The Nutrition Debate #46: How to Treat Heart Disease Risk (a doctor’s prescription)

If lowering LDL and therefore Total Cholesterol is not the great panacea that we thought, how does one treat heart disease risk? “How do we get the right kind of cholesterol – high HDL, low LDL and low triglycerides, and have cholesterol particles that are large, light and fluffy rather than small, dense and hard, which is the type that actually causes heart disease and plaque build-up,” asks Mark Hyman, MD, in a May 2010 blog post, found at http://drhyman.com/blog/conditions/why-cholesterol-may-not-be-the-cause-of-heart-disease/.

Again, according to Dr. Hyman, “We know what causes the damaging small cholesterol particles. And it’s not fat in the diet. It is sugar. Sugar in any form or refined carbohydrates (white food) drives the good cholesterol down, causes triglycerides to go up, creates small damaging cholesterol particles, and causes metabolic syndrome or pre-diabetes. That is the true cause of most heart attacks, NOT LDL cholesterol.”

“One of the reasons we don’t hear about this is because there is no good drug to raise HDL. Statin drugs lower LDL – and billions are spent advertising them, even though they are the wrong treatment. If you are like most of the patients I see in my practice,” Dr. Hyman says, “you’re convinced that cholesterol is the evil that causes heart disease. You may hope that if you monitor your cholesterol levels and avoid the foods that are purported to raise cholesterol, you’ll be safe from America’s number-one killer. If only it were so simple,” he says. “The truth is much more complex. Cholesterol is only one factor of many – and not even the most important – that contributes to your risk of getting heart disease,” he says.

According to Dr. Hyman (and many, many other cutting-edge practitioners), the three prime contributors to cardiovascular disease are: 1) inflammation, 2) imbalances in blood sugar and insulin, and 3) oxidative stress. “To control these key biological functions and keep them in balance, you need to look at your overall health as well as your genetic predispositions, as these underlie the types of diseases you’re most likely to develop. It is the interaction of your genes, lifestyle, and environment that ultimately determines your risks – and the outcome of your life,” Dr. Hyman says.

“This is the science of nutrigenomics, or how food acts as information to stall or totally prevent some predisposed disease risks by turning on the right gene messages with our diet and lifestyle choices. That means some of the factors that unbalance bodily health are under your control, or could be. These include nutritional status, stress levels and activity levels” (italics added). Nutritional status means the foods you choose to eat. They are under your control. Get it?

To demonstrate the effect of diet on nutritional status, I offer my own test results (n = 1) as an example. I previously reported this in “The Nutrition Debate #34: Foods that Raise HDL,” on my blog. You can access this and all other columns at The Nutrition Debate. Before I started eating low-carb 10 years ago, my average HDL over the previous 22 years was 43mg/dl. The desired range for men is ≥ 40mg/dl and for women ≥ 50mg/dl. My average HDL now is 78mg/dl. My most recent HDL was 92mg/dl. Bonus. There seems to be a link between HDL and longevity in men. Check out this link from The American Journal of Cardiology posted in Newsmax Health : http://www.newsmaxhealth.com/health_stories/HDL_Longevity_Men/2011/02/25/377580.html

Before I started low-carbing, my triglyceride average of 21 previous tests was 137. The desired range for both men and women is < 150mg/dl. My triglyceride average for the most recent 21 tests is 54. My most recent was 32mg/dl. My ratio of triglycerides to HDL is 0.35 (ideal range is < 1.0). My ratio of Total Cholesterol to HDL is 2.3 (209/92). Desired range is < 5.0. My doctor says “just keep on doing what you’re doing.” It’s fun (for both) to visit his office. No more hectoring.

As for inflammation, the most statistically significant marker for overall heart disease risk is the hs (high sensitivity) cardio C-Reactive Protein test (hs-CRP). Your C-Reactive Protein level should be less than 1.0. At the time I started low-carbing, mine was 5.8. My most recent was 1.5. It has been as low as 0.7. I’m obviously doing something wrong, and I’ve still got some work to do to figure out what it is. Hey doc (my doctor, not Dr. Hyman): What extra tests can you do to help me figure out whether this low-grade inflammation is acute or chronic, and if chronic (as is likely), the source?

© Dan Brown 4/1/12