And what can you do to reduce risk …
For those of you who have discussed the issue of heart disease with me, you will know that, together with an ever-growing body of people, including some doctors and nutritionists, I am sceptical about what’s called the ‘diet—heart hypothesis’, also known as ‘the cholesterol hypothesis’, the paradigm that currently holds sway in the mainstream. Instead, there is growing evidence that the development of heart disease centres around clot formation, and this is termed the thrombogenic theory of heart disease.
In this article, I summarize the most pertinent information presented by two of my favourite speakers and writers in this area: Drs Malcolm Kendrick and Paul Mason. I’ve put links to some of their key resources so you can go and check them out. They tend to dive deep into the science, so I have tried to keep that side brief, and focus more on the implications it has for diet and lifestyle.
The current cholesterol-based paradigm
Briefly, the diet—heart hypothesis states that if you reduce the level of cholesterol in a person’s blood by replacing saturated fats with polyunsaturated vegetable oils (also called ‘seed oils’), this will reduce the deposition of cholesterol in artery walls, and thus slow the development of artherosclerosis, and therefore reduce cardiovascular risk.
But, what has been becoming increasingly clear is that while replacing saturated fat in the diet with polyunsaturated vegetable oils can lower serum cholesterol and LDL (‘bad cholesterol’) levels, this does not translate to a lower risk of death from coronary heart disease or all causes. In fact, it may even do the opposite. Oooops!
The new understanding
While blood clotting has long been understood to play some role in atherosclerosis formation, the shortcomings of cholesterol hypothesis, together with a greater understanding of true cardiovascular risk factors and the mechanisms involved, points to a clearer picture, involving:
- damage to the inner lining of the blood vessels
- repeated clot formation as a repair process
- metabolic and stress hormone factors
- the role of oxidation
Damage to the blood vessels and the need to repair
The unifying feature of true CV risk factors is that they cause one or a combination of: (a) damage to the lining of the blood vessels; (b) reduced rate of lining repair; or (c) increased clotting tendency.
The body is in a constant process of repair and renewal and the lining of our arteries is no exception. If our health, diet and lifestyle is such that the damage to the artery lining is relatively slow and modest, the usual repair mechanisms are more than able to keep up with it. However, when multiple factors are constantly eroding the endothelium, the usual repair mechanisms are outstripped, and this is when clots and plaques result.
Some common things that increase CV risk in this way include:
- drug and alcohol abuse
- inhaled pollutants, including smoking and poor air quality
- high blood sugar / type 2 diabetes
- lack of exercise
- high levels of the stress hormone cortisol / steroid medications
- high blood pressure
- periodontal disease
- certain medications
Metabolic and stress hormone factors
Under this heading, some of the major factors that will predispose many people to the formation of atherosclerotic plaque formation include:
- high and spiking blood sugar/insulin (as found in T2 diabetes/insulin resistance)
- high levels of cortisol or use corticosteroid drugs
So many people around the world are either diagnosed with T2 diabetes or are well on their way to diabetes; factors such as diet, exercise and stress play an important role.
Psychological stress is a risk factor for cardiovascular risk through the actions of the main stress hormone — cortisol. Chronic stress, anxiety and depression, as well that seen in bipolar disorder and schizophrenia are all associated with increased heart disease via the actions of cortisol. What is more, drugs that are chemically similar to the hormone cortisol have the same damaging effect on the cardiovascular system. These are the corticosteroid drugs (commonly known as steroids), which are widely prescribed for a range of common conditions.
The role of oxidation and inflammation
Oxidative stress is a situation whereby increased levels of unstable compounds called free radicals cause damage to other molecules in the body by reacting with them, causing damage to DNA, proteins and lipids. While some free radicals are created by the body’s processes, some foods can also increase free radicals in the body, including refined sugars/carbs, processed food and unstable oils. Conversely antioxidants are great at ‘mopping up’ free radicals and so have a protective effect
It is becoming increasingly clear that oxidation is one the factors that plays a key role in the development of atherosclerosis, via oxidized LDL (low density lipoprotein, commonly known as ‘bad cholesterol’).
The big ‘So what?’ Implications: some lifestyle and dietary changes
I’ve just given a very brief overview to the current understanding of processes leading atherosclerosis and I would urge you to listen to the experts and explore more about that they have to say on the matter and explain things further.
So, as far as we understand things today, what can we do to help protect our cardiovascular health? Here’s some of the real-world implications for this info:
Things to avoid:
- Drug and alcohol abuse
- Smoking, and other inhaled pollutants
- Acute stress and high-level chronic stress
- High physical stress in extremes of temperature
- Medications (especially long-term use, if possible):
- Steroids
- Proton-pump inhibitors
- Non-steroidal anti-inflammatory drugs
- Diet:
- Processed foods
- Polyunsaturated seed oils
- Refined sugars/carbohydrates
Things to embrace:
- Look after your mental health; manage stress levels
- Stay physically active – include short-burst exercise
- Get regular sun exposure
- Manage your blood pressure
- Breathe through your nose
- A low-carbohydrate diet that includes the whole complement of vitamins and minerals, including potassium and the B vitamins; replete in proteins and good fats; high in antioxidants
- Look after your teeth
- Stay hydrated
Supplement suggestions:
- Vitamin D in the winter (sun in the summer)
- Vitamin C
- Magnesium
- L-arginine (or L-citrulline), esp. if you are vegetarian or vegan
- Co-enzyme Q10
- Chondroitin sulphate
- N-acetyl cysteine
- (Vitamin B complex and potassium if your diet is restricted)
Also take a look at some of my other articles that feed into this topic: on naturally lowering blood pressure, the benefits of sunlight, good fats / bad fats, and keeping things flowing.
So what’s cholesterol got to do with it?
I haven’t gone into the issue of cholesterol or blood lipids more broadly here, but suffice to say it’s more complicated than ‘LDL is bad’. Blood lipids do have an impact on or perhaps reflect cardiovascular risk, but that will be for another day … However, if you do take on some or all of the above changes, you will be moving things in the right direction and that is a very good thing.
Further reading
Kendrick, M. The Clot Thickens: The enduring mystery of heart disease. Columbus Publishing Ltd (2 Nov. 2021). ISBN-10: 1907797769.
Dr Kendrick’s blog: drmalcolmkendrick.org
Mason, P. Hard Science on the Cause of Heart Disease. Bonus: How Seed Oils Kill. Lecture by Dr Paul Mason on YouTube.
