What You Need to Know to Prevent Cardiovascular and Metabolic Disease
by David Wells, D.C., L.Ac., M.S. (Nutrition)
Four centuries ago the English physician, Thomas Sydenham MD (1624 to1689) said, “A man is as old as his arteries.” That statement is as true today as it was then. Our lives are utterly dependent on the 1,800 gallons of blood pumped through our arteries each day. This miracle of oxygen delivery is so critical that we can only survive minutes without it, yet the gradual decline in our circulatory system is barely noticed. To understand how our circulatory system ages and what we can do to slow that aging process, we must first understand how it works.
The heart and blood vessels are not two separate systems like a pump and a hose. It is better to think of the blood vessels as a continuation of the heart. That is, the heart contracts, pumping the blood out into the aorta (the first artery). The aorta swells like a balloon to accommodate all that blood and then it contracts back to it’s original shape, squeezing the blood forward. This process continues as the blood divides into progressively smaller arteries until the blood vessels (by this point called capillaries) are so small that individual blood cells can only fit into these tiny passageways in single file. At this micro level, the oxygen is released from the red blood cells into the tissue cells that line the capillaries. Every single cell in your body whether it is in your muscles or your brain, is adjacent to a capillary. The oxygen given up by the blood cells is replaced with carbon dioxide released by the tissue cells and carried back to the lungs to be exchanged for more oxygen. That way, every cell is provided with fresh oxygen and other nutrients while the carbon dioxide and other wastes are carried away. Pretty amazing. It’s like 24-hour room service to trillions of cells.
On the return trip from the capillaries, the returning blood collects in progressively larger vessels called veins. The pulse pressure from the heart is no longer sufficient to propel the blood back to the heart, but each vein has one-way valves pointing towards the heart. As our skeletal muscles contract, pressure from those contractions pushes the blood back first to the lungs and then on to the heart. The whole system of heart, blood vessels, muscles, etc works together in a coordinated way to circulate the blood. The arteries must be elastic and strong to propel the blood on it’s way from the heart to the tissues. Skeletal muscle contraction is needed to the return the blood to the heart. This last point explains why the muscles of the lower leg are sometimes referred to as “the second heart.” Calf contraction (such as in walking) takes a load off the heart by propelling the venous return of blood to the heart. That’s one reason why walking is so good for your heart.
Tip number 1 walk 30 minutes or more per day.
So what happens in aging? To understand that, it helps to know a little about the structure of the arteries. The arteries are made of three layers. The innermost layer is called the “intima”. To help remember the name, think of this inner lining as being “intimate” with the blood itself. The endothelial cells that line the intima sense changes in the blood and send signals to the middle layer to help the artery adapt to those changes. The middle layer is called the “media” and is made up of concentric rings of smooth muscle cells that contract to propel the blood forward. The outer layer is composed mainly of connective tissue and is called the “adventitia”.
In aging, the intima thickens, stiffens and accumulates plaque. The plaque is made primarily of scar tissue and cholesterol. We’ll get back to how that happens in a moment. Stiffening of the artery wall puts more load on the heart and may eventually cause it to fail. Stiffening also creates more resistance to the flow of blood and raises blood pressure. The plaque can thicken to the point of blocking an artery or a chunk of plaque may break off and cause a stroke or pulmonary embolism. An embolism is a clot that can block a blood vessel causing death to the tissues deprived of oxygen by the blockage. How this happens and what you can do to prevent it is the subject of the article (Hint, the answer is not cholesterol).
What causes thickening of the intima and plaque formation?
In a word, the answer is inflammation. What then causes inflammation? Exposure to oxidants like smoke (everything from cigarettes to pollution), rancid polyunsaturated fats and fried foods, numerous chemicals (everything from solvents, paints, plastics, gasoline, cleaning products, etc), obesity, diabetes and oddly enough, even the iron in your blood that carries oxygen to your tissues.
The way all these diverse substances provoke inflammation is a chemical reaction called oxidation. To illustrate what oxidation looks like, pour some hydrogen peroxide on your toothbrush. You will see a fizzing cluster of bubbles form on your toothbrush. What’s happening? Peroxide is an unstable combination of hydrogen and oxygen (H2O2). Peroxide tries to become stable (H2O and O2) by ripping apart bacterial cells on your toothbrush to grab an extra molecule of oxygen. That’s what creates the fizzing bubbles of water and oxygen. It also creates dead bacteria because the peroxide rips oxygen molecules away from their cell membranes.
A similar process happens in our arteries. Exposure of the intima to any oxidative chemicals (also known as free-radicals) causes cells lining the intima to be ripped apart. To repair that damage, the immune system uses specialized cells called fibroblasts that make fibers of scar tissue to bind the damaged area back together. Picture stitching a wound together. That repair process is provoked by the chemistry of inflammation. After stitching the damaged area back together, the fibroblasts grab cholesterol from the bloodstream to pack it into the spaces between the fibers of scar tissue. Why do the fibroblasts pack cholesterol into the spaces between fibers of the scar? The cholesterol forms a smoother surface on the scar, reducing turbulence in the blood. Since turbulence can form clots in the blood, this is a good thing. That is why plaque is made of scar tissue and cholesterol. Over time, the scar tissue calcifies and hardens like bone (see my article on osteoporosis for more on that).
So cholesterol is just a building material? Yes, in fact it is one of the most common building materials in the body. Every cell membrane is made of cholesterol (plus omega-3 fats and a few other things). It is a building material like a brick (solid, water-proof and stable). It is also the base molecule of all steroid hormones like estrogen, testosterone, prednisone, cortisol, etc. Even vitamin D is made from it. The myelin sheaths that insulate all our nerves are made from it. The brain is almost 50 percent cholesterol. Cholesterol is not some evil foreign substance. We make cholesterol in our liver because we need it. That’s right, ninety percent of the cholesterol in our bodies is made in our livers. Only ten percent comes from our food.
