In traditional medicine, doctors base heart attack prevention on an ever-changing effort to place subjects into low, moderate, and high risk categories all based upon different types and fractions of the cholesterol molecule. Researchers have established scales and guidelines to promote this effort. However, there is very little evidence to support the contention that a diet low in cholesterol and saturated fat actually reduces death from heart disease or in any way increases one's life span. Before a discussion of the true causes of heart disease can begin, a detailed look at the campaign against high cholesterol is necessary.
Cholesterol is a steroid normally present in every cell of the body and is essential to life. Cholesterol is part of the membrane of all cells, works to build and repair cells, and produces hormones, such as estrogen and testosterone. Its main job, however, is for the liver to convert it into cholic acid (up to 80 percent of all cholesterol becomes cholic acid). Cholic acid combines with other substances in the liver to produce bile salts, which the gall bladder stores to aid in the digestion and absorption of fat. The body produces about 70 to 80 percent of its own cholesterol. Only 20 to 30 percent of cholesterol comes from the diet.
The American Heart Association recommends that all persons 20 years of age or older have a lipid profile performed every five years. The lipid profile is the measurement of the different types of cholesterol and the triglyceride levels. Most traditionally trained doctors would agree to the following things:
Total cholesterol below 200 mg/dl is good, and anything over 240 mg/dl is bad.
LDL cholesterol should measure below 130 mg/dl.
HDL cholesterol should range between 35 and 40 mg/dl.
If the HDL cholesterol reaches 60 mg/dl or higher, a person has a reduced chance for a heart attack.
Triglycerides should be less than 200 mg/dl.
Many complementary doctors who deal in the functional realm evaluate these numbers in the following way:
Total cholesterol should range from 150 to 220 mg/dl.
HDL (the “good” cholesterol) should be at least 25 percent of the total cholesterol.
LDL should be less than 120 mg/dl.
Triglycerides should be less than 50 percent of the total cholesterol.
The triglyceride level, not cholesterol, is often a better predictor of heart disease than other markers. Triglycerides are a particular form of fat that the blood transports to the tissue. Triglycerides make up the majority of your body's fat tissue. Serum triglycerides come from two sources. The first source is the foods that you eat. If you consume a meal containing a lot of fat, your intestine will package some of those fats and transport them to your liver. The second source is your liver. Once the liver receives the fats, it then takes fatty acids released by your fat cells and bundles them up as triglycerides, which the rest of your body uses as fuel. Here are two patient examples:
Patient A: Total cholesterol: 280 (above normal) LDL:175 HDL:70 Triglycerides:130
Patient B: Total cholesterol: 180 (normal) LDL:97 HDL:35 Triglycerides:165
Traditional doctors would strongly consider Patient A for pharmaceutical intervention, but is this person really in trouble? It is true that the total cholesterol is above the normal range; however, the HDL number is greater than 25 percent, and the triglycerides are less than 50 percent. This patient actually has a good balance of all the lipid levels. Patient B, on the other hand, is within normal limits on all the levels. However, the triglycerides are more than 50 percent of the total cholesterol, and the HDL is less than 25 percent of total cholesterol. Patient B is actually at greater risk for a heart attack even though the measurements are within the standard normal limits.
WHY IS CHOLESTEROL HIGH? At least four understood reasons can cause an elevated cholesterol level:
1. The body is producing too much cholesterol; 2. A person is eating too much cholesterol in the diet; 3. The body is not breaking down cholesterol properly, resulting in nutritional deficiency; or 4. One or more hormone-producing tissues, usually the thyroid or pituitary is under (hypo) functioning.
The most common of these four is that the body is not properly breaking down cholesterol.
In the previous chapter, the chart of hormonal production included cholesterol. If cholesterol is the precursor to all other hormones, what would happen to the hormones if cholesterol was lowered? All of the body’s important reproductive hormones would lower as well! This is precisely what happens when patients take cholesterol-lowering drugs, like statins.
