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Cholesterol vs Heart Disease (Dr. Michael Berglund)

Heart Disease: Heart disease is the number one cause of death in the United States, resulting in at least 1.5 million heart attacks a year and claiming over 489,000 lives. Medical treatment primarily consists of pharmaceutically controlling high blood pressure, prescribing cholesterol-lowering drugs, and utilizing procedures like balloon angioplasty (and the use of stents to keep the vessels open) and coronary bypass. The challenge with the modern medical approach is that it doesn't deal with the cause of the problem. For years, the consensus has been that we should avoid eggs, switch from butter to margarine, and then we'll be fine. The truth of the matter is both simple and complicated. 

Causes of cardiovascular disease

These are the things that we correlate with cardiovascular disease: positive family history of heart attacks, congestive heart failure, and strokes; elevated blood pressure; obesity; sedentary lifestyle; cigarette smoking; use of birth control pills; chronic allergies; and elevated blood glucose or triglycerides (blood fats). Inflammation, oxidation, and the type and amount of foods we consume are the three most controllable factors to minimizing cardiovascular damage.

Your thyroid plays a part

Hyperthyroidism can cause cholesterol levels that are too low, while hypothyroidism can cause cholesterol levels that are too high. One of the things that we also find with hypothyroidism is an increased rate of ischemic heart disease (coronary artery disease). Since hypothyroidism causes problems with poor healing and chronic inflammation, Dr. Berglund believes these are the factors that play a more central role in the development of occluded arteries in the heart.

The cholesterol story

Elevated total cholesterol has been touted as the primary cause for heart disease, and therefore, lower cholesterol as the number one preventive step you can make to prevent heart attacks (caused by coronary artery disease). Studies going all the way back to pre-1990 have shown cholesterol to be a terrible predictor of a heart attack. One third of all heart attack sufferers have a total cholesterol less than 200. There are many blood "markers" that can be used to evaluate heart disease risk. Triglycerides, HDL cholesterol and the total cholesterol:HDL cholesterol ratio are helpful. Elevated ferritin (storage iron/inflammation marker) is another, as well as elevated fibrinogen, elevated platelets, and cardiac C-Reactive Protein. Obesity, diabetes, high blood pressure are also very useful in predicting who is going to have a heart attack. Here's the scoop: you need to figure out which diet works best for you. For some, fatty foods are toxic and need to be eliminated. For others, the emphasis needs to be on lowering sugars and starches, and even grains.

If sugar/starch intake is more closely related to cholesterol levels, what does that say about elevated cholesterol and its link to heart disease? The truth is that we've been lowering our fat intake for years, hoping that deaths from heart disease would decline. It hasn't happened. In fact, it has increased. In America, we continue to eat more and more calories and eat more sugar and white flour (processed from wheat) products, and our risk rates continue to rise.  

Instead of memorizing your total cholesterol levels, we've known for the past 30 years that the total cholesterol:HDL cholesterol ratio (coronary risk ratio) is a better indicator of heart disease risk. This ratio should be ideally less than 3.0, but we allow levels up to 4.0. How do you calculate this? Take your cholesterol number (say it's 200) and divide it by your HDL cholesterol level (let's say it's 50). Your coronary risk ratio would be 200 divided by 50 or 4.0. That's an acceptable ratio. 

Lowering cholesterol through diet & exercise

For years, we've been left with the idea that eating cholesterol will cause us to have blockages. We switched people off lard and butter and put them on margarine (man-made butter), told them the evils of red meat and bacon, and promised people that if they cut out the saturated fat and cholesterol, they wouldn't get heart disease. We were wrong. The body is far more complicated than that. The body creates inflammation and gains weight when we are eating badly or even excessively. That inflammation is not just joint pain, back pain and headaches. That inflammation is either the result of damage, or causes damage to organs and tissues. One group of tissues affected are the arteries. In the heart, those are called coronary arteries. Long term damage to those arteries is referred to as coronary artery disease or CAD. (Long term damage to the other arteries of the body is referred to as peripheral artery disease or PAD.)

There are two elements that are key to preventing CAD (which is the cause of blockages - the primary reason people get heart attacks and eventually need angioplasty or bypass surgery). One is dietary: if we can figure out what the inflammatory foods are, the arteries will not get damaged. For some people, they really do well when they cut out foods that contain cholesterol and saturated fats. This is how you'll know: when you remove the foods that are problematic, you'll probably lose weight, but also, you'll feel good. You'll have more energy and less pain and inflammation. For some, sugar is the problem (see our page on blood sugar), and removing sugar and carbohydrates is essential. For some, they have issues with grains (some or all). Some need to figure out their food allergies and sensitivities. For some people, Dr. Berglund believes it is necessary to go on a CRON diet (Carlorie Restricted Optimal Nutrition) which requires the patient to eat well below the number of calories that the "experts" tell everyone they should eat based on their gender, age, height, and weight.

It would be great if there was a standard "eat this and you will not have a heart attack" answer. Unfortunately, it's not that easy. Oxidation (think "body rust") causes problems for the heart and arteries, so antioxidant status is very critical for those people that are prone to producing (or ingesting) free radicals/scavengers (pro-oxidants). Exercise is also a key component, since 30-45 minutes of exercise, three days per week helps to raise HDL (good) cholesterol. Dr. Berglund suggests finding a new doctor if the current doctor you're seeing is all about keeping your cholesterol normal. It's so much more than that. Find a practitioner that is capable of helping you understand how you function and can help you find that "right eating" that will make you healthy and ward off early cardiovascular disease.



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