Preventing Cardiovascular Disease; More than just Lowering Cholesterol

Over the past several years there has been a big push by the medical community to lower people’s cholesterol as much as possible in order to prevent cardiovascular disease. The laboratory standard for total cholesterol is becoming lower and lower and before you know it, everyone in America will be on some type of cholesterol lowering drug. People are mislead to believe that if their cholesterol levels are in a normal range than they are considered healthy and at a low risk for heart attacks and strokes. If this was true than why is it that half the people that suffer heart attacks each year have normal to low cholesterol levels? Cholesterol is not the main culprit; in fact your body needs cholesterol. It’s the major building block for your sex and adrenal hormones (including cortisol, DHEA, testosterone, progesterone and estrogen), and it helps to keep your liver and nervous system functioning properly. When you interfere excessively with your cholesterol levels, either by restricting your diet or by taking cholesterol lowering drugs (which have been linked to sexual dysfunction, an increased risk of cancer and numerous other side effects) the results can be problematic. People have this vision of grease and fat floating through the blood clogging up their arteries, but this is just not the case. Cholesterol won’t clog your arteries unless it has something to attach to, like a ridge or a rip in the wall of an inflamed artery. The fact is that cardiovascular disease is an inflammatory process and its treatment is more complex than just simply taking a pill to lower cholesterol. I am not saying that having excessively high cholesterol is a good thing but that it is only one risk factor amongst many others that contribute to cardiovascular disease.

In this article I would like to discuss particular risk factors that I feel take precedence over simply reducing elevated cholesterol in preventing heart disease. The first of these risk factors is something called homocysteine. Elevated homeocysteine in the blood can cause those rips and ridges in the artery wall that cholesterol can stick to. Normally homocysteine is used to build and maintain tissues in the body. Your body forms homocysteine when you eat foods containing the amino acid called methionine, which is present in all animal and vegetable protein. But too much in you bloodstream literally shreds your arteries from the inside out, allowing fat and cholesterol to stick…eventually leading to total blockage, followed by a heart attack or stroke. Thirty years of intensive research has revealed that excessive homocysteine not only damages the artery wall but disables a mechanism in your arterial cells called contact inhibition, which regulates the growth of smooth muscle cells just below the inner wall of the artery. As a result, smooth muscle cells can multiply out of control. This creates a bulge that pushes other cells apart and protrudes into the artery. This is what makes arteriosclerosis possible: The inner wall becomes uneven, torn and rough, and then the build up of plaque begins (cholesterol sticking to the artery wall.) Homocysteine can be checked via a routine blood test run by your doctor. Many of the labs that will run homocysteine state that normal homocysteine can range from 5-15 micromoles per liter (umol/L) of blood. Yet, epidemiological data reported in the American Heart Association’s journal Circulation reveal that blood levels of homocysteine above 6.3 cause a steep progressive risk of heart attack. In my practice I try to get my patient’s homocysteine level as close to 6.3 as possible. The reason why you may never have heard of this particular risk factor is because its treatment is not through the use of drugs or surgery but through vitamin treatment. B-vitamins, specifically folic acid, B12 and B6 in adequate doses will lower homocysteine levels to an acceptable range. I will typically run repeat blood work after 2 months of treatment to reassess the patient’s levels and then adjust their dose of these vitamins accordingly.

Another risk marker that can be checked through routine blood work is something called cardio C-reactive protein. This is a marker that indicates the amount of inflammation in the arteries. Some studies show that people with high levels of C-reactive protein are almost three times as likely to die from a heart attack. I run this test on the majority of my patients and if I find it to be elevated, it can be lowered very successfully by natural means. In addition to changing the person’s diet and using B vitamins to lower their homocysteine, I use high doses of antioxidants such as vitamins A, C and E as well as fish oil, garlic and various anti-inflammatory herbs to efficiently lower C-reactive protein levels. The optimal range for C-reactive protein is below 1.3 mg/L.

