Paul D. Tortland, D.O.
As the name implies, Preventive Medicine strives to be proactive, rather than reactive, with regard to health. Reducing the risk of cardiovascular disease (CVD) is a major area of focus of Preventive Medicine. While a comprehensive discussion of this topic is beyond the scope of this article, there are some overriding principles that readers can employ.
It’s Not Cholesterol’s Fault
Perhaps the largest area of focus of cardioprotection pertains to diet. However, as I wrote in a previous issue of Natural Nutmeg, most of the conventional wisdom being taught by physicians and nutritionists on this topic is actually wrong!
Maligned for the last 40 years as a cardiovascular bogeyman, cholesterol has been vilified as the Devil incarnate when it comes to heart disease. Yet there is no compelling research that demonstrates a correlation between total serum cholesterol and risk of CVD.
We have been—and continue to be—admonished to consume a diet low in saturated fat (i.e. cholesterol), and high in whole grains. For the most part, Americans have dutifully obliged, loading their shopping carts with low fat, ‘lite,’ and fat-free foods. The result? Americans are getting fatter faster, and the rate of CVD continues to escalate.
Only 20% of the total cholesterol in the body comes from diet; 80% is made inside the cells. Cholesterol makes up half of our cell walls, helping them maintain fluidity in the face of environmental temperature extremes.
Although cholesterol is a major component of arterial plaque, it’s not the fault of the cholesterol.
What is to Blame?
Cholesterol is a naturally waxy, non-sticky substance. Only when cholesterol gets oxidized does it become sticky. So what causes cholesterol to get oxidized? Inflammation in the body. And what contributes largely to the inflammation? A high-sugar, high-carbohydrate diet.
Carbohydrates raise the level of the hormone insulin. If insulin levels remain elevated via persistently carbohydrate-heavy diet, a state of chronic inflammation develops. This causes damage to the walls of the arteries. High insulin levels also increase the formation of LDL particles, the so-called bad cholesterol. (HDL and LDL actually are NOT cholesterol at all. Rather, they are protein carriers for cholesterol.)
The body attempts to repair the ongoing arterial wall damage by bringing cholesterol to the damaged sites. (Remember that cholesterol is a major component of cell walls.) But the now-sticky cholesterol continues to get lodged in the arterial wall, and in the face of persistently high insulin the process continues uninterrupted. This results in plaque formation which leads to the narrowing and hardening of the arteries.
Dietary fat, on the other hand (I’m referring here to the good saturated fats), has absolutely NO effect on raising insulin levels, and therefore it does not contribute to inflammation. The result is no oxidation of cholesterol, no arterial wall damage, and no plaque formation.
Fats in general are not only NOT dietary villains, but saturated fats are actually vital for optimal health. In fact, the only really dangerous fat is trans fat (margarine, vegetable oils). Fats have the following properties:
- Building blocks for your cell membranes
- Necessary for production of a variety of hormones and hormone-like substances
- Carriers for the fat-soluble vitamins A, D, E, and K, and required for the conversion of carotene to vitamin A, for mineral absorption, and for a host of other biological processes
- Useful antiviral and anti-fungal agents
Recent research has started to confirm the theory that high-carbohydrate diets are in fact atherogenic (plaque-forming), while low-carbohydrate, moderate fat and protein diets are in fact either neutral regarding CVD or even protective.
Reduce Your Risk of CVD
To reduce your risk of CVD (and in mild cases, perhaps even reverse it), take the following steps:
- Gradually start restricting carbohydrates, especially sugars, fructose, and grains. Ultimately, carbs should represent the smallest portion of your diet (aim for fewer than 100 grams of carbohydrate per day).
- Increase healthy fat consumption.
- Maintain adequate protein intake (0.5 gram per pound of body weight per day for sedentary people, up to 0.8 gram per pound of body weight for those who engage in moderate-to-intense exercise on a regular basis).
Fructose is one of the largest sources of dietary calories in the US. It is found in virtually all processed foods (mostly as high fructose corn syrup or corn sugar). And while fructose is a natural sugar in fruits, it occurs in relatively small amounts and is bound with the fleshy fiber of the fruit. On the other hand, one 15.2 oz bottle of apple juice has the same amount of sugar as 25 powdered Dunkin Munchkins! So ditch the juice and eat whole fruit!
Refined carbohydrates (breakfast cereals, bagels, waffles, etc) quickly break down to sugar (ALL carbs become sugar), increase insulin levels, and cause insulin resistance, which is the number one underlying factor of nearly every chronic disease known to man, including heart disease.
However, it’s important to recognize the difference between carbohydrates from grains and those from vegetables. As you decrease your ‘junk’ carbs you will need to radically increase your intake of vegetables, particularly green leafy and fibrous veggies. (Intake of starchy veggies—peas, corn, carrots, white rice, white potatoes, etc.—should be kept to a minimum.)
While both carbs and fats are sources of energy, saturated fat is actually the preferred fuel for your heart. In fact, unlike protein and certain fats, there is no such thing as an ‘essential carbohydrate.’ Good sources of saturated fats include:
- Omega-3 fish oil
- Olives and Olive oil
- Coconuts and coconut oil
- Avocadoes
- Lean cuts of animal meat
- All-natural peanut butter
- Butter made from raw grass-fed organic milk
Exercise
The next piece of the puzzle is exercise. Exercise lowers inflammation in the body. It also reduces peripheral vascular resistance, which helps lower blood pressure. The heart IS a muscle, after all, and regular exercise can help improve cardiac function. It can slow your resting heart rate and make your heart contract more efficiently.
