statins are poisonous to the mitochondria and can increase insulin resistance and diabetes. Statins should NOT be used for preventive heart disease. High cholesterol is NOT a statin deficiency!
• Around 0.5% of the population have what’s called familial hypercholesterolemia which is a genetic trait where one cannot get rid of cholesterol easily. If you have total Cholesterol of over 300 with LDL levels higher than 190, you may want to get tested to see if you have this genetic variation. This group of patients would really benefit from a cholesterol controlling medication like statins.
• Did you know that you can make your LDL get bigger and fluffier by removing sugar and processed foods from your diet? You should ask your provider for an NMR Lipid Profiles Test to determine the molecular structure of the lipoproteins (number and size). “Particle number” is a measure of how many LDLs you have and the size is how big/fluffy they are.  Small, dense LDLs penetrate into the endothelial layer and build plaque quickly. But if you have big LDL particles and fewer of them, you are at less risk. It’s covered by most insurance so ask your provider for the test.

What to take to optimize your cholesterol

• Plant sterols (compounds found in plants) will bind to cholesterol in the intestines and remove them via the stool. It’s been shown that 2 grams of plant sterols can lower LDL cholesterol by 10%. So make sure to include legumes, nuts and seeds in your diet as these are rich in plant sterols.
• Vitamin B3 (niacin) can have a positive impact on cholesterol – it can lower triglycerides and LDL and raise HDL. But work with your provider if trying niacin as it can cause very uncomfortable hot flushes.
• Fish oil has been widely studied to lower LDL cholesterol, TG and raise HDL. The rule of thumb is that if you eat less than 1.5 servings of oily fish per week, supplement with ~1 gram of fish oil per day. If you’re mostly pescetarian, you may not need additional fish oil.  Not a fan of fish? Flaxseed (1-2 TBPS) and nuts (1 oz daily) can also impact cholesterol. To minimize the healthy oils going rancid, buy fresh flaxseed and raw nuts and keep them in the freezer and take out as needed.
• If you’re taking statins, you should supplement with Co-Q10 as statins are known to inhibit Co-Q10. Co-Q10 is vital for body and mitochondrial function. Also, as we get older, our Co-Q10 levels drop so it may be a good idea to supplement.

Genes may load the gun but the environment pulls the trigger

• Inflammation, oxidative stress, insulin resistance, hormonal imbalance and toxins from bad diets, stress, nutritional deficiency, lack of exercise, etc. all lead to high cholesterol, high BP, high sugar levels and ultimately heart disease.
• BUT, 90% of all diseases including CVD are caused by the sum total of all our life inputs into our body: diet, activity, stress, sleep, relationships, connections, meaning, purpose, toxins, microbes, allergens and more.  So the good news is that we have control over almost all of it.

Adopt these 4 behaviors to prevent heart disease

• A multinational study of over half a million participants showed that four simple behaviors prevented 93% of diabetes, 81% of heart attacks, 50% of strokes and 36% of all cancers.  No medication can do that!
  • Stop smokingStick to a plant rich diet, low starch, nuts, seeds, with a moderate amount of quality fish and meatExercise – at least 150 minutes per week including resistance training
  • Maintain strong mental health with stress-relieving meditation and breathing techniques

Click here to listen to this podcast.