In addition to the Elite’s regular standard issue risk factors that I have mentioned previously (they are age, gender, family history, lipid status, hypertension, smoking) some other risk factors are strongly associated with CAD. These are referred to as the new, emerging risk factors also mentioned earlier. If you wish to stop progression of your CAD, and other inflammatory based processes, or reverse it you will need to carefully assess each of these factors.
We will be discussing the most important risks throughout this book. I will go over every one of these in detail where appropriate. Why? Because we have to in order to become healthy again, to stay vigorous. If I succeed in highlighting every risk that I think is clinically important without burying you in minutia, you will be an expert in cardiometabolic risk. As a consequence you will avoid the ravages of heart disease and 100 more ailments which have their starting point in endothelial inflammation. Think about that statement for a moment, there are at least 100 diseases that you can potentially avoid by healing your endothelium! My SMD and lifestyle changes are all you’ll need to do to achieve this status.
IT’S LIKE A CHAIN LINK
To keep the chain strong every link must be free of defects. It’s the same with our list of cardiometabolic risk factors. If you wish to be free of disease then every one of these factors need to be taken into account. For example, if you do everything else correctly, you exercise 7 days a week, eat plenty of fresh fruits and veggies, drink only purified water but still enjoy a nightly dessert far too many times a week you are still leaving yourself quite vulnerable by keeping the high glycemic pathway open. Therefore, you really need to address cardiovascular disease from all of the angles. Ignoring one of these factors sets yourself up for a heart attack, stroke or a cancer-it may take longer to develop-or not-but either way you are setting yourself up. At first it may seem daunting trying to keep track of so many variables but it’s easier than you think.
Although this list is not complete here’s a few of the chain links that are extremely important: deconditioning; metabolic syndrome, overweight/obesity; dietary indiscretion: excess consumption of omega 6 fatty acids, sugar, grains, ID’s; estrogen levels in men (too low & too high); LDL particle oxidation status, your oxLDL level (as of 2014 not a commonly ordered lab test yet); Lp(a); low testosterone and or high estrogen in men; high uric acid level; high homocysteine level; low vitamin K, low vitamin D3 and other nutritional deficiencies; low magnesium; low antioxidant levels in blood; low omega 3 consumption and a high AA/EPA ratio; high fasting blood sugar and high fasting insulin level, abnormal oral glucose tolerance test (OGTT); high hsCRP, and a high TG/HDL ratio. These can be quantified with blood tests which are discussed in the lab section.
FINAL COMMON PATHWAY
You’ll notice there’s nothing about reducing cholesterol numbers. That should make sense now. The information in my book, if followed, puts the reader in an antioxidant, high ORAC, position which is geared toward preventing heart disease, but since most first world diseases have the same inflammatory causes we are really providing an antidote to most, if not all, first world diseases. This is true preventive medicine, the likes of which is not taught in medical school, nor practiced in any major academic medical centers.
FOCUS ON CHOLESTEROL AT YOUR OWN RISK
When you examine the above list you can see that there are many Irritating Agents (IA), or paths toward blood vessel inflammation. This explains why statins are so disappointing and why so many people stay sick while their LDL cholesterol dances dandy in the therapeutic range. Cholesterol is but ONE PLAYER in an entire actor’s guild of IA.
By concentrating on cholesterol, and ignoring the real causes of chronic inflammation you are developing a sure-fire way to slowly “broil” your endothelium over time. Like a fat hen on a spit, cauterizing every square centimeter, you are always exposing yourself to more disease: more strokes, more heart attacks and more cancers. It gets worse if you are on a statin because you slowly poison yourself while letting inflammation run amuck through your system like a pack of feral pole cats.
We can’t let that happen. The one feature common to all of these risk factors is that they not only generate a sick vascular endothelium but they also promote systemic inflammation in the brain and other vulnerable areas. Anything that’s proinflammatory isn’t necessarily contained in any exclusive organ system like the endothelium. Rather the processes that generate endothelial dysfunction nicely overlap and assist those actions or chemicals that promote neurodegeneration. That’s why you see many cardiac patients with co-morbidities in neurodegeneration or cancer for example.
A VISIT TO A FAMOUS CARDIOLOGIST
Is there anything we can do when you are already on high dose statins (as per the CSCS, not my recommendation), with an LDL cholesterol of 60 mg/dl, and you keep progressing your plaque burden? Then there’s nothing you can do so go home and die right? That’s the answer a good friend and patient of mine heard from a “famous” cardiologist from UCSF medical center. While braying to his gaggle of medical students how important he was, he arrogantly quipped: “you have no chance and we can do nothing for you.” Granted his case was very complicated. However, the response this doctor gave him was so wrong on so many different levels that it’s disturbing to think that this guy actually treats patients. On my worse day ever, with an anoxic brain injury, I would still have more common sense than to dispel any hope of recovery from a patient. A statement like that can destroy any optimism they may have. That’s not a doctor’s job. You never destroy a patient’s hope. My friend was calcifying his arteries at an alarming rate (as per his successive heart scans) because he was in a high state of inflammation. I only bring this up because it’s a very familiar story in commercial medicine.