So why are doctors always trying to get us to reduce our cholesterol levels? The reason is that elevated serum cholesterol is associated with increased risk of death due to cardiovascular disease. However, association is not the same as cause. To illustrate this idea, imagine you find a dead bird on the sidewalk. On closer examination, you see that there are ants eating the bird. Do you assume that the ants killed the bird? No, you don’t. Even if every time you see a dead bird on the sidewalk and there are ants eating it, you don’t assume that the ants killed the bird. Why? Because ants don’t fly and aren’t able to kill a bird. The same is true of cholesterol. Just as the presence of ants confirms that the bird is dead, elevated cholesterol confirms that the body is out of balance.
Elevated cholesterol is one of the markers of what has been referred to as “metabolic syndrome”. Other markers include elevated triglycerides (another kind of fat) and blood sugar, high blood pressure and increased waistline. In other words, the most common reason for elevated cholesterol is eating more calories than you are burning. There can be a number of reasons for this imbalance. One of those reasons is low thyroid (not enough calories burned). Lack of exercise is another (again, not enough calories burned). Too many sweet tasting foods, particularly those made with high fructose corn syrup is another (too many calories consumed). High stress plays a role (greater demand for cortisol, requiring greater production of cholesterol). Not enough fiber in the diet (fiber carries cholesterol out in the stool). The answer is less likely to be that you ate too much cholesterol. It is certainly not because you have a deficiency of statin drugs (more on that later).
Tip number 2 check your thyroid health and metabolic rate by checking your basal temperature.
Tip number 3 increase exercise.
Tip number 4 avoid sweets, especially those made from high fructose corn syrup such as in soft drinks.
Tip number 5 manage your stress through exercise, life changes, Tai Chi or Yoga, vacations, rest and adding more pleasure to your life.
Tip number 6 eat large salads and flax meal to increase your fiber intake.
While you don’t hear much about this by name, this is what’s killing the majority of people in the industrialized world. The names we know metabolic syndrome by are heart disease, stroke, diabetes, cancer and obesity. Together these diseases kill over half (around fifty-five percent) of people in the United States.i Metabolic syndrome is a disease of affluence. It is only possible in a society that can afford to eat more and move less. Most of human history was spent working very hard to get enough to eat, so we are strongly programmed to like the taste of high calorie foods. If you had to run down an antelope for dinner, you would also appreciate rest and relaxation. To this day, people in the Third World burn a lot more calories than we do just trying to stay alive and they don’t get nearly as much to eat as we do. Also, the foods they do eat are high in fiber, vitamins, minerals and other nutrients – not high in sugar and fat. We have solved the problem of getting enough to eat and enough rest. Now we have the problem of getting too much to eat and too little physical activity.
The simplest measure of metabolic syndrome is your waistline. If you do nothing else with this article, get out a tape and measure yourself at the waist and the hips. Your waist should be ten percent smaller than your hips if you are a man and twenty percent smaller if you are a woman. When your waist gets bigger than this ratio, you have a significantly increased risk of getting diabetes, cancer, stroke or heart disease. In the Nurses Health Study, women who had the highest waist sizes – 35 inches or more – had nearly double the risk of dying from heart disease compared to women who had waist sizes less than 28 inches.i How long has it been since your waist was that much smaller than your hips? Think about it. The visceral fat packed around the waist is like dynamite. I see a lot of suicide bombers walking around every day. In fact, according to the CDC nearly three-quarters of men and more than 60% of woman are obese or overweight.ii
Tip number seven Measure your waistline.
So how do you measure yourself? Slide your hands down your sides until you come to the bottom rib. This is your waist. It is above, not below your navel. Wrap a cloth tape measure around yourself at this level and write down the measurement. Then, slide your hands down farther to find the widest point of your hips. Your hips should feel firm because the widest point are comprised of the bones of your hips. Wrap the tape around that area and write down that measurement. Now divide the waist measurement by the hip measurement and subtract the total from 100 to get the percent difference. So for example, if a woman measures her waist at 32 inches and hips at 40 inches, here’s how the formula looks: 32/40 = 80. 100 – 80 = 20. So the answer is twenty percent.
Another way to look at it is if your hips are forty inches, your waist should be thirty-two inches or less. So if you are up to thirty-four inches, you have two inches to lose. How many pounds is that? It’s around four pounds per inch but pounds aren’t the goal, inches are. If you were lose two inches off your waist but not lose any weight, then it is likely that you lost eight pounds of fat and gained eight pounds of muscle. That would be fabulous. So focus more on losing inches from your waist and less on losing pounds. If you lost eight pounds but your waist remained the same, that would be a disaster as it would mean you lost eight pounds of muscle. Since muscle is what burns fat, people who lose muscle in a weight loss program will gain back more weight as soon as they begin to eat anywhere near enough to satisfy their hunger. That is how extreme dieting causes extreme weight gain.
Besides the waist to hip ratio, there is an absolute upper limit to waist size to prevent all these deadly diseases. For men, that upper limit is 40 inches. For women, it is 35 inches.
“Losing inches is hard,” people say. Yes it is, but there is no better way to prevent the major killer diseases. I frequently hear, “Can’t I just take a pill to lower my cholesterol?” The answer is “Taking a pill will not help you to avoid heart disease, stroke, diabetes and cancer.”
Cholesterol lowering drugs.
Before going on, I want to repeat that cholesterol is not the problem, inflammation is the problem. Despite that, researchers have developed drugs to lower serum (blood) cholesterol in the assumption that this will lower the risk of death from heart disease (Kill the ants to save the birds?). What these drugs actually do is lower a number on a lab test without providing significant protection. They also cause serious harm.
To hear all the breathless reports on the miracles of statin drugs, you would think everyone needs to take them. You would think they will save your life or at least substantially lower your risk of death. They do not. At best, they provide a mild benefit for a subset of middle-aged men who are at high risk of heart attack. To listen to the hype, you would assume that they cut your risk of death by 80% or 50% or at least the 20% commonly attributed to placebo effect. This is not the case. One of the strongest studies in support of statins was the WOSCOPS study. This study of middle aged men treated with Pravastatin showed a 0.6% reduction in death rate. Given the price of the drug and the number of men who would have to take it to get a benefit, that would amount to 1.2 million dollars to extend one man’s life by five years.
