The No.1 killer in the West (for both men and women), is heart disease. So a lifestyle plan to reduce that risk has to be one of your main health strategies.
Coronary artery disease is the result of the narrowing of the arteries that supply the heart with blood, oxygen, and nutrients. It is caused by atherosclerosis, the build-up of cholesterol-rich fatty deposits, or plaques, on the inside of arterial walls.
As these deposits accumulate over time, the coronary arteries narrow to the point that the flow of oxygenated blood to the heart is restricted. This causes increased blood pressure and can result in angina, heart attacks and strokes.
Most medical attention and drug development has been directed at the question “How do you lower blood cholesterol?” That does have a positive effect, so it’s one we will address. But it’s more complicated than that. To really reduce your risk of heart attack and stroke you need to know the answer to two other key questions:
1. Why do the cholesterol deposits build up in the first place?
2. Why do almost 50% of people who suffer a heart attack have normal cholesterol levels?
Why do cholesterol deposits build up?
Atheroma – the build-up of cholesterol – starts when there is chronic inflammation of the arteries, which is known as Endothelial Dysfunction or ED. This inflammation attracts immune cells that migrate into the inflamed tissue and break down, forming the atheroma. (This is the main reason why high blood pressure is associated with an increased risk of heart attacks. Both have a common cause, namely the inflammation.)
This inflammation also upsets the normal balance of ‘dilator’ and ‘constrictor’ muscles. Dilators encourage the arteries to keep open, constrictors encourage them to close. When inflammation develops, the arteries become less sensitive to dilators and the constrictors dominate. The arteries narrow, and blood pressure goes up.
The fact that chronic sub-clinical inflammation is the root cause of the problem has recently been acknowledged in many articles (‘chronic’ = long term and ‘sub-clinical’ = below the level of detection).
“Low-grade inflammation is associated with everything from heart disease and diabetes to Alzheimer’s and arthritis, and may even be the cause of most chronic diseases.”
University of California Berkeley, School of Public Health, 2010
PRIORITY 1 TO REDUCE RISK – Increase anti-inflammatory nutrients
So the first priority in reducing your risk of heart disease is to increase your intake of anti-inflammatory nutrients from foods and supplements.
In particular you’ll want to increase your intake of the polyphenols and flavonoids – naturally occurring anti-inflammatory compounds in fruits and certain spices. These target the blood vessel linings and restore normal vascular function surprisingly rapidly.
These compounds are relatively easy to put into supplements, as they can be extracted from a variety of fruits and spices. Some of the most potent natural anti-inflammatory supplement sources are curcumin, green tea, grape-seed and bilberry.
As we have been eating them as part of our normal diet for millennia, they are of course completely safe to take. Which raises the question – why prefer more expensive and synthetic compounds like statins, given there is a natural alternative?
Statins are expressly designed to lower levels of LDL cholesterol; but cardiologists now realise that lowering cholesterol levels is not necessarily the most effective way of reducing the risk of a heart attack. In fact, around half of all heart attacks occur in people who have apparently normal levels of LDL cholesterol!
There are at least four other problems – each with its own natural solution.
PRIORITY 2 TO REDUCE RISK – Add anti-oxidants to reduce LDL oxidation
LDL (‘bad’) cholesterol may be insufficiently protected by anti-oxidants and therefore too prone to oxidation, also known as free radical damage. In this state Cholesterol Oxidation Products (COPs) are formed which damage the lining of the arteries, setting up sites of inflammation.
NUTRITIONAL SOLUTIONS: Ensure that your diet is rich in anti-oxidants, which are found in fruits and vegetables. In a supplement you need good levels of vitamin E and C and the carotenoids like beta carotene, lycopene and lutein – plus other flavonoids which also have an anti-oxidant as well as anti-inflammatory effect.
Eating nuts – walnuts, almonds, pecans, pine nuts, pistachios, almonds – has also been found to reduce blood cholesterol. Rich in polyunsaturated fatty acids and vitamin E, nuts also help keep blood vessels healthy. But, of course, nuts are high in calories, so stick with a handful and choose unsalted in preference, as excess salt can raise blood pressure.
PRIORITY 3 TO REDUCE RISK – Increase good HDL cholesterol
Levels of HDL cholesterol (the protective form) may be too low. HDL particles seem to ‘scrub’ the artery walls, removing excess LDL cholesterol that might otherwise be used to make the atheroma plaque that causes coronary (heart) disease. The cholesterol is then carried to the liver, where it is processed into bile and excreted out of the body.
NUTRITIONAL SOLUTIONS: HDL cholesterol can be increased through aerobic exercise, and through a maximum of two alcoholic drinks a day – ideally of red wine which contains flavonoids.
An increased intake of Omega 3 fish oil is especially beneficial. Omega-3 fatty acids are found in mackerel, herring, sardines, tuna, wild but not farmed salmon, and halibut. You should grill the fish to avoid adding extra fats.
Eat more high-soluble-fibre foods like oats. Oats contain a compound called beta glucans which not only increase HDL, but also help reduce bad LDL cholesterol. Beta glucans act like a ‘sponge’ by binding to cholesterol into your bloodstream, so it is removed as waste.
Soluble fibre is also found in beans, apples, pears, barley, prunes and vegetables like aubergines (eggplant) and artichokes.
You need to average 10 grams or more of soluble fibre a day. A cup of cooked oatmeal provides 6 grams of fibre and you can increase that by adding fruit such as prunes or bananas, which would add about 4 more grams and by eating wholemeal bread.
Most fruits and vegetables will also boost fibre intake. Apples, grapes, strawberries and citrus fruits are rich in pectin, a type of soluble fibre. There is also an indication that cranberry juice can help raise HDL levels.
