(In part 1 of this article, we looked at the good things cholesterol does for us and examined the questionable research that established a direct connection between cholesterol and heart disease. We also saw the role that the pharmaceutical companies play in funding and possibly manipulating studies to push the use of the drugs they manufacture. Now we will look at what really happens in order for plaque to form in the arteries and cause a heart attack or stroke).
The anatomy of a heart attack
Lets’ get a basic understanding of what happens when one has a heart attack. A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. As the Cleveland Clinic describes, your heart muscle needs to receive a good supply of blood at all times to function properly. Your heart muscle gets the blood it needs to do its job from the coronary arteries. Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart.
Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.
A network of blood vessels known as coronary arteries surround the heart muscle and supply it with blood that is rich in oxygen and nutrients. The heart muscle needs this continuous supply of oxygen and nutrients to function. A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it.
The role of cholesterol in plaque buildup
Exactly what the role of cholesterol is in the buildup of plaque is where our presumptions have been faulty. It’s not what people have thought for years. You see, something has to happen in order for cholesterol to oxidize first before it can start clogging up your arteries. As we stated in the first part of this article, cholesterol in and of itself is a substance that does good things for our bodies. What we should be looking at as the evil doer is not cholesterol, but the catalyst causing our cholesterol to oxidize. And this is where we now know something that should absolutely, positively debunk the lipid hypothesis. We now know what makes cholesterol into a villain, but it isn’t the cholesterol by itself.
Those of you who follow health news are aware that there has been a tremendous amount of news and research about our gut bacteria, known as the microbiome. What is the microbiome? The Harvard School of Public Health has a great description. Picture a bustling city on a weekday morning, the sidewalks flooded with people rushing to get to work or to appointments. Now imagine this at a microscopic level and you have an idea of what the microbiome looks like inside our bodies, consisting of trillions of microorganisms (also called microbiota or microbes) of thousands of different species. These include not only bacteria but fungi, parasites, and viruses. In a healthy person, these “bugs” coexist peacefully, with the largest numbers found in the small and large intestines but also throughout the body. The microbiome is even labeled a supporting organ because it plays so many key roles in promoting the smooth daily operations of the human body.
The real problem
Each person has an entirely unique network of microbiota that is originally determined by one’s DNA. A person is first exposed to microorganisms as an infant, during delivery in the birth canal and through the mother’s milk. Exactly which microorganisms the infant is exposed to depends solely on the species found in the mother. Later on, environmental exposures and diet can change one’s microbiome to be either beneficial to health or place one at greater risk for disease.
Different foods have a pronounced effect on your gut bacteria. Some foods that we might consume will cause our microbiome to produce something called TMAO– trimethylamine N-oxide. THIS IS WHAT CAUSES CHOLESTEROL TO OXIDIZE AND CAUSE PLAQUE BUILDUP IN THE CORONOARY ARTERIES! Studies published in 2013 indicate that high levels of TMAO in the blood are associated with an increased risk of major adverse cardiovascular events. So the answer to preventing heart attacks, heart disease and strokes has a lot more to do with things that effect the microbiome, like food consumption, than taking statin drugs.
Testing TMAO levels is far more important than seeing your cholesterol levels, HDL and LDL. Can you get this test readily? NO! Even in the United States it is only available in a few places, the Cleveland Clinic being one of them. This should be one of the primary tests to see if you are at risk for a heart attack! And if your TMAO is indeed high, then it would be essential to change your dietary intake to improve your situation.
It’s all about the food (and exercise)
There are certain foods that are more likely to produce TMAO. Those who try to make the majority of their food intake plant based and use very little refined and processed food will come out ahead with this. The foods to minimize? Beef, lamb, veal, processed meats, whole milk, eggs, yogurt, cream cheese, butter, energy drinks, and dietary supplements. The foods to maximize in your diet? A lot and a nice variety of vegetables, fruits, whole grains, and use more plant based proteins like lentils, beans, nuts, seeds, and chickpeas. If your TMAO is currently high, it can take weeks or months for the bacteria in your intestines to change. We still don’t have accurate information on how often a TMAO test should be run but as it takes a long time for gut bacteria to change, it is probably best to wait at least three months to check levels a second time.
The importance of exercise, even just moderate intensity can’t be overlooked. Keep your heart muscle in great working order with daily brisk walking or other aerobic exercises that you like to do. Cardio-respiratory fitness is the best predictor of good health, quality of life and length of life.
Dear Dr. Cardiologist,
Medicine and related research is always evolving. You and your fellow doctors save lives daily using the various interventions available to you. But in medical school, you had practically no training in the field of nutrition. Please open your minds and your hearts. As it stands now, you still think that lowering one’s LDL to very low levels with statin drugs will prevent heart attack and stroke. What that will do is up someone’s risk of hemorrhagic stroke. Recent research is also showing that lowering LDL levels can lead to Parkinson’s disease. We now know that low LDL isn’t the answer. Work on getting the medical establishment to introduce TMAO testing as standard. Most of all, please remember that food can heal and food can cause damage, even kill.
We all understand the burdens you face daily with your patients. But can we please begin to start working on prevention through lifestyle changes? You don’t have the time or knowledge for that? Refer out to good wellness coaches, health coaches, and the modern trained dietician who also works on behavioral modification. There are some personal trainers with expertise in nutrition and behavioral change. We have also proven beyond a doubt that heart disease can not only be prevented with the right lifestyle changes, heart disease can definitely be reversed. That’s correct, reversed. This is more important in curing than medication is.
Meds are necessary to control symptoms many times, but it’s time to change our focus. With the proper lifestyle approach, people can stay out of the doctor’s office! Please start looking at exercise and proper diet as an essential part of medicine. I have told many clients over many years to look at their daily brisk walks as important as taking medication daily—it might even be more important. And when they hear that from their physician, it has a huge impact. You can even consider writing on a prescription pad so they will take it seriously.
You are in charge
Ultimately, you have to take charge of your health. That means eating the things you must eat for good health like fruits, vegetables, whole grains, seeds, nuts, lentils and beans. It means avoiding harmful foods. That doesn’t mean total deprivation, but make sure your treats come in moderation, and that your moderation is truly moderate! When you need your doctor’s help, participate in the decisions made regarding medications and procedures and always find out if there is a way to gain health with lifestyle changes. The side effects of lifestyle changes are only positive. We can’t say the same of meds. Keeping your cholesterol from oxidizing is one of the keys to a healthy heart. Eating with that in mind will “add hours to your days, days to your years, and years to your life.”