Zero point six percent! This is the life saving, miracle drug that everyone needs to take? In my opinion, it is only a life-saving miracle for the pharmaceutical industry. Statin drugs generate 29 billion dollars a year for the drug companies. We hear a lot of press about statins. We don’t hear much about cheap, natural alternatives. How much do you think the lettuce lobby spends on advertising? Or, the flax meal consortium? Not much, I’d guess.
Combining the results of many studies gives a more accurate picture by creating a greater sample size. This is called a meta-analysis. The largest such study, a 2010 meta analysis of 65,229 participants, did not find a reduced death rate in those at high risk but without prior cardiovascular disease, for those who took statin drugs.ii
Having failed to prove that statins lower the risk of death due to heart attack, drug company researchers looked for another justification for the use of statins. Normally, researchers investigate a question without prior bias. Research may be called, “Study to determine if statins lower the risk of death” for example. That was not the case in this study. The name “Jupiter” study stands for Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin. In other words, the title of the study reveals that the researchers were biased in their intention to find a justification for the use of statins.
Despite the glowing press reports, the Jupiter Study, found that statins did not significantly lower the overall death rate in the men (that’s right, it too wasn’t tested on women) who participated in the study. There was a reduction in non-fatal cardiac events in the statin versus placebo group and the overall rate of cardiovascular deaths were lower, 0.45% for the statin group versus 0.85% for the placebo group. This was reported as “cutting the death rate in half” by the press but what was not reported is that the death rate from all causes was 27% higher in the statin group.iii In fact, there were more fatal heart attacks in the Crestor group (9 versus 6) than in the placebo group.
Something else buried in the fine print of the study is that the placebo and statin groups were not equal. The placebo group had 51 more subjects with a family history of premature coronary heart disease than the statin group. Also, there were 71 more patients in the placebo group than the statin group that had Metabolic Syndrome. These are the two greatest risk factors for dying of a heart attack. One last note on the study relates to cost. If you have to treat 180 people to prevent one death from a heart attack, factoring in the price of the product means that it would cost about $500,000 to prevent one death. If that half million were used to combat smoking or obesity, far more lives could be saved.
How did we get to this point of thinking that reducing cholesterol was going to reduce heart attack risk? Back in the 1950’s, Broda Barnes, MD wrote a book called The Riddle of Heart Attacks Solved. In it, he pointed to research showing that rabbits fed a high cholesterol diet showed no change in their health despite the fact that cholesterol is not a normal part of their diet (How’s that square with all the advice to lower your dietary cholesterol?). The research did show that when the thyroid glands of the rabbits were removed, they became obese, developed fatty deposits in their arteries and died of cardiovascular disease. When thyroid hormone was given to the surviving rabbits, the arteries cleared and their health returned to normal. In his practice, Dr. Barnes found that normalizing metabolism prevented heart disease. He primarily treated his patients using Armour Thyroid (porcine thyroid tissue). He diagnosed by asking his patients to take their temperature every morning. He adjusted the dose of the thyroid medicine to normalize their temperature at 98.6 degrees. His work was generally ignored by the medical profession and the public.
The person who really brought cholesterol to the public’s attention was Nathan Pritikin. Beginning in the early 1980’s, the Pritikin Center helped many people restore their health by teaching that a low fat, low calorie diet combined with a lot of mild aerobic exercise could dramatically reduce the risk of death from heart attack, stroke, diabetes and cancer. Pritikin’s program made the news and put the word “cholesterol” on everyone’s lips. But who wants to exercise and eat salad? The drug companies saw an opportunity.
A few years prior, in 1976, a Japanese researcher named Akira Endo found a compound in red rice yeast that interfered with the liver enzyme that produces both cholesterol and coenzyme Q10. This inhibitor is called mevastatin. In 1979, researchers at Merck isolated lovastatin from another fungus. By 1987, Merck used that research to develop the first statin drug, Lipitor. Merck patented the right to co-market their drug with CoQ10 but never did, effectively preventing any other drug manufacturer from doing so as it would be a patent infringement. In my opinion that was a crime against humanity.
What is CoQ10? It is an enzyme that is needed by the body to burn fat and oxygen to make energy. Without CoQ10, all cells would die. This was proved by the statin drug, BayCol (made by the Bayer company). BayCol was so effective at blocking the liver enzyme making both cholesterol and CoQ10 that the muscle cells in the people who took the drug died in massive numbers. So quickly did the cells die, that the waste products of these dead cells clogged up the kidneys of these patients and they died of kidney failure. After 52 confirmed deaths, BayCol was removed from the market.iv The next strongest statin drug is Crestor, the one used in the Jupiter Study.
One of the best known side effects of statin drugs is pain, weakness and muscle wasting, particularly in the legs. This is undoubtably due to the lack of CoQ10. It’s worth noting that CoQ10 is used to treat weakness of the heart muscle. It stands to reason that if the muscles of the leg are getting smaller and weaker from being deprived of CoQ10, so is the heart. The heart is after all, a big muscle. How’s that for a drug that’s supposed to save us from dying of a heart attack?
The risk of weakening the heart muscle is not just theoretical. Statins were first approved in 1987. From 1989 to 1997 the rate of heart failure in this country doubled.vi Statins may have slightly reduced the rate of non-fatal heart attacks but increased rates of death from heart failure. Heart failure doesn’t kill you all at once either. Have you ever heard the term “cardiac cripple?” That term describes a person with heart failure who is unable to walk or do many activities of daily living because their heart is so weak.