The next risk factor that I would like to discuss is something called insulin resistance. This is the early stages of type II diabetes and in one of the major causes I have found of elevated cholesterol and inflammation in the arteries. Insulin is a hormone that is manufactured by the pancreas and its main function is to regulate the level of sugar (or glucose) in the blood stream. When we consume a diet high in sugar and refined carbohydrates our cells become insensitive to the actions of insulin which is required to move sugar, fats, cholesterol and protein into our cells to be used up as energy. Instead of entering the cells of body all of these things stay in the blood stream and become elevated as seen on a blood test. When this insulin doesn’t work properly our bodies compensate by making even more insulin. Excessive insulin in the blood can cause inflammation in the arteries as well as increase our blood pressure leading to more inflammation and damage to the arteries. People with insulin resistance are typically overweight with a lot of abdominal fat and tend to have a fasting glucose level on their blood work of above 100 and fasting insulin above 5. My major treatments for this risk factor are dietary changes consisting of small frequent meals, eliminating all sugar and refined carbohydrates, protein at each meal and exercise for at least an hour a day. I also incorporate natural herbs, vitamins and minerals into the treatment plan. The trace minerals chromium and vanadium are two of the most important as well as alpha-Lipoic acid, magnesium, and zinc. The doses of each of these nutrients are determined on a patient to patient basis.

Low thyroid function is the next risk factor that needs to be discussed. Your thyroid gland produces hormones that help regulate your metabolism (how quickly our body utilizes the nutrients you take in as energy.) When a person’s thyroid is under active, all of their bodily functions tend to slow down. Weight loss becomes very difficult, cholesterol levels and blood pressure can become elevated, fatigue can set in, and depression can occur, to just name a few common symptoms. I have found that many physicians will just look at a blood test called TSH and unless it is out of range no treatment will be offered despite the patient exhibiting symptoms of an under active thyroid. Often these symptoms are treated with other drugs like cholesterol lowering medications, an antidepressant or a blood pressure lowering drug which don’t address the root cause of the symptom. The problem with treating the person based on the blood test only, is that the range is so large: .40 to 5.50. Many doctors will wait until this TSH is extremely out of range before they will even consider treating the person. I consider the optimal range to be .40-2.0. This range is based on research that shows that patients with a TSH above 4 run a significantly greater risk of developing heart disease. Another study showed that patients with a TSH above 2, when they are treated with thyroid medication, experienced significant drops in their elevated cholesterol levels. I also run a test called free T3, which takes a look at how much active thyroid hormone the person is actually making. The treatment I typically recommend is supplementing with a natural thyroid hormone replacement called Armour thyroid or one called Nature-Throid. I have found both of them to work extremely well in correcting symptoms of an under active thyroid. Some important nutrients I will also prescribe for proper thyroid function are iodine, selenium, zinc and copper.

Finally, this last risk factor pertains to just men and cardiovascular disease. According to a recent study in the journal Metabolism, low free testosterone is considered a major risk factor in predicting the severity of artery blockage in men. This study goes one step further in stating low free testosterone is considered an independent risk factor, meaning that if you did everything else recommended to protect your heart (lower your blood pressure and cholesterol, stop smoking, lower homocysteine, lose weight and control diabetes), you would still be at a greater risk for serious cardiovascular problems like heart attack or stroke. This study has prompted me to check all of my male patient’s free testosterone levels. An interesting point to note is that testosterone is a hormone that is formed from cholesterol. If we were to excessively block cholesterol formation with the use of drugs, then we wouldn’t have enough to make sufficient testosterone, further increasing your cardiovascular risk. The typical laboratory range for free testosterone is 50-210, which once again is a very large range. I consider 150-210 a much healthier range for most men. These ranges can often be achieved through natural herbs and vitamins. My favorite herb for doing this is one called Tribulus terrestis. It can actually strengthen the heart and can naturally lower cholesterol levels as well. Also, zinc and vitamin A are two nutrients that are needed by the body for adequate testosterone production to occur.

So the next time your doctor says that you are in good cardiovascular health because your cholesterol in the normal range, ask him or her to run the following tests: Homocysteine, cardio C-reactive protein, TSH, free T3, free testosterone, fasting glucose and fasting insulin. Then visit a Naturopathic physician to help you change your diet and get you on the proper nutritional / herbal supplements that are best suited to treat you and your condition.