INSIGHT THE|TIDES

Protecting yourself against Cardiovascular Disease

Protecting yourself against Cardiovascular Disease
Dan Kenner, Ph.D., L.Ac.

There is an overwhelming amount of information on heart disease, but it’s extremely vital to sort through it because, according to the American Heart Association, 50 percent of the American population over age forty will develop cardiovascular or cerebrovascular disease (That means heart attack or stroke). And people in their 20s and 30s should realize that by the time they are over 40, the percentage could be even higher. We all need to know our options.

When former President Clinton went into the hospital to have a clogged artery opened in February 2010, the Associated Press declared that “there is no cure for heart disease.” Is that really true? Clinton had done everything his doctors instructed him to do but he is still expected to need “tune-up” cardiac by-pass surgery every few years for life. Former Vice-President Dick Cheney, who has had 6 heart attacks has taken statin drugs for over 20 years. His LDL cholesterol was 72 (mg/dL) when he had a heart attack in 2001. The now-famous Dean Ornish study (Ornish D, et. al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23): 2001-2007 1998)  has shown that coronary artery disease can be reversed, but the mainstream media message is basically, if surgery and drugs can’t control the problem, then it’s incurable. How’s that for controlling the message? If drugs and surgery can’t do anything, it’s incurable!

But the Ornish study isn’t the only one in the peer-reviewed scientific literature. There are hundreds of studies from mainstream medical journals even the most prestigious, that challenge this pharmaceutical industry-centered viewpoint. Let’s take an overview of heart disease prevention and treatment.

The Conventional Medical Approach
Cardiovascular diseases are diseases in which blood flow through essential arteries is blocked. Three strategies have been developed for prevention and treatment over the last 60 years. The first is lifestyle change including diet, quitting smoking, weight loss and exercise; this is often combined with prescription drugs and is called “Optimal Medical Therapy.” Interventions using angiography, angioplasty, plaque removal and stenting are also used, and there are surgical methods like coronary by-pass grafting. Today medical research supports the view that Optimal Medical Therapy and lifestyle management are not used enough and that there is a tremendous overuse of the high tech methods like coronary angiography (an angiogram is an X-ray test that uses a special dye and camera to take pictures of the blood flow in an artery), stenting (inserting an artificial tube into an impeded vessel), and coronary artery bypass surgery (grafting).   

Angiograms are in widespread use today, but in 1984 researchers found that if an artery looked blocked in an angiogram, it wasn’t necessarily medically significant! The degree of blockage did not correlate with a lack of blood flow downstream, and so clinicians should not depend on routine angiograms for diagnosis. How could that be? This is probably because in many cases collaterals form. Collaterals are blood vessels that form spontaneously, almost magically, when other ones are blocked. Studies on angina pectoris, deep chest pain, have shown that as many as 30% of cases simply disappear on their own, and it’s probably for the same reason – these new blood vessels form spontaneously. Research also revealed a considerable placebo factor in which “sham” surgery cleared up chest pain as reliably as actual surgical intervention. They actually opened people up and sewed them back up again to see how they would respond.
Fortunately a new technique that shows whether or not the narrowing of an artery is hazardous can help to target which arteries really need a stent. The technique called FFR (fractional flow reserve) has already shown positive results in reducing the death rate from heart attacks.

Optimal Medical Therapy: High cholesterol and high blood pressure were identified as risk factors, and prevention has concentrated on risk-factor modification through lifestyle adjustment and drug intervention. Blood pressure control has had a tremendous effect in reducing the incidence of stroke and death from stroke. The Framingham Cardiac Risk Score summarizes risk factors including age, sex, blood pressure, smoking, and cholesterol. Other factors like body weight, kidney function, and resting EKG also help predict heart attacks and stroke.

More invasive technologies – stress tests, radioisotope studies and the like offer little improvement over this basic risk score assessment. Coronary angiography is expensive and overused especially for patients who have no symptoms, AND especially when you consider that a severe angiographic stenosis or narrowing of the artery does not mean that it is clinically significant.
In a study with over 2000 patients with heart disease, it was found that there was no difference in the number of deaths, heart attacks and strokes between groups of patients who received stents and those that did not.  Since a stent costs over $50,000, this was a significant discovery for economic as well as medical reasons.

