Monday, April 14, 2008

Passion For Eradication: Part Deux

Why does low carb, saturated fat Paleo work? (Part 2)

The coronary risk factors have all been discovered and discussed in major medical journals by well-known experts in the field for a decade now, but a complete package of viable solutions (and manners of identification of heart disease) have seemed to fail to come to fruition in national consensus guidelines that would effectively improve care in primary and secondary cardiovascular disease prevention.


Beyond bandaid-statins and common coronary surgeries, which do little to correct underlying disease processes, what exists that actually works? Why is coronary artery disease still the #1 killer in America... and strokes #3? Why aren't these stats changing (and seem to get worse, especially for women)? Why is CAD not being broadly reversed with the huge resources and high-tech approaches currently available in our great country??

The use of a convenient, low-radiation diagnostic tool --- the EBT heart scans --- to guide and dictate therapy, the only plan and protocol for effective plaque reversal that has a true TRACK record of success.

Is seeing is not believing when plaque is present? Usually unfortunately... affirmative... (unless you're symptomatic with anginal pain or erectile dysfunction (future blog topic)).

These are subsequently quenched... For a lifetime…

Proatherogenic mechanisms and progression pattern
from initial artery injury through clinically manifest disease

Lists of potential CAD risk factors were discussed for the past 10 years:
These physicians above all have brought up a variety of coronary risk factors which are strong nasty plaque-builders. They did an immense service by listing new variables in the equation for heart disease. In addition, Drs. McCarron and Oparil et al demonstrated in a controlled trial that a comprehensive nutrition program was spectacularly powerful in lowering BP, insulin, glucose, LDL, LDL/HDL ratio, homocysteine and other drivers of heart disease. McCarron DA, Oparil S, et al. Comprehensive nutrition plan improves cardiovascular risk factors in essential hypertension. Am J Hypertens. 1998 Jan;11(1 Pt 1):31-40.

The below publication from 2002 was produced from the AACE , the venerable group of brilliant forward-thinking experts which I mentioned earlier (updated recently in 2006 to take into account the Heart Protection Study and other landmark trials).
The American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Dyslipidemiaand Prevention of Atherogenesis 2002 (Amended Version)

The first thing that blew me away about these guidelines was the demonstration of the utilization of CT scan scoring is on Table 16 on p.195 for an evaluation of a CAD patient case study (although I believe truly 'normal' is a zero score). Back in 2002 even CT scan results provided value to the AACE as a standard of practice for detecting high risk heart disease and the presence of plaque.


Isn’t that interesting? Back in 2002...

This is why I like the AACE…

Personally, in my opinion the pictures also are fantastic. Please see if you're into the pathogenesis of pro-atherogenic lipoproteins:
  • Fig 1, 2, 3 on p.175
  • Fig 4 on p.176
  • Fig 5 on p.180

The AACE also identified the below Risk Factors for Coronary Artery Disease (Table S-1 on pg.166) which enumerate the same ones listed in the above medical journal articles.

Coronary Risk Factors
High total cholesterol or LDL-C
Small, dense LDL
Advancing age
Type 2 diabetes mellitus
Cigarette smoking
Family history of CAD
Increased levels of Lp(a) lipoprotein
Factors related to blood clotting, including increased levels of fibrinogen and PAI-1
Certain markers of inflammation, including C-reactive protein

And… this is why I really REALLY like the AACE:

  1. Other risk factors for heart disease were additionally identified -- PCOS, hypothyroidism, SLE/lupus, Cushing's disease, etc (common theme: inflammation, insulin resistance)
  2. A moderate, lower-carb diet is favored over a typically AHA high-carb diet (on p.196; first 1-2 paragraphs) for a patient with elevated triglyerides (which is 50% of all Americans according to the NHANES data, although I'd predict that would probably be about 70% now)
  3. Can the AACE top their already prescient anti-atherogenesis guidelines?? Absolutely... A brief cost-benefit analysis (on p.196 Fig 6) of the resources conserved when cardiac events, surgeries and hospitalizations are successfully averted with lifestyle/medical/nutritional therapy.

The AACE are surprisingly one of the most progressive group of classic, systemic heart disease and prevention experts (btw they are not Cardiologists – wonder why is that?).

So who... can possibly... trump the AACE??

Strategies for control and reversal of vascular calcifications (HTN, carotid, peripheral, renal, coronary, ED, etc):

Plaque-BuildersFood/Supp StrategyGoals For Health
Blood pressureL-Arginine, Vitamin D3, exercise, IBW, weight loss, carb restriction, cocoa extracts, etcNormalization: BP = 110/70 Pulse 60
Vitamin D3 DeficiencySupplementation of D3 (cholecalciferol in oil gel capsules)Normalization: 25(OH)D3 = 60 ng/ml
Presence of Small LDLWheat elimination, carb restriction, Niacin, Vitamin D3, Oat bran, Intermittent Fasting, etcSmall LDL less than 10% (LDL less than 60 mg/dl)
Elevated TGWheat elimination, increased intake good oils/fats, high dose fish oil, Vitamin D3, Vitamin B3 (niacin), etcTG << 60 mg/dl

See above, strength training, carbohydrate restriction, dietary oils/fats, etc

HDL 60 mg/dl or higher
Lipoprotein(a)Niacin, Vitamin D3, high dose fish oil, Carb restriction, L-carnitine, coQ10, raw nuts, DHEA, Estrogen, Testosterone, adequate good oils/fat, etc

Normalization: Lp(a) less than 30 mg/dl or large buoyant

HomocysteineVitamins B6, B12, Folic acid, Wheat elimination, Estrogen, etcNormalization: Homocysteine less than 8.0
FibrinogenAspirin, fish oil, raw nuts, carb restriction, exercise, smoking cessation, etcNormalization
Abnl Glucose, Hyperinsulinemia,Type 2 Diabetes, Type 1 DiabetesWheat elimination, Carb restriction, Exercise, IBW, Vitamin D3, high dose fish oil, raw nuts, Magnesium, Estrogen, etcNormalization: Premeal glucose less than 85 mg/dl; Insulin < 4 uIU/L; A1C < 5.0%
Metabolic syndrome (including Central Obesity, NAFLD, Cardiac Steatosis, PCOS, Acanthosis Nigricans)Same As AboveNormalization: ALT, AST < 20-40 (Normal Echo)
Estrogen DeficiencyBio-identical HRT, Vitamin D3, etcNormalization
Testosterone DeficiencyReplacement, Vitamin D3, etcNormalization
Antioxidant DeficienciesDiet/supplementation of Vitamin K2, C, E, A, D3, etcNormalization
Thyroid DisorderReplacement, Vitamin D3, Magnesium, Calcium, etcNormalization: TSH 0.2 - 1.0 mIU/L
Oxidative Stress, InflammationAbove strategies, exercise training, yoga, meditation, Natural Vitamins, improvement of sleep (quantity, quality), mental stress reduction, high dose Vitamin ‘O’, etcNormalization: CRP less than 3.0
Chronic Kidney DiseaseBP and glucose normalization, Vitamin D3, high dose fish oil, address Lp(a)/Homocysteine, etcNormalization: Cr less than 0.8-1.0 Microalbuminuria less than 10- 20 ug/mg
Abdominal/Thoracic Aortic Aneurysm, Valvular DiseaseAll the above, BP normalization, Vitamin D3, etcNormalization: Prevention of dissection and expansion
Other CAD Risk FactorsSee above articleNormal