We are led to believe by most conventional doctors that the measurement of LDL and total blood cholesterol levels are the primary predictors for cardiovascular disease. If this were true, though, why is it that more than half the cases of patients having acute cardiovascular events have normal or even low cholesterol levels? The truth is, there is much, much more to cardiovascular disease than simply elevated cholesterol levels.
The Patient
There is a case that exemplifies this concept completely: The patient is a 72-year-old man with a history of repeated heart attacks and multiple bypass surgeries and arterial stenting that began in his late 50s. He decided to come see me because he felt that his current cardiologist’s approach had not been working too well and he was afraid his next heart attack would be his last.
I took a very detailed case, questioning him on his current diet, lifestyle, and current medications and supplements. At the strong urging of his cardiologist, he had become a strict vegan after his first cardiovascular event more than 10 years previous and noted that he had been a vegetarian for decades before making the switch to vegan. He was also taking a relatively heavy dosage of the statin drug Lipitor (the top dosage of 80 mg daily) along with a laundry list of every known cardiovascular supplement on the planet, including niacin, flax seed oil, pantethine, coq10, vitamin E, and so on. This patient had been determined to do everything he could to prevent future cardiovascular events, which started even before his first heart attack at the age of 57. He had been taking most of those supplements and had been on some type of statin since they came on the market over 20 years ago. He couldn’t understand why he was having all these cardiovascular issues despite being so proactive.
The Tests
I performed a complete physical on him, noting he appeared emaciated with very low muscle tone but with a sizable pot belly. He mentioned that he had been maintaining his current weight for several years but no matter how thin he got, he could never get rid of his pot belly. I decided to do a complete blood work-up on him from my perspective to uncover the root cause behind his cardiovascular issues.
He came back for his follow-up visit two weeks later and we went through his results in detail. The first thing I asked him was whether any of his doctors had mentioned to him that he was prediabetic, based upon a blood test called a hemoglobin A1C, which measures average blood sugar over several months. My patient was shocked; no one had ever told him that. “How can that be? I eat so well!” I then asked him to please go over with me again exactly what he eats in the course of a day.
The Diet
My patient began listing what he consumes on a daily basis: “I eat lots and lots of fruit [which he consumed as mostly fruit juice, multiple times a day] and of course vegetables. My protein comes from soy as well as other beans and legumes and some nuts. I eat lots of healthy whole grains with each meal, like corn, whole wheat breads, pastas, cereals, and plenty of brown rice. I also love all types of potatoes. I eat virtually no fat in my diet, just what’s found in a few nuts and seeds and maybe a drizzle of olive oil here and a teaspoon of flax oil there…but that’s it! I’m very strict.”
I explained to him that most of his daily calories were coming solely from carbohydrate sources (even if they were from whole food sources) and that even his protein sources were comprised mostly of carbohydrates—especially the beans and legumes.
The Results
After the discussion about his prediabetes, I noted that his LDL and total cholesterol levels were extremely low—in part because he wasn’t eating enough, but also because he was taking enough Lipitor to choke a horse. And although he had low cholesterol levels, his triglycerides (the fats in his blood) were quite elevated.
Once again, my patient was very surprised, believing that because he rarely included fats with his diet, he should not have elevated triglycerides. I explained that the excess carbohydrates he was consuming were being converted to triglycerides in his liver and what he didn’t burn was being stored in that pot belly of his…and that even though he had quite low total cholesterol, he had a very high amount of LDL cholesterol particles—especially the small, dense type.
He had never heard of cholesterol particle number and size and wanted to know more about it, so I told him that because he was eating so many carbohydrates and was a borderline diabetic, although the particles that carried cholesterol were quite depleted of it, there were way too many of them, and they were comprised primarily of triglycerides.
People with abundant LDL particles are predominantly small and dense and have a threefold greater risk of coronary heart disease, and I explained that concerning cholesterol, in his case it was more about quality and less about quantity. In research studies that track total and LDL cholesterol as well as cholesterol particle number, when these number disagree (as in his case), the particle number takes precedence—which probably explains why more than half the people suffering similar cardiovascular events have normal to low total and LDL cholesterol levels.
From there, we discussed various other overlooked risk factors I had seen on his lab work, such as his extremely low testosterone levels (most likely due to his diet and the statins). I told my patient that low testosterone has been shown in numerous studies to be an independent risk factor for cardiovascular disease, and that without adequate cholesterol there is not enough raw material to make testosterone or any other steroid molecule, such as pregnenolone, cortisol, and DHEA (which, incidentally, were also extremely low).
The Plan
After covering several other risk factors, I noticed my patient’s head looked like it was ready to explode from information overload. When I asked if he had any more questions, he said, “Just one…what the hell do I need to do to fix all this?! I’ll do whatever you tell me, Doc!”
I told him since he was taking plenty of (maybe too many) great supplements I would not recommend more, but he should trade in his flaxseed oil for fish oil instead. And of course, he immediately balked. “Wait a minute,” he said. “I can’t take fish oil. I’m a vegan, remember?”
My response?
“Guess what? Not anymore! Your current high-carb, vegan diet is part of the reason your health is where it is right now. You said you’d do whatever I told you and the best thing you could possibly do to help yourself is stop being a vegan. Follow the diet I lay out for you, which essentially consists of eating completely the opposite that you have for years. I’d like you to switch over to a higher, real fat diet with moderate amounts of complete protein from animals fed their natural diets, such as grass-fed beef and dairy, pasture-raised poultry and eggs, and low carbohydrates from non-starchy vegetables, small amounts of fruit, nuts, and seeds, and full-fat dairy.”
Much to my surprise, he looked me right in the eyes and said, “I’ll do it, Doc, you’ve got my word!”
And that’s exactly what he did.
Fast Forward
I’ve been seeing this patient now for the past five years, which makes him 77 years old—one of the healthiest 77-year-olds I know. He has not had another cardiovascular event of any kind, has gotten off all his medications, and takes only a couple of supplements. He also complies very strictly with his paleo/primal way of eating—and he feels fantastic. He not only reversed his prediabetes and high triglycerides but also his other risk markers completely. Oh, and that emaciated body has been replaced by some pretty good muscle mass for a 77-year-old, and his pot belly almost entirely gone.
This case clearly represents the power of proper diet customized for the individual. I’m not saying that a vegan diet is the cause of cardiovascular disease—there are many people out there who do very well on a properly balanced and supplemented vegan diet. In this specific patient, however, I felt it was detrimental to his health and therefore a change was crucial.
Dr. Frank Aieta is a board certified and licensed Naturopathic Physician who has had a private practice in West Hartford, CT, for close to two decades. Also see Dr. Aieta’s e-book, Taking Back Your Health, which can be found in its entirety at draieta.com/ebook. More info can be found on his website: www.DrAieta.com