How common is the risk of muscle deterioration? The risk of catastrophic destruction of muscle tissue (rhabdomyolysis), which can lead to kidney failure and death is 61 out of every 1,000 patients who take doses of 80 mg of Lipitor. Simvistatin in doses as low as 20 mg can cause muscle destruction if taken with a common blood pressure medication, amiodirone or if it is taken within days after consuming grapefruit or grapefruit juice. The drug companies would have us believe that the side effect of muscle pain and weakness occur in around two to three percent of patients. Dr Beatrice Golomb MD, PhD is currently conducting a study. She has found that 98% of patients taking Lipitor and about a third of patients taking Mevachor (a lower dose statin) suffered from muscle problems.vii
What other side effects do statins have? How about decreased cognitive ability? “There are reports about memory loss, forgetfulness and confusion in all users of all statin products and in all age groups.”viii Studies have shown 100% of people on statin drugs show cognitive decline. Many have also suffered total or partial amnesia and other memory problems. Early tests on non-statin, cholesterol-lowering drugs found a doubling of the risk for violent death or suicide.ix This is likely because the brain is dependent on cholesterol for healthy functioning. Low cholesterol is associated with depression and rage.
Perhaps the most frightening degenerative disease of the nervous system is Lou Gherig’s Disease or Amyotrophic Lateral Sclerosis. There is now evidence showing an increased incidence of that devastating illness linked to the use of statin drugs.x The number of cases is small, but it reinforces the idea that statins are not good for the nervous system.
Why is this? As it turns out, one of the functions of cholesterol is to cement together the synapses in the brain as they form memory. Too little cholesterol in the brain is a problem.
What else? It turns out that statins also increase the risk for cataracts. This is important because cataracts are one of the leading causes of blindness. Statin users have “a 27% higher chance of cataracts than non-users.”xi
How about diabetes? According to the British Medical Journal, statins increase the risk of diabetes by up to 22%xii In the Jupiter Study, the increased risk was 27%., more than wiping out any gains in heart attack risk.
What about statins for women? For the most part, statins have not been tested in women. However, one study to specifically test statins in post menopausal women was the ASCOT study. The results of that study were that women who took statins had a 10% increase in heart attacks compared to those who took the placebo.xiii The MEGA study, a prevastatin trial, found substantially increased risk of heart disease and stroke in women under the age of 60.xiv
Speaking of women, what about risk of fetal abnormalities? Statin drugs are classified as a “pregnancy CategoryX” medication because they are known to cause serious birth defects. No woman of childbearing age should ever take statin drugs.xv Very few doctors seem to be aware of that. The drug companies are pushing for younger and younger people to take statins as a “preventative medicine”. Pfizer has even introduced a kid-friendly, chewable form of Lipitor! No kidding. Considering that children’s brains are still developing and that many of them will someday become pregnant, this is akin to genocide.
Some of the lesser side effects noted in the Physicians Desk Reference include sleep problems, sexual function problems, fatigue, dizziness and a sense of detachment, swelling, shortness of breath, vision changes, changes in temperature regulation, weight change, hunger, breast enlargement, blood sugar changes, dry skin, rashes, blood pressure changes, nausea, upset stomach, bleeding, and ringing in ears or other noises.
Still not convinced? It gets worse. The strongest predictor of death due to heart attack is the degree to which the coronary arteries are calcified.xvi A 2012 study published in the journal Diabetes Care found that those who used the most statin drugs showed the greatest increase in calcification of the coronary arteries!xvii Wow. More statins equals more plaque equals more heart attacks. That is exactly the opposite of what we are led to believe. Conversely, Vitamin K2 actually removes calcium from arterial plaque and reduces death rate from heart disease by 50%. For more on that, see my article on osteoporosis.
To sum up, statins don’t reduce your risk of death but they guarantee that you will be weaker, fatter and dumber. That’s what every aging person wants, right? Despite that, statins are the number one class of drugs prescribed in America. What can you do about it?
Tip number 8 If you are on statins, ask your doctor if you can get off. In the meantime, take CoQ10.
The irony of all of this is that there is no evidence that cholesterol causes heart disease. Elevated cholesterol is merely the evidence of metabolic syndrome. Pritikin used cholesterol levels to track progress in his program because it is more convenient and less expensive than angiography or ultrasound to track the actual amount of plaque in the arteries. Remember, the ants didn’t kill the bird. A more reliable and readily available predictor of cardiovascular risk is your waistline. Of course, there is no money to be made in empowering people to measure their waist and improving their own health through diet, exercise and lifestyle. Taking a drug to make your lab test look better is far more profitable but simply lulls everyone into complacency. “Pass me another slice of cake. My cholesterol numbers are good!”
So if statins aren’t the answer, what is? To answer that question, it’s best to go back to our discussion on how plaque forms in response to oxidation.
Oxidative Damage to the Arteries
So to review, oxidation damages the inner lining of arteries. Immune cells called fibroblasts repair that damage using scar tissue and cholesterol. The scar tissue eventually calcifies. The blood vessels no longer expand and contract to push the blood forward and instead are stiff and resistant to the flow of blood, putting stress on the heart and raising blood pressure. The blood vessels continue to narrow, reducing the supply of oxygen. If that lack of oxygen is to the muscle of the heart, the heart can be damaged or fail completely. If a chunk of plaque breaks off and blocks the blood supply to the brain, we call that loss of function a stroke or cerebral vascular accident (CVA). If the clot lodges in the lung, it is called pulmonary embolism. Anywhere a clot blocks blood delivery, tissue dies. If enough critical tissue dies, you die. I assume that you, like me don’t want that to happen anytime soon if at all.
So what can we do? First of all, stop ingesting chemicals that cause inflammation. Second, take nutrients that reduce inflammation. If you had a headache from hitting yourself in the head with a brick, the first thing to do would be to put down the brick. Next, you would apply an ice pack to your head. Sounds obvious right?
