Preventing Heart Disease the Functional Medicine Way

I listened to a fascinating series of podcasts called the Longevity Roadmap offered by Dr. Mark Hyman and his Ultrawellness Center. In one episode, a group of specialists provided a short summary on the causes of cardiovascular disease, how to identify the root cause, adequate testing and ways to protect and support the heart using functional medicine approaches. Here are the highlights:

• The endothelial system lines the inside of every blood vessel in the body and the one cell thick layer called the endothelium is found in the inner walls of our arteries. The proper function of the endothelial system is intimately tied to our health – it delivers oxygen and removes waste. It needs to be able to relax to allow blood to get to all the different tissues in the body. If it doesn’t relax, blood pressure will go up and inflammation of the system leads to cardiovascular disease (CVD). Oxidative stress can damage the endothelial layer and abdominal visceral fat is an inflammatory trigger for damage. For example, in men, this can cause higher erectile dysfunction. To improve endothelial function, foods rich in anthocyanins like blueberries should be consumed. It has been shown that two cups of blueberries over four weeks helped drop systolic blood pressure as much as regular meditation practice.

• The misconception is that CVD is about cholesterol – it’s actually about inflammation and they explain why cholesterol has gotten a bad rap.
  • Cholesterol is not water soluble so it needs to be carried around by lipoproteins which include low-density lipoproteins (LDL which carries cholesterol from the liver to parts of the body) and high-density lipoproteins (HDL which carries cholesterol from peripheral parts of the body back to the liver for disposal). 
  • Cholesterol has an affinity for inflammation so if the endothelial lining of the blood vessel wall is inflamed, that creates an opening in the protective lining. The LDL cholesterol then attaches to the inflamed blood vessel and gets underneath the lining and begins to accumulate, eventually turning into plaque. This plaque will restrict blood flow, eventually leading to ischemic heart disease. And when the plaque cracks, it causes the blood clot to fill up the remaining space in the blood vessel leading to a heart attack.

• What causes inflammation?
  • Processed refined foods with sugar, salt and fake fat and vegetable oils all become inflammatory when consumed. 
  • Leaky gut and leaky mouth can cause inflammation in the brain and cause heart disease so the oral and gut microbiome should be examined. There are tests now available to examine the status of both microbiomes.

• CVD is not a statin deficiency disease. It’s inflammation, oxidative stress, insulin resistance, hormonal imbalance, toxins, bad diet, lack of exercise and nutritional deficiency that lead to high cholesterol and CVD. Up to 90% of all CVD can be prevented with lifestyle measures like proper diet, exercise, no smoking, reduced stress and sleep optimization.

• Statins have a role in CVD but for primary prevention, it’s not optimal. They can have side effects including destruction of mitochondria which is critical for energy function. If you require a statin, it’s important to take CoQ10 (an antioxidant nutrient) as statins block CoQ10 which is vital for antioxidant and mitochondrial functions.

• CVD is the leading cause of death in the US and two-thirds of it is related to our diet and lifestyle. According to Dr. Hyman, the central feature of all age-related disease is insulin resistance. And since we consume around 150 pounds of sugar and 133 pounds of flour per person every year in the US, it makes up 60% of our calories which causes insulin resistance. Only 12% of the US population are metabolically healthy versus the 88% who are unhealthy including 75% of those that are overweight. Even 20-40% of those that are normal weight are also metabolically unhealthy – and these ‘skinny’ fat people are at equal risk for heart disease.

• The biggest risk factors for those getting very ill or dying from COVID-19 are being overweight with high blood pressure, glucose, insulin resistance and high cholesterol.

• By decreasing insulin resistance, you can make the small dense LDL particles bigger and fluffier which makes it less athrogenic and plaque inducing. If your LCL cholesterol number is high, you can ask your physician to run an NMR lipid profile test to look at particle size and quantity. The NMR lipid profile determines the actual molecular structure of lipoproteins in your bloodstream and is a more important marker of heart disease than just HDL, LDL or total cholesterol. For LDL, you want a low particle number and a big fluffy size. For HDL, you want them to be big as they collect cholesterol from the body and take it to the liver to be disposed of. So big HDL is like having big dump trucks. You also want to know if you are one of 250 people who have familial hypercholesterolemia, a genetic variation that prevents the body from getting rid of LDL easily, as this condition significantly increases your risk of heart disease. 

• Some dietary ways to improve cholesterol include:
  • Plant-based foods and proteins like legumes, nuts and seeds. For example, an ounce of nuts 5X a week can improve cholesterol and lower inflammation. Look for organic raw nuts and keep them in the freezer to prevent the good nut oils from oxidizing.
  • B3 (niacin) vitamin can have a positive impact on cholesterol and has been shown to lower triglycerides, lower LDL and raise HDL. Make sure to work with a provider as this vitamin causes uncomfortable hot flushes.
  • Fish oil has been shown to lower triglycerides, LDL and raise HDL. In a study, eating 1 gram of fish oil per day decreased heart risk if you ate less than 1.5 servings of oily fish per week. If you eat more servings of fish, you may not need to supplement. Wild caught salmon, sardines, anchovies and mackerel are good choices.
  • Flaxseeds are also recommended for their omega 3 and fiber content. You can add two tablespoons to your morning shake.  

• Insulin resistance is the number one cause of CVD and happens when our body has to produce a lot more insulin to get the food into our cells. Even though insulin levels are high, the body becomes resistant and the food and nutrients don’t get into the cells. This results in weight gain around the belly which is the inflammatory visceral fat leading to CVD, stroke, dementia and even cancer. It’s critical to keep insulin levels normal – even though the standard Quest Diagnostics measure considers insulin NORMAL if less than 19.6, it’s worth bearing in mind that this average is based on the entire US population, most of whom are overweight.

• Here are functional medicine parameters to indicate inflammation and metabolic syndrome which are markers for heart disease:
  • Optimal fasting insulin is less than 5. If you have insulin in the 7-12 range, you are pre-diabetic or have metabolic syndrome.
  • Greater than 0.8 waist to hip ratio for women or 0.9 for men is also a sign of insulin resistance and metabolic syndrome. 
  • High blood pressure is also a clue.
  • If HDL is too low – less than 50 for women, 40 for men and if triglycerides are too high (>150), it’s a signal.
  • Glucose of >100 is a sign of pre-diabetes and if higher than 125, signaling type 2 diabetes.
  • High C-reactive protein (higher than 1mg/l) and homocysteine numbers (higher than 7 micromol/L) are also markers of inflammation.

• If you have a poor diet, sleep habits and your stress and nutrient levels are off, you should focus on these – there are those with a genetic profile that won’t respond to these parameters but for most of us, it will prevent CVD.

• It’s important to remember that it’s not a “one size fits all” approach and functional medicine science is personalized to your health. Working on getting the right data with proper testing along with food and diet, exercise, stress management techniques and proper sleep with appropriate supplementations should be of priority.   

There was a very large European study done that showed that following a protocol of no smoking, exercising 3.5 hours a week, healthy eating and maintaining a healthy weight prevented 93% of diabetes, 81% of heart disease, 50% of strokes and 36% of all cancers.  No medicine in the world can do this today! Lifestyle changes and addressing root causes is important and can reverse CVD with miraculous results.

Dr Hyman’s Longevity Roadmap 8-part series is offered here.