Expensive and Unnecessary
It is estimated that $35 billion is spent unnecessarily on stents and about $20 billion on unnecessary cardiac by-pass surgery. Coronary Artery By-Pass Grafting, unlike optimal medical therapy, does nothing for rough plaque--the actual cause for most heart attacks. If 70 percent of the 250,000 yearly Cardiac By-pass operations are unnecessary at $112,000 hospital cost per operation, approximately $20 billion is spent on unnecessary CABG surgery. And the plaque can return within months if the lifestyle changes are not carried out.

The Main Risk Factors
Rough plaque is arterial plaque around which blood clots form and eventually block blood vessels. Enlightened medical opinion maintains that we need to employ Optimal Medical Therapy, that is, the use of lifestyle and drug interventions more frequently and more intensively. What are really missing are better drugs and lifestyle changes to slow or stop the process of arterial plaque accumulation. The strategy of these lifestyle changes and drug interventions is to address the primary risk factors: cholesterol, blood pressure and obesity. First is the issue of cholesterol. The whole idea of dietary reform is built around an attempt to lower blood cholesterol, since high cholesterol is considered to be a risk factor.

The Framingham Study is used by those who endorse the cholesterol hypothesis. In this study approximately 5000 people were followed and studied every five years. After twenty-two years of research, the researchers concluded: “There is, in short, no suggestion of any relation between diet and the subsequent development of Coronary Heart Disease in the study group.” After a further twenty-seven years, the Journal of the American Medical Association carried a follow-up report that showed that dietary saturated fat reduced strokes.
In a meta-analysis published in 1992, this was a review of twenty-six studies, the authors concluded that: “Lowering serum cholesterol concentrations does not reduce mortality and is unlikely to prevent coronary heart disease.” One study that seemed to support the conventional recommendations was a Finnish trial published in 1975. In the five years that the trial ran, cholesterol levels were lowered significantly, and the study was hailed as a success. But in December 1991 the results of a 10-year follow-up to that trial found that those people who continued to follow the carefully controlled, cholesterol-lowering diet were twice as likely to die of heart disease as those who didn't!

Vegetable oils have been recommended to replace the “dangerous” saturated fats. Paints were once made from seed oils. Linseed oil, AKA flax seed oil was used as a paint base and used to make linoleum. Lin-oleum means LINseed OLEUM or oil. When petroleum-based paints came along about 50-60 years ago seed oils companies went into survival mode and began to seek new markets. In 1961 a corn oil producer launched a marketing campaign to popularize the word “polyunsaturated.” We little kids learning new math with polynomials caught on to the new term quickly.

Unsaturated vegetable oils, with aggressive marketing, became regarded as “heart healthy,” even though some of them cause thromboses (blood clots) in test animals. Even though they were used to fatten up livestock for the slaughterhouse because they suppress thyroid activity, even though they suppress immunity – soybean oil is used to suppress immunity in organ transplant patients to prevent rejection of the new organ by the immune system. 

Studies have shown that diet does not have such a direct effect on cholesterol production by the liver. All of our steroid hormones: testosterone, DHEA, androstenedione, etc. the estrogens, progesterone are made out of cholesterol. So is vitamin D. Sunlight helps convert cholesterol into this extremely important substance. The liver requires thyroid hormone for this conversion of cholesterol to hormones. When cholesterol is too high, doctors once considered it to be a sign of low thyroid activity. If the studies show that blood cholesterol levels are not related to dietary consumption, what causes high cholesterol? The thyroid could be one factor. Another theory is that cholesterol production is increased by the body to help repair damaged tissues such as inflamed arteries. All cell walls use cholesterol for growth and repair. Studies have shown that low cholesterol increases the risk of strokes and cancer and may increase gall bladder disease.
 
Do We Want To Stop Producing Cholesterol?
The use of drugs for lowering cholesterol goes back to the early 1960s. A drug called Triparanol was developed to cause the levels of blood cholesterol to fall by inhibiting the liver's ability to make cholesterol. Two years later they took it off the market because of serious side effects. Another drug was called Compactin, which used the same principle of inhibiting cholesterol synthesis in the liver, caused cancer in dogs and was quietly terminated. Today the statin drugs also are enzyme inhibitors and many of them are approved for lifetime use. The long term consequences of preventing cholesterol from being manufactured could be devastating. Low cholesterol increases cancer risk and is associated with some mental disorders including violent behavior.