THE TRUE CAUSE OF HEART DISEASE - INFLAMMATION Doctors who cling to the shibboleth, “High cholesterol is the cause of heart disease,” continue to look for more sophisticated ways to measure the cholesterol molecule. The NMR LipoProfile, a sophisticated test using the principle of natural resonance, breaks cholesterol down into 15 specific kinds of lipoprotein subclasses. Likewise, the Vertical Auto Profile or VAP Test also measures 15 fractions, but it does so through high-speed centrifugation, separating cholesterol apart into smaller and smaller bits. Many assume that the more doctors understand about cholesterol, the more the links between it and heart disease will be. But there are major problems with the cholesterol-heart disease connection.
Approximately half of all patients who develop clogged arteries, called coronary heart disease (CHD), have normal or only marginal elevations in total and LDL (bad) cholesterol levels. Conversely, a significant number of people with elevated cholesterol never develop CHD. These facts illuminate an approach that is missing the mark. Instead of looking beyond cholesterol for the cause of CHD, pharmaceutical medicine chose to tighten its guidelines, lowering “bad” cholesterol (LDL) from 130 to less than 100. This, of course, led to greater sales of cholesterol-lowering drugs, called statins. Statin drugs, which prevent an enzyme necessary for cholesterol formation from working, riddle the person with nasty side effects, including liver toxicity and severe muscle pain. These medicines do in fact lower cholesterol; but one must ask the following question: Do they help prevent heart attacks? In 20 to 40 percent of people taking statins, the answer is no. The main question for heart attack prevention is, “How do we stop arteries from clogging?” Clogged arteries are the result of the buildup of atherosclerotic plaques. These are not just cholesterol-based deposits. They are comprised of numerous components, including smooth muscle cells, calcium, connective tissue, white blood cells, cholesterol, and fatty acids. The growth of plaques begins inside the artery wall, between the inner and outer layers. But why? With a scrape or a cut on the skin, the body protects the injured area by forming a hard scab. This wall of defense prevents further damage while the body heals the torn tissue. Likewise, plaques acts as internal scabs, laid down by the body to protect damaged or weakened arteries. Why are they damaged? If researchers could answer this question, they would know the cause of heart disease. Alternative practitioners know the cause and the answer: Excess inflammation damages the arteries.
C-reactive protein (CRP) is a substance that serves as a marker for inflammation inside the body, especially the arteries. CRP has attracted a great deal of attention ever since a large study published in the New England Journal of Medicine in 2002 suggested that this protein was a significantly better predictor of future cardiovascular events than LDL cholesterol. A second study published three years later, examined the relationship between statin use, CRP levels, and subsequent coronary event rates. Regardless of the levels of LDL cholesterol, patients who had low CRP levels had better clinical outcomes. In other words, those who were less inflamed had fewer heart attacks. Measuring the blood levels for cholesterol—the lipid profile—is still a good idea because any additional data about one’s health is never bad. However, to assess the risk of heart disease, it is critical to include blood levels of the inflammatory chemical C-reactive protein, along with two others, homocysteine and fibrinogen. Homocysteine is strongly correlated with heart disease and is discussed at length in the chapter Panic or Pass Out? in my book, Hope for Health.
Several factors, including infections, trauma, and toxicity, can cause inflammation. In life, these are usually temporary states. The chronically inflamed person, however, most likely got that way because of his or her diet. Heated oils, processed grains, and refined sugars are the troublesome food trio most responsible for systemic inflammation. The American Heart Association recommends a low saturated fat diet and the liberal use of vegetable oils. But there is a problem. Many cultures, including Eskimos and the Masai tribes of Africa, eat saturated fat as their primary food but have low or no heart disease. So what does this mean?
All fats are not created equal. Man-made synthetic and processed fats (trans fats) interfere with cholesterol breakdown, and should be avoided. The process of partial hydrogenation changes the shapes of natural fats and oils so they interfere with, rather than promote, normal fat metabolism. According to a study published in the New England Journal of Medicine, it has been estimated that by simply eliminating trans fats from the U.S. food supply could prevent between 6 and 19 percent of heart attacks and related deaths, or more than 200,000 each year.
