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Myth Busters

Nine things your doctor may not be telling you about heart disease

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For decades, doctors have concentrated on the “big five” causes of heart disease: elevated cholesterol, high blood pressure, diabetes, obesity, and smoking. But that conventional wisdom really doesn’t cut it anymore. With that in mind, here are nine important things about heart disease you need to know right now. They don’t tell the whole story-but they are a great place to start.

1 Cholesterol Tests are Out of Date. The standard cholesterol test tells you three numbers: your total cholesterol, your HDL (so-called “good”) cholesterol, and your LDL (so-called “bad” cholesterol). It’s out of date.

We now know there are at least five different kinds of HDL and five different kinds of LDL, and they behave quite differently in the body. Most HDL is good, but not all of it. HDL-2B is very protective, while HDL-3 may be pro-inflammatory. And the real action is in LDL, which has two major types. LDL-A is a big, fluffy, molecule that does virtually no damage whatsoever, while LDL-B is a small, dense, nasty little bugger that has a tendency to oxidize and get stuck in the artery walls.

Knowing your total LDL is next to worthless. You must know the type and number of your LDL particles, which you can easily find out using one of the modern “cholesterol particle tests.” They’re often covered by insurance, and are not expensive at all.

2 The main culprit in heart disease is inflammation. Inflammation is the real cause of heart disease. Slight injuries to the vascular wall become inflamed, trapping oxidized LDL-B particles and other nasty compounds. Free radicals create more damage, and inflammatory chemicals create more inflammation. Inflammation loosens the connections between cells in the artery walls, making it easier for foreign substances to get trapped there. Before you know it, you’ve got a “toxic brew” that can form into plaque.

In fact, many health professionals now believe that any benefit that statin drugs may have is due to the fact that they slightly lower inflammation, not because they lower cholesterol.

And speaking of inflammation …

3 Sugar is a far greater danger to your heart than fat. Sugar directly contributes to inflammation in the artery walls, and is the missing link between diabetes, obesity, and heart disease. Sugar-and foods that convert quickly to sugar in the body, such as cereals, breads, pasta, rice, and potatoes-drive up insulin, which tells your body to store fat and raises blood pressure.

High-carb, high-sugar diets also raise triglycerides, a fat found in the bloodstream that’s a serious risk factor for heart disease. “When sugar consumption rises, HDL decreases and triglycerides increase”, says Mark Houston, MD, author of What Your Doctor May Not Tell You About Heart Disease. The most heart-healthy diets contain very little sugar.

4 Saturated fat does not clog your arteries. For years, researchers used cholesterol as a “stand in” for heart disease, assuming that if cholesterol was high, heart disease was just around the corner. Problem is, cholesterol and heart disease aren’t the same thing. Recently, two major studies examined the effect of saturated fat on heart disease. And they found-no relationship at all.

Eating saturated fat often raises cholesterol, but it raises the “good” kinds (both HDL-2 and LDL-A) more than the inflammatory kind. The one thing saturated fat intake does not dois increase the risk for heart disease.

That doesn’t mean you should eat saturated fat by the spoonful-but it does mean that you don’t have to fear it, especially when it comes from healthy whole foods such as eggs, coconut, and grass-fed meat.

5 Stress matters. Seriously. Emotional stress produces hormones and biochemical activity that contributes to inflammation. In some cases, stress can precipitate a heart attack or cause sudden death, even in the absence of any clear risk factors and in the presence of relatively healthy arteries. Stress weakens the immune system while raising blood pressure and heart rate. “The mind and body are not separate entities, but rather different aspects of a single unit, ” says Houston.

6 Omega-3s are your heart’s best friend. Omega-3 fats are some of the most anti-inflammatory substances on earth. They are the “parent molecules” for many of the anti-inflammatory chemicals your body makes, while omega-6s (vegetable oils) are the parent molecules for our inflammatory chemicals. These anti- and pro- inflammatory chemicals are called thromboxanes, leukotrienes, and prostaglandins. We actually need both, but we need them to be in balance, with a 1:1 ratio being ideal. Unfortunately, our diets are stacked 16:1 in favor of the inflammatory omega-6s, meaning that we’re “funding” our inflammatory army far more than our “anti-inflammatory” army.

Omega-3s are found primarily in fish, grass-fed meat, flaxseed and flaxseed oil, and chia seeds. All have anti-inflammatory action, but the omega-3s that have been most studied for heart health are DHA and EPA, the two found in animal sources, primarily wild, cold-water fish. Houston recommends 3-4 grams of EPA and DHA combined in a 3:2 ratio.

