Retrospective #46: How to Treat Heart Disease Risk

If lowering LDL and therefore Total Cholesterol [by taking a statin] is not the great panacea that we thought [See Retrospective #45 below],” Dr. Mark Hyman asks, “then how does one treat heart disease risk?” “How do we get the right kind of cholesterol?” he asked in an old post on his website.  How do we get high HDL, low LDL and low triglycerides, and have cholesterol particles that are large and fluffy rather than small and dense, which is the type that actually causes heart disease and plaque to build up?”

Dr. Hyman continues, “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) that 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.” (emphasis added by me)

“One of the reasons we don’t hear about this is because there is no good drug to raise HDL,” Dr. Hyman says. (See Retrospective #34, “Foods that 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,” he 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 laments.

According to Dr. Hyman (and, increasingly, 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 disease you’re likely to develop. It is the interaction of your genes, lifestyle, and environment that 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.” Nutritional status means the foods you choose to eat. They are under your control.

To demonstrate the effect of diet on nutritional status, I offer my own test results (n = 1) as an example. Before I started eating Very 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 (when this was originally in 2012) was 92mg/dl. An old link (no longer working) from The American Journal of Cardiology, posted in Newsmax Health, suggests a correlation between high HDL and longevity in men.

Before I started eating Very Low Carb, my triglyceride average of 21 previous tests was 137. The desired range for both men and women is <150mg/dl. My triglyceride average is 54. My most recent (again, in 2012) was 32mg/dl.

The ratio of triglycerides to HDL is “…the strongest predictor of a heart attack.” See Retrospective #27. My ratio of triglycerides to HDL is now 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 never asks me what I eat any more. He just says, “just keep on doing what you’re doing.”

As for inflammation, the most statistically significant marker for overall heart disease risk is the high sensitivity C-Reactive Protein (hs-CRP) blood test. 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 0.8 (August 2017). With such a low Chronic Systemic Inflammation score, and my continued Way of Eating, my doctor says he can’t “medically justify” ordering the test more often.