What are the causes of inflammation? If you smoke, the single biggest change you can make is to stop hitting yourself in the head….. oh, I mean stop smoking. If you work around toxic chemicals like a nail salon or welding shop, be sure you have good ventilation. To a lesser degree of importance, if you are putting artificial anything in or on your body – yes that includes most perfumes, hair products and other fragrances – stop it. If your food has a list of ingredients that require a degree in chemistry to understand, stop eating it. An apple does not have a list of ingredients. It is an apple. Same with any other real food. As the author Michael Pollan said, “If your grandmother wouldn’t recognize it, it isn’t food.”
Tip number 9 Reduce your exposure to toxic chemicals.
Reduce sugar in the diet
Driven largely by the abundance of cheap, government-subsidized corn sugar, Americans now consume more refined sugar than anyone ever has before. How much? Between 150 and 170 pounds of sugar per person, per year according to the US Department of Agriculture. To make this easier to visualize, picture 6 cups of sugar per week. I know I am not eating that much sugar, so someone is eating my share, probably in the form soft drinks loaded with high-fructose corn syrup. Soft drinks are the largest source of hidden sugars in the American diet. A 20 oz soft drink contains between 15 and 18 teaspoons of sugar. My beverage of choice is water.
Most prepared foods are also loaded with sugar. For instance, there is 1 teaspoon of sugar in every tablespoon of ketchup. Six ounces of fruit flavored yogurt can have 7 teaspoons of sugar. Before it was sweetened, yogurt was known as a “health food”. Other former health foods such as granola are often now heavily sugared. Products marketed as “Low Fat” or “Diet” have often replaced fat with sugar. Why? Because sugar tastes good. We are genetically programmed to like a sweet taste because it was once rare. It isn’t rare any longer. Too much sugar is killing us. Perhaps that’s why the Jack La Lanne (the man who made exercise a household word) once said, “If it tastes good – spit it out.”
Of the different forms of sugar, fructose is the most damaging. I’m not talking about the fructose that you might get by eating an apple. I’m talking about fructose that is added to sodas and other prepared foods. Fructose causes you liver to make fat, raise your triglycerides, cause insulin resistance and obesity.iii A high fructose diet causes fat to deposit around the heart and internal organs.iv Daily consumption of the amount of fructose in 2 and a half cans of soda causes a 28 to 87% increase in the risk of high blood pressure.
Tip number 10 Avoid sodas and other foods with high-fructose corn syrup.
Are you getting to much sugar?
If you are eating like most people, i.e. refined grains and sugars, then the answer is yes. But what if you are being more careful with your diet? How can you be sure you are careful enough? One way is to test your blood. The common tests are fasting glucose and hemoglobin A1c. It may also be necessary to test your blood sugar with a finger prick 30 minutes and 2 hours after eating to see how your body responds to sugar in your foods.
Let’s look at these tests one at a time. Hemoglobin A1c is a good measure of your average blood sugar over time. The test is based on the fact that sugar damages proteins through a process called cross-linking or glycation. You can think of glycation as being similar to cooking. Proteins harden and become dysfunctional. These dysfunctional proteins are called Advanced Glycation End-products – AGE for short because they are a hallmark of aging tissue. In fact, advanced glycation end products are associated with atherosclerosis, kidney disease, dementia, neuropathy, cataracts and elevated blood pressure.
So what does this have to do with A1c? Elevated blood sugar damages the hemoglobin in your red blood cells. Since each blood cell lasts about 90 days, the damage to a random sample of blood cells is a pretty good, three month moving average of your blood sugar levels. The higher your average blood sugars, the more damage to your hemoglobin. The American Diabetic Association says that a hemoglobin A1c level below 6 is normal, between 6 and 6.4 is pre-diabetes and anything higher than 6.4 is full blown diabetes. As with many blood tests however, there is a difference between “normal” and ideal.
An ideal hemoglobin A1c is between 4.6 and 5.3. This equals an estimated average blood glucose of 86 to 105mg/dl. As blood glucose rises from 4.6 to 5.6 you double your the risk of cardiovascular disease.v Furthermore, an article in the New England Journal of Medicine reported that compared with people who had an average blood glucose of 100, those with an average blood glucose of 115 had an 18% increase in the risk of dementia.vi Brain cells, like blood cells are also damaged by glycation.
While the A1c test is a really good measure of average blood glucose, it is not infallible and should not be used alone. For one thing, the number will appear low (false good news) if you are anemic. This means that many menstruating women will get an erroneous (falsely comforting) reading.
Perhaps the most common lab test is the fasting blood sugar. The ADA (American Diabetic Association) normal for this test is anything under 100mg/dl but ideally, it should be under 86mg/dl. Why? Because people with fasting blood glucose levels above 85mg/dl have increased risk of cardiovascular disease and diabetes. A 22 year study of nearly 2,000 men found that those with fasting glucose greater than 85m/dl have a 40% increased risk of death from cardiovascular disease.vii Another study showed those with a fasting level of 95mg/dl have three times the risk of developing diabetes as those whose level is below 90.viii Remember, these people have “normal’ levels according to your lab and the ADA.
The last test is harder but may be the most important if you have concerns about developing diabetes, heart disease or dementia. I’m speaking of testing your blood glucose 30 minutes and 2 hours after a meal. This is what diabetics do, using a finger prick and test strip to monitor glucose in response to food and exercise. When I say it is harder, that is because the test has to be performed more often and of course, it involves pricking yourself.
Why do this? Your blood sugar levels normally rise after a meal. Ideally, they rise to about 125mg/dl at peak, then drop under 100mg/dl by two hours after a meal. If it rises above 140 and stays there, glycation damage is occurring in the nerves, blood vessels, eyes, brain and kidneys. Remember, glycation = aging. If you wish to be healthy in your later years, making sure you have normal blood sugar is worth doing.
So what can be done if your blood sugar is too high? Obviously, limiting quick carbohydrates is a good start. Combining what carbohydrates you do eat with fat, protein and fiber to slow absorption can also help. Some people find they need to fast or go on a ketogenic (extreme low carb diet) for a short period of time. Another strategy is to use exercise to build muscle and to deplete muscle stores of glycogen (stored sugar). When you have depleted your muscles of glycogen, you can absorb glucose into the cells without needing insulin. I have had two Type 1 diabetic patients who have controlled their diabetes without using insulin. One was a dancer and the other walked several hours a day.