Exercise can—and should be—fun. But it should not be easy! If exercising is a breeze, you’re probably not pushing yourself hard enough. Go to the gym to work, and save the socializing for later! If you have a hard time gearing up for a vigorous workout, try focusing on the prize: a healthier you.
Cardio vs. Weight Training
Many people who exercise do not do it in a way that maximizes its effectiveness. First, people put way too much emphasis on cardio exercise and little or no emphasis on weight training. As we get older we lose muscle mass faster than we lose cardiac function. Contrary to popular belief, as we age we should be doing more weight training than cardio, not the other way around, or at least an equal balance of the two.
Weight training will burn as many (if not more) calories than cardio. Unlike cardio, however, the calorie-burning effects of weight training continue long after the workout. The more muscle you have, the more calories you burn, even at rest.
Good muscle tone helps propel venous blood back towards the heart, reducing swelling in the arms and legs, reducing blood pressure, and improving cardiac efficiency. Strength training also improves insulin sensitivity and reduces insulin resistance, both of which maximize your body’s ability to control sugar and—you guessed it—inflammation!
Proper Weight Training
Here again, however, most people fall short of the mark when they engage in resistance training. They don’t use enough weight to stimulate a muscle response. They don’t push their muscles to failure or near failure (a prerequisite for stimulating muscle response). They rest too long between sets. They use poor form or technique (such as performing repetitions too quickly). And they do their weight training after they just spent 30 minutes on a cardio machine, thereby depleting their muscles of the necessary glycogen energy stores needed to do the weight training.
Instead, try this approach: For each exercise choose a weight or resistance level with which you can perform 15 slow, controlled repetitions, but only do 10. Rest 30, but no more than 40, seconds (shorter is better), and do another set of 10 reps. Rest and perform a 3rd set. Rest again and do a 4th set, but this time go to complete muscle fatigue or failure. If you can do more than 10 to 12 reps on this last set then increase the weight next time. Every six to eight weeks change the exercises that you are doing to prevent your body from adapting.
For cardio, not only is traditional aerobic exercise one of the least effective forms of exercise, it’s also one of the most time consuming. You’re really getting the least amount of bang for your buck when you spend extended amounts of time running on a treadmill or grinding it out on an elliptical machine.
High-Intensity Interval Training
Research is starting to show that the best way to condition your heart and burn fat is not to jog steadily for an hour. Rather, it’s to alternate short bursts of high-intensity exercise with gentle recovery periods. This is known as High-Intensity Interval Training, or HIIT, and can be done using any cardio machine, swimming, or even walking or running outdoors.
Warm up at a comfortable pace for four minutes. Then do 30 seconds of maximal effort, followed by 90 seconds of reduced effort recovery. Repeat for seven more intervals (for a total of eight intervals). Your total workout time will be only 20 minutes, but you will burn more calories and have a markedly more effective workout than plodding along at the same pace for 30 minutes, or even 45 minutes or longer!
Supplements
A comprehensive discussion of supplements to help reduce the risk of CVD could fill an entire book. However, there are a few that are particular noteworthy.
Omega-3 fish oil is a healthy fat that reduces the risk of cholesterol oxidation and has natural anti-inflammatory properties. A good range for cardioprotection is 3000-4000 mg per day combined of DHA + EPA (the two major types of fats in fish oil).
Vitamin D3 is an essential hormone that helps reduce cardiac risk. (Yes, vitamin D is a hormone, not a vitamin!) Optimum blood serum levels of D3 are 60 to 80. Most people need 5000 to 10,000 IU of D3 daily for maximum benefit. (Do not use D2. It is much less effective than D3.)
Co-enzyme Q10 is a supplement that helps support cardiac mitochondria. Mitochondria are the small energy-producing organelles inside each cell. They literally are the cell’s powerhouses, generating the ATP (adenosine triphosphate) our cells depend on for life. Approximately 60 to 100 mg per day is adequate for healthy people. Those taking statin drugs for cholesterol need higher amounts, up to 200 mg/day.
Niacin (also known as B3 or nicotinic acid) is a critical B vitamin for cardioprotection. It increases production of protective HDL by 15% to 35% and is the most effective ‘drug’ for raising HDL. It also lowers LDL and triglycerides, both of which are risk factors for CVD. Because of the side effect of flushing, which many people cannot tolerate, Niacin is best taken in a sustained-release form. Doses between 500 mg and 1000 mg per day are required. To reduce the risk of flushing, some people may find it helpful to take it with a baby aspirin. But consult your physician first.
Hormone Balancing & Optimization
Hormones play a key role in cardiac health, although they receive relatively little attention in this regard. A sluggish or underactive thyroid can compromise cardiac function. Estrogen can reduce arterial plaque formation.
Testosterone improves cardiac contractility and improves blood flow to the heart muscle. Testosterone also improves insulin sensitivity and reduces insulin resistance, and it increases lean muscle mass. Both men and women can benefit from testosterone, but levels need to be monitored with blood tests.
Lifestyle
Perhaps the hardest variable to control, or to get control of, is lifestyle. Stress is a known risk factor for cardiac disease, and getting control of stress is critical to reduce the risk of CVD. Stress induces hormonal changes that increase the formation of arterial plaque, increase the chance of plaque rupture, increase blood pressure, and induce irregular heartbeats.
When it is not possible to change your environment to reduce stress, it is critical to learn techniques to manage the stress. Prayer, meditation, exercise, laughter, hobbies, even counseling—whatever it takes is worth the time, effort, and money.
Summary
The good news is that cardiovascular disease is largely completely preventable. The bad news is that, like anything worthwhile, it takes planning, discipline, and diligence—for the long term. The benefits last only as long as you are taking the steps. But the alternative—a slow painful decline in health and vitality, and the possibility of premature death—leaves little choice.