Coronary Heart Disease: Making Real Changes to Reduce Risk

16 Jun 2018

As we approach cumulative sales of $1,000,000,000,000 for “Statins” worldwide, we have witnessed the steady, unrelenting deaths, heart failure and debility related to strokes and heart disease not just in the United States but the world over.

What is amazing is that when I was in Medical School and participating in my first Advanced Cardiac Life Support Course in 1979, I was taught that there were approximately 200,000 out of hospital victims of sudden cardiac death in that era. That number has risen to somewhere between 350,000 to 700,000 people suffering from the same malady in recent years (depends on what you read as to the exact number) in spite of spending massive amounts of money to try to reduce that number.

Why is it that we are spending so much to reduce this disease and yet the numbers continue to grow? Perhaps we are not attacking the problem correctly. Let me explain. We have known for many years that the identifiable risk factors for the evolution of coronary artery disease include:

1. Age
2. Sex
3. Family History
4. Smoking
5. Type 2 Diabetes Mellitus
6. Elevated Serum Triglycerides
7. Reduced HDL Cholesterol
8. Elevated LDL Cholesterol
9. Centralized Obesity
10. High Blood Pressure
11. Lack of Exercise

As you peruse this list, you can see that nothing can be done concerning the first three on this list, the rest of these items are directly in our control.

Smoking, without a doubt, significantly increases the risk of both sudden cardiac death as well as chronic heart disease. Major efforts have been made to try to educate the public concerning smoking. One of the confounding issues facing us in America is the steadily increasing use of legalized, recreational marijuana through smoking. It is not yet well established what impact this is going to have on heart disease; however, people are smoking marijuana at younger and younger ages as death rates in Washington State demonstrate from the 240% increase in deaths (as reported by AAA, Washington state) related to marijuana intoxication reveal after the first two years of legalization of its use.

The next items in this list (items five through ten) are components of the metabolic syndrome. Metabolic syndrome was a new diagnostic entity in 1981. It now affects nearly 100,000,000 adults and approximately 20,000,000 youth of America.

The medical answer for treating metabolic syndrome has been to initiate statin, diabetes and blood pressure medication treatment regimens rather than reverse the metabolic syndrome. Patients can easily escalate their medication list to include five or more medications very quickly in an attempt to normalize LDL cholesterol, blood sugar levels and blood pressure. Yet, the number of cardiac deaths continues to grow. The billions of dollars spent annually have not made a dent in the number of Americans suffering from the consequences of heart disease or stroke.

Let’s take a look at what causes metabolic syndrome for a moment. Omega-6 fats (vegetable oils) raise our LDL cholesterol and lower our HDL cholesterol. These are two of the risk factors for heart disease as you can see from this list. We consume excessive quantities of these inflammatory oils from processed foods and deep-fried fast foods. They are also found in large quantities in nuts (see recent article). No guidance from nutrition academia, government entities or medicine advisory panels has advised us to lower our intake of these oils.
Fructose metabolism activates a pathway in the liver that causes a rise in LDL cholesterol and serum triglycerides and lowers our HDL cholesterol. Additionally, its metabolism leads to excess uric acid production which then causes high blood pressure. Over time, continued activation of fructose metabolism leads to type two diabetes. Americans now consume about 85 grams of fructose per day. Our liver can only handle about 10-15 grams per day without activating metabolic syndrome. The big five sources of fructose include: fruit, fruit juice, honey, table sugar and high fructose corn syrup. We also get some from agave syrup, maple syrup, and the like. Again, we are instructed through nutrition, government and medicine efforts to reduce soda pop in schools but that has been the primary extent of their focus on this problem.

We had been told to reduce our dietary intake of cholesterol-rich foods until Nina Tiecholtz published her amazing book, The Big Fat Surprise, in 2014. This book exposed the fraud surrounding fat metabolism that had been perpetrated on the American people that dated back to 1953. Rather than right a wrong, the Federal Government quietly announced in February, 2015 that cholesterol in the diet had nothing to do with heart disease. They did nothing to rectify the fraud surrounding saturated fat.

The next major piece of dietary advise that continues to plague us to presently is that we are told not to consume food high in saturated fat. You see, saturated fats raise your LDL cholesterol. The problem with the guidance as it related to this LDL elevation is that there are two types of LDL cholesterol: small dense cholesterol (SDL) and large foamy LDL (LFL) cholesterol. The SDL increases your risk of heart disease while LFL reduces your risk of heart disease. Saturated fats increase your LFL and have no effect on SDL. What’s more, saturated fats also increase your HDL cholesterol; this is a good thing if you are trying to reduce your risk of heart disease.

My dietary recommendations to reduce your risk of heart disease are as follows:

1. Reduce your omega-6 intake. This includes decreasing processed foods prepared with these oils, farm foods fed soy and corn products (rich source of omega-6 fats) and deep-fried foods cooked in vegetable oils. Watch your nut intake as well.

2. Reduce your daily intake of fructose dramatically to about ten grams or less per day. This includes reducing the big five listed above. As I have written in the past, it requires a total fast from all digestible carbohydrates (fruits, vegetables, grains, sugars) for about three weeks for most of us to close the fructose-induced metabolic gate.

3. Don’t worry about saturated fat and cholesterol intake; they have nothing to do with heart disease.

4. We are deficient in omega-3 fat intake since the early 1960’s. omega-3 fats reduce our risk of heart disease. We should take a supplement or else consume these oils daily from foods such as fatty fish.

5. Avoid all Trans fats as these are highly inflammatory omega-6 fats that are directly linked to heart disease and cancer.

I have worked with thousands of patients to help them change their diet through these guidelines and monitor appropriate laboratory tests; and, as they reverse metabolic syndrome, they see their blood pressure, blood sugar and lipid panel normalize. They are often tapered off many of their medications as they no longer need them. It requires commitment and hard work to change our diet in multiple areas that we have grown so accustomed to consuming. We live on fruits, grains (pastas, breads, pizzas, etc), sweets, fast foods, processed foods (rich with omega-6 oil laden soy and corn) of all types. Finding alternative choices in our diet can pay dividends over time however as we reduce the risk factors associated with heart disease that are in our control. Best of luck.
Dr. Lyons