Tip number 11 Know your blood sugar levels and bring them into the ideal range.
Limit Omega-6 fats fats
Another big source of inflammation is fried or rancid oils, particularly seed oils like Canola, safflower, sunflower or corn oil. You can assume that any seed oil is rancid just from the manufacturing process. Most processed foods are made from Canola or corn oil. That’s another reason not to eat them. The first reason is that they are “processed”, meaning that all the good nutrients have been removed to make them shelf stable. Generally they are high in sugar, salt and all those unpronounceable chemical additives and preservatives. If it comes in a package or a can, you probably don’t want it.
What’s the matter with these supposedly healthy seed oils like Canola or corn oil? Manufacturers and advertisers have long promoted the health benefits of these oils because they contain polyunsaturated omega-6 fatty acids.” While it is true that omega-6 fatty acids are essential, they cause inflammation and we are already getting way too much of them. It’s almost impossible to not eat too much omega-6 fats. They are in every food that comes from a seed (like bread and other flour products) and all animals that eat seeds like corn. That would be all of them, except the few animals that freely roam a pasture, eating bugs and grass and weeds. All the beef, chicken, dairy products, pork, eggs, etc. we eat are from animals that were fed corn. These animals and animal products are loaded with omega-6 fats. Even salmon is now “farm raised” meaning the fish are fed corn! Since the majority of the food we eat is grains or animals fed grains, particularly corn, we are getting way too much omega-6 fats. We don’t need more in the form of seed oils.
I mentioned that omega-6 fats cause inflammation. That means that every disease that ends with “itis” is made worse with omega-6 fats. Inflammation is also the source of pain. More omega-6 fats equals more pain. Yum, pass the French fries!
Besides making us feel miserable, why are these oils bad for our arteries? Polyunsaturated fats have lots (“poly”means many) of open, or “unsaturated” bonds. These open bonds are looking for a hydrogen to grab and bind to themselves. Kind of like magnets picking up iron filings. They can suck hydrogen ions out of your artery walls, creating little rips in the fabric of your blood vessels.
Tip number 12 Avoid polyunsaturated oils and the products made from them. That’s just about all processed foods because these oils are cheap.
Oddly enough, the “bad” saturated fats that these polyunsaturated fats have replaced are not reactive. They don’t rip up your cells. People in this country have been told to avoid animal fat like lard or butter and instead eat fats made from seed oils. Take a look at how heart disease and cancer (that’s another story) have gone up in this country since we have shifted to eating more polyunsaturated seed oils. This shift is particularly bad for any oil that is heated. The more you heat a polyunsaturated fat, the more oxygen it picks up. This makes it even more reactive. If you heat up a saturated fat, nothing happens. It has no open bonds to react to anything.
My grandmother (like everyone else in her generation and for generations before her) kept a can of animal fat (usually captured when cooking meat) on the stove. That lard was used to grease the pan when cooking anything. It was never refrigerated. It couldn’t spoil. In moderation, it wasn’t harmful.
The best saturated fats to eat are coconut oil and butter. This is because they are short-chain saturated fats. Short chain means that they are 12 carbons long instead of 18 carbons long. Our bodies and every other animal we eat makes 18 carbon chain fats. This is what we use to make cell membranes and everything else in our bodies. 12 carbon chain fats are useless building materials – like a 6 foot long sheet of plywood in a house that has standard 8 foot tall walls. They are like scraps. Our bodies burn them up to keep us warm. We don’t store them to any degree. Eating them is very unlikely to make us fat and they don’t go rancid or cause inflammation in our bodies.
Tip number 13 It’s okay to eat saturated fats, particularly butter and coconut oil.
What other fats are good?
In addition to the short chain saturated fats listed above, fats with fewer open bonds are also good. These include olive oil, avocado and nuts. Most of these contain monounsaturated fatty acids, meaning that they have only one (“mono” means single) open bond. This means that there are fewer potential sites of oxidative damage and free radical production. While these monounsaturated fats are usually non-essential omega-9 fats, they are still an important source of calories and micronutrients.
Consider how olive oil is green in color and has a distinct smell and flavor. The color, smell and flavor is provided by minerals, vitamins and flavenoids that are important for good health. They also protect the oil from oxidation. Now compare that with the lack of color, flavor and smell in commercially prepared seed oils such as Canola, safflower or corn oil. All of the healthful nutrients have been stripped out of those oils leaving only the calories. This is comparable to how all the nutritional value of whole grains and molasses have been stripped out to make white flour and white sugar.
Like olive oil, nuts have their own distinct flavor, smell and color. It’s easy to tell the difference between an almond and a pecan. Nuts also have a lot of fiber. Avocados contain a lot of Vitamins A and E. Real food has flavor – not a list of ingredients.
Interestingly, macadamia nuts contain large amounts of omega-7 fatty acids. These fatty acids have been shown to reduce C-reactive protein (a measure of inflammation) triglycerides and LDL (“bad”) cholesterol. Omega 7’s also improve insulin sensitivity and cause an increase in fat metabolism by increasing the enzymes that help to burn fat.ix
Tip number 14 Eat nuts, avocados and olive oil instead of refined seed oils.
Our bodies cannot make omega-6 and omega-3 fatty acids. We must eat them. As I discussed above, we already get too much omega-6 fatty acids. They are pro-inflammatory and are found in abundance in all foods made from grains or from the animals that eat grains. What about omega-3 fatty acids?