7 Get the right tests. Besides the cholesterol particle test, there are several other tests that can give you useful information about your risk for heart disease. Chief among them is the HS-CRP test (high sensitivity C-reactive protein), a measure of inflammation in the body. CRP is a potent predictor of future cardiovascular health-high levels are associated with infections, high blood sugar, and excess weight. Houston likes to see a CRP reading of under 2, while The Great Cholesterol Myth co-author, Stephen Sinatra, MD, goes even further. He likes to see a CRP reading of 1.0 or less. The point is, the lower the better.

Homocysteine causes your body to lay down sticky platelets in blood vessels. Some homocysteine is normal, but an excess can affect cardiovascular health. Homocysteine contributes to atherosclerosis, reduces the flexibility of blood vessels, and slows blood flow. “Too much homocysteine alters the environment inside the arteries and sets the stage for arterial disease,” says Houston. Homocysteine should ideally be under 10 and should not go above 12.

Other tests that give valuable information about the health of your arteries include interleukin-6 (an inflammatory compound that also stimulates the liver to produce CRP), and a carotid intima medial thickness test (IMT), which uses ultrasound to measure the thickness of the carotid arteries. “Thickening of the carotid arteries has been shown to be a strong indicator of cardiovascular disease and atherosclerosis”, says Houston. “It also signals an increased risk of coronary heart disease, heart attack, and stroke.”

8 Diet matters-and so does exercise. Everyone knows that a diet high in vegetables, fruits, nuts, clean protein, monounsaturated fat (olive oil), and omega-3s, and low in sugar, is cardioprotective. Recently, a study published in Circulation that followed 32,000 people from 40 different countries for five years found that people with the healthiest diets were 35 percent less likely to die from a repeat heart attack or stroke. Conclusion: diet matters.

Even something as ordinary as tea can help. Green tea is a great source of substances called catechins that have wide-ranging protective effects against heart disease. The best known is epigallocatechin gallate, also known as EGCG. “The goal is to get 500 mg of EGCG twice a day, which is easiest to achieve by taking supplements and drinking several cups of green tea,” says Houston.

And don’t forget dark chocolate with a high cocoa content. Flavanols in cocoa have been found to lower blood pressure, a really serious risk for heart disease. They also stimulate the release of nitric oxide, an important molecule involved in opening up the arteries. Consume a square or two of dark chocolate a day, or add cocoa flavanols to your supplement regimen. They’re available in any health food store.

As far as exercise goes, there’s probably no better activity to protect the heart. “Specific kinds of exercise can alter the way genes function and interact with your cells”, says Houston. “By triggering the right exercise-gene interactions, you can tamp down inflammation, reduce oxidation, strengthen your cardiovascular system, turn your body into a fat-burning machine, and slow-or even reverse-many aspects of aging.” To do this, use a combination of aerobic exercise and strength training. You need both.

9 Don’t ignore supplements. Supplements can make a huge difference to your heart. Whether you take antioxidants (such as vitamin C and E), anti-inflammatories (especially omega-3s), or supplements with multiple actions (such as resveratrol or curcumin), supplements should be part of your heart disease prevention program. Experts disagree about which ones are the most important, but a naturopathic physician can tailor a well-designed supplement program to meet your needs based on test results, diet, lifestyle, and family history.

Sinatra and I are partial to Coenzyme Q10, carnitine, and magnesium, as well as pantethine, curcumin, and resveratrol. Houston likes Coenzyme Q10, EGCG, vitamins C and E, and resveratrol. And we’re all positively bullish on omega-3s. You don’t have to take every single one of them, but you should definitely take some.

The Bottom Line

Heart disease is complicated. Diet, exercise, stress, and genetics all play a part, and any of them can tip the scales into dangerous territory. The best strategy for prevention includes sticking to a diet that contains plenty of antioxidants and omega-3 fats, lowering your intake of sugar, exercising almost every day, and managing your stress effectively. Oh, and throw out your tobacco.

Remember, in the Nurses Health Study-the longest running epidemiological study of diet and disease ever undertaken-82 percent of cardiovascular events were attributed to lack of adherence to just five factors:

  1. Maintaining a healthy weight
  2. Not smoking
  3. Exercising regularly
  4. Consuming alcohol in moderation
  5. Eating a diet high in fruits, vegetables, nuts, and fish

That’s a prescription anyone should be able to follow!

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Read All About It

For more information-including a complete list of meaningful tests you can have to find out your risk for heart disease-I strongly recommend two books: What Your Doctor May Not Tell You About Heart Disease by Mark Houston, MD, MS, and The Great Cholesterol Myth by Stephen Sinatra, MD, and yours truly.