There was something this “famous” cardiologist DIB could’ve done-he just didn’t know it. Just because there wasn’t a new drug that he could prescribe doesn’t mean there was nothing else to offer him. That’s one of the big problems you experience when you decide to remain within the Commercial Sick Care System (CSCS). It’s all drug and procedure oriented. As I prove to you in this book a proper diet, and some supplements perform much, much better in this setting. Hell, I had a heart attack at 40 that’s quite rare and unique. I got the same response-a one vessel bypass as the only option. Talk about killing a fly with front end loader.
Incidentally, the very statin that he was taking may in fact be the promoter of his accelerated plaque formation. As I demonstrate elsewhere recent studies confirm that statins can accelerate atherosclerosis. For the patient mentioned above the very best thing that he could do, after stopping his statin therapy, is go to a fasting retreat for 2-4 weeks or longer. Miracles sometimes happen in these places. I tried to convince him but his argument was that he was too sick to go. I have another friend who has been through a cancer hell yet she stays within the CSCS even though I told her she should go to a fasting retreat. She gets progressively worse every year-one day the CSCS will kill her. I wonder how many patients do indeed go home to die after their DIB runs out of options (medications) to offer. Heaven help us all. Whatever happened to first do no harm. The patients that could benefit from a fasting retreat are exactly the type I refer to here yet often enough they go to great lengths to avoid a cure.
If you have bad genetics you often need an environmental component to cause that gene to express itself. I have terrible genes as far as carbohydrate metabolism goes. What’s my answer? The only thing that can offset my genetic propensity to have metabolic syndrome, diabetes and heart disease is a low carb diet and plenty of aerobic exercise and resistance training. In fact I am such a setup for heart attack and stroke that if I don’t constantly watch out I can easily spiral downward into an inflamed organism again. So I keep very active, take the necessary antioxidants, minerals, micronutrients, and vitamins. Plus I keep my body fat down, and I eat the right kinds of foods. Simple right? Yes, if you know how to go about it, and you will soon enough. Next, I will go over a selected number of risk factors to show their role in generating inflammation.
This brings us to the next section on insulin resistance which is a defining feature of the metabolic syndrome. Insulin resistance can be assessed by checking a fasting insulin level in your blood. Metabolic syndrome is really the disease of civilization. Virtually unknown 50 years ago it is now pandemic. Briefly it is characterized by an overweight “grain belly.” The apple shape rather than the less harmful pear shape body habitus, insulin resistance (high fasting blood sugar and high fasting insulin level), low HDL (good cholesterol), sdLDL particle on cholesterol profile, high triglycerides and hypertension. Those with metabolic syndrome are easily recognized by their typical beer belly. In the Midwest it’s virtually every male featured in a TV commercial. Not good is it? I basically had this except I don’t believe I had developed hypertension
Overweight and obesity are very closely linked to the metabolic syndrome but they are actually growing faster than metabolic syndrome. For the most part you need high insulin levels, plus the extra fat, the grain belly, to develop metabolic traits. It’s the kind of fat-located on your internal organs like the liver and pancreas called visceral fat that’s very inflammatory. Visceral fat is promoted by consumption of processed, high-glycemic, foods and inactivity. Subcutaneous fat while not inert is much less inflammatory. Sub Q fat is the kind of fat Sumo wrestlers have. Although many are huge leviathans they are not ill. By staying super active and eating the right types of foods these athletes prevent visceral fat from forming. Surprisingly, they are not at increased risk for heart disease. But don’t be lulled into thinking you’re healthy if you don’t have a grain belly. You could still have metabolic syndrome.
There’s a new kid in town and he’s homelier than the freckled, red headed kid everyone’s avoiding. Hormonal deficiencies are such a common finding in so many patients these days that I always suspect it even in young patients. I have confirmed low testosterone (T) in some as young as 25 years old. Besides the most obvious (relative) hormonal deficiency of insulin resistance in type II diabetes we should also be concerned with hypothyroidism and low testosterone in men and hypothyroidism in women. Hypothyroidism is spreading across the country like a brush fire as is the inability of doctors to diagnose and treat it correctly. Low testosterone or hypogonadism in males is still viewed with a jaundiced eye from many practitioners due to ignorance. Low T and hypothyroidism are affecting alarming numbers of people because of the high concentrations of environmental toxins such as metal nanoparticles, fluoridated and chlorinated water and the estrogen rich feedlot beef industry. Hypothyroidism and metabolic syndrome share many interesting traits. They are seen together so often that I have coined a new term called hypometabolic syndrome which describes the signs and symptoms of both diseases. I discuss this in detail elsewhere. Easily overlooked in the doc’s office it’s a big one and getting bigger all the time.
What I have discovered is that the American way of life with all its creature comforts, and plentiful food supply has created an epidemic of inflammatory diseases that manifest mainly in three regions of the body: blood vessel inflammation, brain inflammation, and fat cell inflammation. These are what I refer to as the Three Amigos of Inflammation. Let’s now meet my new friends, or as Scarface would exclaim “say hello to my lil fren.” But first come on over, grab a sandwich and a beer, or if you are doing the low-carb route, a lettuce wrap and a shot of tequila, and sit down by the fire and get comfy.