These are also essential and are harder to come by. The highest food source is cold water fish like salmon (wild caught – not farmed), sardines, cod and halibut. The highest non-animal source is flax and chia seeds. Animals that wander around the pasture and eat grasses and bugs also have high amounts of omega-3 fats. The cattle eaten by cowboys in the 1800’s had omega-3 fatty acid levels comparable to salmon. This of course was ruined by feeding corn to cattle, which in addition to making their milk and meat full of inflammatory omega-6 fats, also makes the cattle sick so they have to take antibiotics. This practice is breeding “super bugs” that threaten to make all our antibiotics ineffective. While “pastured” meats are still expensive and harder to find, more stores are offering high omega-3 eggs from pastured chickens. You’ll notice that the color of the yolks are much richer as well due to the increased amounts of vitamin A.
So why do we need omega-3 fats? Omega-3 fats are flexible and impart that flexibility to our arteries. In fact, they add flexibility and porosity to every cell in your body. Each cell is enclosed in a cell membrane. These membranes selectively allow nutrients and wastes to move in and out of the cells. These membranes are made from cholesterol and omega-3 fats.
Like I mentioned earlier, cholesterol is used as a building block. Cholesterol is impermeable to water. If the entire cell membrane were made of cholesterol, nothing water soluble would get in or out of the cell. Nutrients couldn’t get in and waste products couldn’t get out. Cholesterol is very stable. It melts at 298 degrees F. which never happens in a living body. So in addition to the solid wall provided by cholesterol, cell membranes need to have passageways to get nutrients in and waste products out of the cell. That’s where omega-3 fats are particularly useful. Their very shape is twisted and angled like kinky hair. They can’t line up next to each other or anything else. There are gaps all around omega-3 fats. Therefore, every part of the cell membrane that is made of an omega-3 fat has space between the kinks that allow the exchange of nutrients and wastes across the membrane.
In addition to allowing each cell to “breathe”, ingest and excrete, omega-3 fats make cell membranes flexible. If you remember my description of how the heart and arteries expand and contract to pump the blood, you can appreciate how flexibility or the lack of it affects how well the arteries work.
Omega-3 fatty acids are also essential for brain function. All neurotransmitters are made from omega-3 fats. You literally cannot think, feel or function without omega-3 fats in your brain. Insufficient omega-3 fats is associated with low IQ, behavioral problems and many other conditions of the brain and nervous system. I consume them every day.
Tip number 15 Eat cold water fish, flax, chia and pastured animals, or eggs, butter, cheese, etc from pastured animals.
An oxidant that’s harder to avoid is Iron. We need Iron in our red blood cells to carry Oxygen. Iron is really great at carrying Oxygen because it has 4 open bonds. The problem is that too much Iron can cause oxidative damage to our blood vessels. How do we know this is true?
Women who are menstruating have a lower risk of heart attack than men of the same age until two years after they stop menstruating. This is still falsely used as a rationale for women to take female hormones after menopause. Men who are vegetarians such as Seventh Day Adventists have the same low risk of heart disease as menstruating women. It isn’t because they are taking female hormones. They aren’t eating meat. Meat has high levels of Iron. Men who eat meat but give blood 4 times per year have the same reduced risk of heart disease as menstruating women or vegetarian men. Get the picture? It’s the Iron. According to a study in the America Journal of Epidemiology, “blood donors had a 88% reduced risk of acute myocardial infarction compared with non-blood donors.” x
By the way, some of my patients use reddish colored salts like Himalayan or Celtic salt for it’s supposed health benefits. What makes the salt red or pink is Iron. Skip it unless you are menstruating and need Iron.
Tip number 16 Limit or avoid red meat. If you eat red meat, give blood.
Another source of inflammation is an amino acid called Homocysteine, a metabolite produced in the incomplete conversion of the amino acid Methionine to the amino acid Cysteine. If you have adequate amounts of Folic acid and Vitamin B6, the conversion of Methionine to Cysteine will be complete and you will not accumulate high levels of Homocysteine.
Why is elevated Homocysteine important? Homocysteine is easily oxidized and produces Superoxide and Peroxinitrite. These potent free radicals inhibit Nitric Oxide (more on Nitric Oxide later) and damage the endothelium (inner lining of the blood vessels). Elevated Homocysteine is also associated with apoptosis (death) of muscle cells adjacent to plaque, contributing to rupture and thromboembolism. Elevated serum Homocysteine is found in 40% of patients diagnosed with premature coronary artery disease or recurrent venous thrombosis.
Tip number 17 Make sure you have adequate levels of Vitamin B6 and Folic acid.
What else helps reduce Homocysteine? Get more of your protein from plants and less from meats. “High animal-protein diet was positively associated with high tHcy (Homocysteine) concentrations, whereas high plant-protein diet was inversely associated with tHcy concentrations” xi
Tip number 18 Eat less animal protein and more plant protein.
How do you know if you have high levels of Homocysteine?
There is an inexpensive blood test.
The optimal range is 10 – 12
Moderate elevation 15 – 30
Intermediate 30 – 100
Severe > 100
If I had to name a single molecule that is wonderful for the arteries, it would be Nitric Oxide. Why is that? Nitric Oxide dilates capillaries, delivering more blood to the heart and other muscles. This lowers blood pressure and allows the heart and skeletal muscles to produce more energy. The other great thing about Nitric Oxide is that it is an anti-oxidant that prevents the initiation of atherosclerosis. It does so by preventing foam cells from infiltrating the tunica intima. In other words, Nitric Oxide prevents oxidative damage to the inner lining of the blood vessels.
Where do we get it? Nitric Oxide is produced in the vascular endothelium (and also the oral cavity). This production is stimulated by thyroid hormone and also by exercise. The amino acid Arginine converts to Citrulline which converts to Nitric Oxide with the help of Folic Acid and Vitamin C. A high food source of Arginine is nuts. A high food source of Citruline is watermelon rind. You can also purchase nutritional supplements of Arginine and/or Citruline. Some of the better products come with Folic Acid and B12.
Some Nitric Oxide is also produced by bacteria in the oral cavity. Mouthwash kills the bacteria. Mouth breathing prevents inhalation of the Nitric Oxide. If you aren’t breathing through your nose, you are losing out on some of your Nitric Oxide. Check if you have a sinus infection or other airway obstruction.
