Heart disease driver is not cholesterol

Why is it that some 50% of people who have a heart attack have a cholesterol level in the normal range?

Many of these are people who know, and have followed, the basic advice – reduce overweight, build in 30 minutes of exercise at least 5 times a week, restrict your intake of saturated fats and salt, eat more fruits and vegetables and oily fish and get a regular screening for blood. They were also almost certainly sufficiently health conscious not to smoke.

So what was missing?

The answer almost certainly lies in the latest research which shows that a – probably the – key driver of heart disease is ‘chronic, sub-clinical inflammation’.  ‘Chronic’ merely means continuous and ‘subclinical’ means not diagnosed.  In other words it’s a silent threat.

“Inflammation is an underlying contributor to virtually every chronic disease… rheumatoid arthritis, Crohn’s disease, diabetes and depression, along with major killers
such as heart disease and stroke.”

Scientific American (2009)

The clear message from this, and a very large amount of the latest health research,is that reducing inflammation in arteries and cells is critical for maintaining not just a healthy heart – but all round health.

You do that by increasing anti-inflammatory foods and nutrients in your diet and reducing pro-inflammatory foods. Anti-inflammatory foods include Omega 3 rich fish, and especially dark coloured berry fruits and brassica vegetables all of which contain flavonoids which are anti-iflammatory.

Nutritional supplements that have a powerful anti-inflammatory effect are flavonoids like green tea and grapeseed extract, curcumin , and soy isoflavones.

Pro-inflammatory foods include corn oil, processed foods including corn oil and high temperature cooking.

Inflammation is now regarded as a key driver of the aging process itself. You can get a free report on this breakthough scientific discovery at the end of this article.

But risk reduction can go even further- with a little known supplement called betaine.

Betaine is important because it helps lower a blood protein called homocysteine –  excess levels of which are a marker for heart problems. It’s a marker that may be more important than cholesterol.

Homocysteine is another silent threat.

Research has shown that people with high homocysteine levels have a 3 times higher risk of heart disease than those with a normal level, and it is also now seen as a marker for stroke, osteoporosis, dementia and birth defects.

Homocysteine is an amino acid that is naturally made in the body. Usually, homocysteine is quickly converted by certain enzymes into other harmless substances, but these enzymes need good supplies of vitamins B12, B6 and folic acid to work properly.

Some people inherit versions of the enzymes that work poorly, or which need higher levels of vitamins to function properly. Homocysteine processing also becomes less efficient as we get older, especially after the menopause in women.

Homocysteine triggers oxidation of LDL cholesterol so it is more likely to stick to artery walls, forming atheroma.  To process and reduce homocysteine, it is important to eat plenty of foods that are rich in folic acid and vitamins B12 and B6. Unfortunately, dietary lack of these vitamins seems to be common. A survey in the US suggests that only 40 – 50% of people obtained enough folic acid from their diet to process homocysteine normally.

Harvard Medical School recently warned in its Health Letter that vitamin B12 deficiency is the most common nutritional deficiency in the Western world. Adults over 50 are also more likely to be deficient, as a third of people in this age-group suffer from atrophic gastritis, where the stomach lining thins and the amount of B12 absorbed by the small intestine is reduced.

Folate (the natural form of folic acid) is found in green leafy vegetables, whole grains, nuts, beans and yeast extracts. Vitamins B12 and B6 are in liver, kidney, oily fish especially sardines, red meats and eggs. Some B6 is also present in whole grains, soy products, bananas, nuts (especially walnuts), green leaves, avocado and yeast extract.

It is hard to obtain optimum levels from foods alone. Natural folate, for example, is not absorbed or used in the body as well as the synthetic form, folic acid, so supplements are often needed to have a significant effect on homocysteine levels.

In addition to folic acid, B12 and B6, several studies have shown that betaine is highly effective in helping to lower homocysteine levels. It is particularly important in the many people who are unable to metabolise folic acid effectively. And these should all be combined with antioxidant compounds and co-factors such as selenium, vitamins A C and E, the carotenoids and the flavonoids.

Get the free report called Inflamm-ageing now and learn how to cut the risk of heart disease.

Colin Rose:  2013


Guthikonda S, Haynes WG. Homocysteine: role and implications in atherosclerosis. Curr Atheroscler Rep 2006 Mar;8(2):100-6. Review.

Schwab U et al. Orally administered betaine … J Nutr 2006 Jan;136(1):34-8.