If cholesterol is not a risk factor, what is? Triglycerides are the most common type of fat in the body. Some of the triglycerides are stored in the body as fat, but when the levels are high, some remains in the blood and this can cause problems with the health of the arteries. When both cholesterol and triglyceride levels are high, it is considered to be a sign of an increased risk for heart disease and stroke, more so than if cholesterol or triglycerides alone are elevated. Triglycerides are strongly affected by sugar intake.

There is a type of cholesterol called VLDL (very low density lipoprotein), which is not naturally produced by the liver. It is a type of sludge that accumulates in the blood and liver when triglycerides are high. When VLDL are secreted, they carry almost all of the triglyceride in the blood-stream (they are about 85% triglycerides themselves). Their function is to carry triglycerides from the liver, possibly to avoid the development of fatty liver, taking them to the peripheral tissues for storage in adipose tissue or for use in skeletal muscle. When we are overweight, in positive caloric balance, insulin resistant, or have diabetes, our livers secrete more VLDL with more triglycerides on every VLDL particle (they are larger).

Other Risk Factors
Recent evidence shows that there is an inflammatory process in the arteries that could be a warning sign. Inflammatory markers like CRP can be a warning sign. Experts are saying that men with high blood pressure and inflammation are over four times more likely than other men to suffer a stroke. Smoking is a factor that increases inflammation. Another factor may be inflammation in the blood vessels caused by the immune system trying to break down and eliminate accumulated plaque in the arteries.

Another substance that promotes inflammation is a type of fatty acid called omega-6 fatty acid. These fatty acids are found in large amounts in vegetable oils. Not only do they promote inflammation, but they also play a role in weight gain by stimulating something called IGF or insulin-like growth factor. Omega-6 fatty acids need to be balanced with omega-3 fatty acids, which have the opposite characteristics – anti-inflammatory and weight suppressing. This is why you hear so much about fish oils because fish oils are rich in omega-3s, especially two called DHA and EPA,. The balance of omega 3s and 6s should be 1:1, but most Americans get too much of the omega 6s, ratios of up to 15:1. But animal fats, if they are pasture-raised, have a balance of 1:1 between the 3s and 6s. If livestock are fattened up with corn and soybeans, however, the balance is thrown off again and the fats are unhealthy. And some nutrients are missing in meat or dairy products that are not from pasture-raised animals including cancer-preventive nutrients. 
   
Other Risk Factors include homocysteine, an amino acid that sometimes shows up in the blood of cardiovascular patients. If there are high levels, it is easily treated with B vitamins, especially B-12 and folic acid. A less recognized risk factor is radiation exposure. We know that radiation is a risk factor for cancer, but we need to know that it can have an adverse effect on the interior walls of arteries.

High Blood Pressure is another commonly accepted risk factor for cardiovascular disease. As a risk factor high blood pressure could be a result of inflammation. In any case, inflammation combined with other risk factors is a risk multiplier. The conventional medicine approach is to use drugs to lower blood pressure. Lowering blood pressure may be beneficial but blood pressure lowering drugs do nothing to improve the health of the arteries or the rough plaques. Lowering blood pressure without drugs can be accomplished with diet. General guidelines include increasing vegetable and fruit consumption, reducing sweets, including some whole grains and fish, eating pasture-raised free range meat and dairy products. The Mediterranean diet, for example, fulfills these criteria. There are also supplements that can be used for high blood pressure that I will mention later. Stress plays a role as well, but any kind of chronic inflammation in the body is a result of the immune system and other vital resources attempting to break down unmetabolized debris that has deposited in the tissues. In the case of arteries it is the rough plaques that create risk. Inflammation and swelling around these plaques can create oxidative stress that forms blood clots. We all know that blood forms clots when it has a large oxygen exposure. It is also well known that a high level of sodium is a risk factor for high blood pressure.   

Here is a summary of what to do based on what I’ve shared with you today:

Omega-3/Omega-6 balance Free range beef, dairy, poultry products; fish and fish oil
High potassium diet Vegetables, fish, olive oil
Stress Exercise

Risk Factors: CRP, homocysteine, triglycerides, VLDL, urinary sodium/potassium ratio

But there is more, much more. I mentioned that there is a need for better drugs for controlling risk factors and treating symptoms. There are a number of supplements that can be used for a variety of symptoms and to control risk factors. Many of these are foods or nutrients. Almost all of them come from foods. In my next article I will share more important information on empowering ourselves to prevent and treat cardiovascular disease.