The largest amount of Nitric Oxide is produced in the inner lining of your blood vessels and that production is driven by circulating levels of thyroid hormone. Production of thyroid hormone declines with age. Incidence of high blood pressure and atherosclerosis rises with age. Coincidence? Not likely. Improving thyroid health is covered in another article.
Something we can control is our level of exercise. Production of Nitric Oxide rises with exercise.xii This is one of the reasons exercise is so helpful in preventing cardiovascular disease.
Exposure to sunlight also causes the release of Nitric Oxide from our skin. A number of foods (notably beets) contain nitrites. These Nitric Oxide precursors are stored in the skin and converted to Nitric Oxide when exposed to ultraviolet light (UVA) from the sun. I have found my systolic blood pressure drop 15-20 points after less than 10 minutes of sun exposure. My rule of thumb for sun exposure is to only expose myself when my shadow is as long as I am tall. I also wear a hat to cover my face as my face is always getting at least indirect sun exposure. Sunlight ages the skin and is a risk for melanoma and other skin conditions but is essential for producing Vitamin D and producing Nitric Oxide. I don’t use sunscreen as it gives a false sense of security and contains chemicals that according to the Environmental Working Group may be hazardous. I would rather wear a hat or long sleeves when in bright sun. In the winter or in the morning or late afternoon when the angle of the sun is low, I expose my body to the sun as it causes the production of melanin to the point of creating a tan, not a sunburn. The melanin in our skin is our best sunscreen.
Nitric Oxide is impaired by high levels of glucose or fructose.xiii As mentioned earlier, high levels of blood sugar cause advanced glycation end-products that destroy tissue and account for why diabetics have damage to their arteries, nerves, eyes and internal organs.xiv
So what can we do?
Tip number 19 Exercise at least 30 minutes per day, at least 5 days per week.
Tip number 20 Get adequate Folic Acid and Vitamin C.
Tip number 21 Eat nuts and/or take Arginine and/or Citrulline supplements.
Tip number 22 If you are a mouth breather, see and EENT and get your airway evaluated.
Tip number 23 Consider not using an alcohol based mouthwash.
How can you tell if you have high levels of inflammation?
There is a simple and inexpensive blood test called C-Reactive Protein or CRP. A slightly more expensive and accurate version of this test is called high sensitivity C-Reactive Protein or hCRP.
Tip number 24 Get tested for hCRP
What can you do for high levels of inflammation?
First of all, follow the steps listed above. If you still have too much inflammation, or if you just want to be proactive, try taking curcumin, the active ingredient in turmeric. You can take it as a supplement or as part of your daily diet. The best way to prepare it as a food is to heat turmeric in coconut oil with a little black pepper to increase absorption. Think South Asian cuisine. Saute turmeric, black pepper, garlic, chiles and other spices in coconut oil. Then add vegetables and meat or beans. It’s what’s for dinner! By the way, ginger is a related plant and has the same active ingredient. Making ginger tea or eating jerk sauce in Caribbean cooking has a similar effect.
Tip number 25 Take turmeric is you still have markers of inflammation.
I hope that this article empowers you to prevent disease and add years of health to your life. I know that what I have written can all seem overwhelming and technical. I put in a lot of detail so you can come back and get more later. You don’t have to do it all now. Take any one tip and make a change. The life you save could be your own.
David Wells, D.C., L.Ac.
i Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause cardiovascular, and cancer mortality: sixteen years of follow-up in US women.
iii Dietary Fructose Consumption Among US Children and Adults: The Third National Health and Nutrition Examination Survey. Medscape J Med. 2008; 10(7): 160. Published online 2008 Jul 9.
iv J Clin Invest. 2009 May;119(5):1322-34. doi: 10.1172/JCI37385. Epub 2009 Apr 20. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans.
v Glycemic Control and Coronary Heart Disease Risk in Persons With and Without DiabetesThe Atherosclerosis Risk in Communities Study
vi Glucose Levels and Risk of Dementia
Paul K. Crane, M.D., M.P.H., Rod Walker, M.S., Rebecca A. Hubbard, Ph.D., Ge Li, M.D., Ph.D., David M. Nathan, M.D., Hui Zheng, Ph.D., Sebastien Haneuse, Ph.D., Suzanne Craft, Ph.D., Thomas J. Montine, M.D., Ph.D., Steven E. Kahn, M.B., Ch.B., Wayne McCormick, M.D., M.P.H., Susan M. McCurry, Ph.D., James D. Bowen, M.D., and Eric B. Larson, M.D., M.P.H.
N Engl J Med 2013; 369:540-548August 8, 2013DOI: 10.1056/NEJMoa1215740
vii Bjornholt JV, Erikssen G, Aaser E, et al. Fasting blood glucose: an underestimated risk factor for cardiovasculardeath. Results from a 22-year follow-up of health nondiabetic men. Diabetes Care. 1999 Jan;22(1):45-9.
viii N Engl J Med. 2005 Oct 6;353(14):1454-62. Normal fasting plasma glucose levels and type 2 diabetes in young men. Tirosh A1, Shai I, Tekes-Manova D, Israeli E, Pereg D, Shochat T, Kochba I, Rudich A; Israeli Diabetes Research Group.
ix Bernstein AM, Roizen MF, Marintez L. Purified palmitoleic acid for the reduction of high-sensitivity C-ractive protein and serum lipids: a double-blinded, randomized, placebo controlled study. J Clin Lipidol. 2014;8(6):612-7
xi Journal ListNutr Jv.12;2013PMC4176105
xii J Cardiovascular Risk. 1994 Aug;1(2):173-8
xiii Kimura C, Oike M, Koyama T, Ito Y. Impairment of endothelial nitric oxide production by acute glucose overload. Am J Physiol Endocrinol Metab. 2001 Jan;280(1):E171-8
xiv Vlassara H. Advanced glycation end-products and atherosclerosis. Ann Med. 1996 Oct;28(5):419-26.