These processed fats are in nearly everything people buy in the grocery store, from salad dressings to candy bars, and from chips to breads. Partially hydrogenated fats and oils block the normal conversion of cholesterol in the liver, causing an elevation of cholesterol in the blood. Margarine, which is often touted for its lack of cholesterol, is produced from partially hydrogenated fats. One of the biggest cases of misinformation in recent history is the suggestion that eating margarine instead of butter will reduce cholesterol. It is true that butter contains cholesterol and that margarine does not. But, butter also contains high levels of normal fat mobilizing nutrients. It is a whole food designed to take care of its own fats if eaten in moderation. Margarine can actually increase cholesterol levels and heart attacks.
The same facts are true for eggs. Egg yolks are one of the highest sources of cholesterol. But they are also one of the highest sources of natural fat mobilizers. Eggs and butter are two examples of whole foods, which research shows are actually useful for lowering cholesterol and improving fat metabolism. Only patients who have severely elevated cholesterol, such as those who have a family history of poor fat metabolism and breakdown, should avoid them.
So why would the American Heart Association recommend a low saturated fat diet? Misguided ideas have led to people barring saturated fats like butter from the dinner table. But most of the fat found in clogged arteries is not saturated, it is polyunsaturated. Polyunsaturated oils are the inflammatory ones and include corn, soy, safflower, and canola oils—the very same oils recommended by the American Heart Association. These fats tend to become oxidized or rancid when exposed to heat through cooking. Oxidation is one of the most aggressive forms of tissue inflammation and is the reason why antioxidants, such as those found in fresh vegetables are the cornerstone of an anti-inflammatory diet and therefore an important part of heart disease prevention. Remember, the primary goal when trying to prevent heart attacks is inflammation reduction. Saturated fat by itself is neutral or can be anti-inflammatory, but not when combined with sugars.
Americans love sweets and grease. In the Standard American Diet, rarely will saturated fat be unaccompanied by copious amounts of sugar. With each dessert, Americans increase their risk for heart disease, eating roughly 150 pounds of refined sweeteners each year.
The rise in CHD to America’s #1 killer began around 1920 and continues to the present. During the same period, the percentage of dietary vegetable oils in the form of margarine, shortening, and refined oils increased nearly 400 percent while the consumption of sugar and processed foods increased about 60 percent. Studies from around the world have consistently demonstrated that in populations where the diet was high in sugar, processed flours, and heated vegetable oils, deaths from all manner of disease, including heart disease, are much higher.
The body has three choices when wanting to reduce extra blood sugar (glucose): 1. Convert it to fat; 2. Store it as glycogen; or 3. Make more triglycerides (a sugar molecule attached to three fatty acids). These three options directly relate to the dysfunctions defining metabolic syndrome: high blood pressure, insulin resistance (high insulin and high blood sugar), elevated triglycerides, and being overweight.
Glucose is also critical for the formation of all soft tissues, such as ligaments and cartilage. Excess glucose, along with the inflammation it generates, has a direct negative impact on the joints, which is one reason why so many people in their middle years begin to complain of joint pain. The primary goal of heart disease prevention is to avoid any lifestyle or dietary pattern that promotes blood sugar instability and generates inflammation.
FBA FOR HEART DISEASE FBA can do a great deal to help lower the risk of heart disease. By using the inflammatory biomarkers C-reactive protein, homocysteine, and fibrinogen, an FBA practitioner can discover the type of inflammatory process and the prime movers needed to stop. Nutritional factors that help to lower cholesterol, reduce inflammation, and lower the risk for heart disease include adequate levels of vitamins A and C; specific B vitamins, especially niacinamide (B3); magnesium; zinc; chromium; trace elements, which can increase the levels of HDL; and fat mobilizing substances, including choline and betaine. (Remember that most cholesterol is broken down to cholic acid in the liver.) Each person’s prime movers will be different. The beauty of FBA is that it can find which specific nutrients a person may need.
Beyond the prime movers, lifestyle considerations are essential. Good digestive health; a proper diet full of anti-inflammatory fats, antioxidant-rich foods, and unheated oils; along with proper exercise are critical, not only for reducing the risk for heart disease but for improved health in general. These topics are discussed throughout Hope for Health.