Finally, vitamin B3 (niacin) as nicotinic acid appears to help raise HDL levels, but be careful not to exceed the RDA for this vitamin.
PRIORITY 4 TO REDUCE RISK – Reduce homocysteine
In many people who have normal cholesterol but still have a heart attack, blood levels of the toxic amino acid homocysteine are too high. Homocysteine can also drive inflammation.
NUTRITIONAL SOLUTIONS: The vitamins B6, B12 and folic acid work together to help reduce homocysteine levels, and another lesser-known B vitamin called betaine is particularly effective. So an optimum level of these nutrients in your diet and supplement is cardio-protective.
PRIORITY 5 TO REDUCE RISK – Reduce blood platelet stickiness
Blood platelets may be too sticky and therefore clump together – which makes it easier for blockages to take place.
NUTRITIONAL SOLUTIONS: Once again Omega 3 fish oil is an effective way to reduce blood platelet stickiness – and research indicates that lycopene, the ‘active’ carotenoid in tomatoes, can have the same effect.
The factors listed above explain why LDL cholesterol levels alone are a poor indicator of risk. Total cholesterol levels and LDL levels are just one element in a complex balance of factors which affect overall risk.
If the person with high LDL levels is also low in antioxidants, high in homocysteine and low in anti-inflammatory agents like the flavonoids – a pattern common in the Western diet – high LDL levels will indeed increase the risk of a heart attack.
But if the person with high LDL is eating a diet rich in antioxidants, B vitamins, lycopene and betaine and anti-inflammatory compounds like flavonoids and Omega 3, high LDL may have little effect.
It is because there is a complex, combined sequence of events that leads to a heart attack that a single pharmaceutical ‘magic bullet’ like statins, which target only one element, is an inadequate strategy on its own. (Even apart from the possible side effects!)
STATINS AND OTHER DRUGS CARRY RISKS OF THEIR OWN
Recent research shows that some of the drugs in the statin group have slight anti-oxidant and anti-inflammatory effects. It is now thought that it may well be these effects, rather than any cholesterol-lowering ability, that lie behind their modest cardio-protection. In other words, statins are behaving like synthetic flavonoids.
Other drugs like ACE-inhibitors do lower blood pressure and thereby reduce the risk of strokes, as do other anti-hypertensive drugs such beta blockers.
None of these, however, prevent the accumulation of atheroma in blood vessel walls and none of them reduce the risk of a heart attack significantly, because they are not acting on the root cause of the problem – which is inflammation.
As for the aspirin-type drugs which reduce the tendency of platelets to form clots – one of the last links in the chain that leads to a heart attack – they also have no effect on atheroma formation at all.
In addition, heart disease does not, of course, develop overnight. When its symptoms become overt – tingling in the arms and hands, high blood pressure, angina, chest pain etc – the disease has already been progressing for years.
Fortunately this state can be halted and even reversed in months, using a combination of dietary solutions listed above, plus …
PRIORITY 6 TO REDUCE RISK – Get moving!
Being overweight and not exercising both increase fats circulating in the bloodstream. Excess weight boosts harmful LDL, while inactivity depresses protective HDL. Losing weight if needed and exercising more reverse these trends.
Increased physical activity also helps to reduce insulin resistance and reduce the risk of diabetes, which is an even stronger risk factor for cardiovascular disease in women than in men.
Diabetes increases the risk of cardiovascular disease by 3 to 7 times among women, compared with a 2 to 3 times higher risk increase among men. Approximately half of all deaths in patients with Type 2 diabetes are due to heart disease.
MEDITERRANEAN DIET VS DRUGS – Proof of heart disease risk reduction
A ground-breaking French study published in Circulation magazine compared the effectiveness of the Mediterranean Diet versus drugs in preventing heart attacks. The dietary change was about 3 times more protective than statins.
Similarly, scientists at the University of Naples showed that in a high-risk group of people, the Mediterranean Diet decreased blood pressure, body weight, levels of glucose, insulin, total cholesterol and triglycerides (blood fats). It simultaneously increased levels of HDL cholesterol – to the point where half the Mediterranean group were effectively cured, and fell out of the high-risk category altogether.
The reason why foods are so much more protective than drugs is because the right combination of foods (plus comprehensive supplements), can support ALL the body’s defence mechanisms and create a body status that is ‘hostile’ to heart disease and stroke – and indeed hostile to other so-called age-related diseases, like diabetes, arthritis and even some cancers.
This is a situation that exists naturally in parts of the world where sudden (cardiovascular) death is rare – as in Crete, where it is as little as 10% of the UK and US rate!
The Mediterranean Diet is characterised by high levels of fruits and vegetables, sea fish, olive oil, minimal processed food and red meat – and some red wine. These findings are one reason why the American Cancer Society now recommends as many as nine portions of fruits and vegetables a day! And other health researchers advise at least two and as many as four servings of oily fish a week.
PRIORITY 7 TO REDUCE RISK – Add comprehensive supplements to good food
For many people, these are not very attainable guidelines – hence the advantage of a comprehensive supplement that goes beyond a simple vitamin and mineral pill. A one-a-day vitamin supplement will prevent outright deficiency – but does not include any anti-inflammatory nutrients.
In nutrient terms, a Mediterranean-diet-style supplement means adding anti-inflammatory flavonoids like green tea, grape-seed and curcumin, anti-oxidants like beta carotene, lutein and lycopene, vitamin E, betaine, Omega 3 and more to a full range of vitamins and minerals.
What is a healthy cholesterol level? Click here to read more