Heart disease is a leading cause of death in the United States, and a major problem throughout the industrialized world. Despite the abundance of low-fat and low-cholesterol foods and diets, the numbers of new cases, and deaths, keep growing.
Chronic inflammation may be the most common cause of heart disease. If you have chronic inflammation, your risk for having a heart attack is doubled. Studies show that the more inflammation — as indicated with a simple blood test (C-reactive protein as discussed in the previous chapter) — the greater your risk of having a heart attack. In fact, each of the many stages of cardiovascular disease is associated with inflammatory factors. In addition, there is a strong association between chronic inflammation and other cardiovascular problems including sudden cardiac death, peripheral arterial disease, stroke and other conditions.
Of course, other unhealthy lifestyle factors significantly increase the risk of heart disease. These include smoking, being overfat, hypertension and others. Diabetes, an end-stage problem of carbohydrate intolerance, is a major risk factor. These problems, however, contribute to heart disease because they also are associated with and/or increase chronic inflammation. Aerobic exercise is also very important for the heart; inactivity puts you at nearly as great a risk as smoking.
One of the most misunderstood subjects related to heart disease is cholesterol. Abnormally high levels of cholesterol can also be a risk factor for heart disease, although your total cholesterol is not the best — or only — measure for heart-disease risk. Many people who die of heart disease have normal total cholesterol numbers, and many with high cholesterol never develop heart disease.
Perhaps the greatest misconception about cholesterol is that eating foods containing it significantly raises levels in the blood. In truth, most studies have shown that eating cholesterol does not alone substantially increase blood-cholesterol levels. Moreover, some studies show that not eating cholesterol can prompt your body to make more — and that eating eggs can improve your cholesterol numbers!
While there is a correlation between higher total cholesterol in the blood and incidences of heart attacks, evaluating cardiac risk calls for a complete fasting blood-lipid profile that measures at least total, HDLand LDLcholesterol, and triglycerides.
The most important thing to know about cholesterol is that cholesterol itself isn’t “bad,” but rather something to be kept in balance. It’s also important to understand that most of the cholesterol in the bloodstream is actually made by the liver. If you eat more cholesterol, your body prompts the liver to make less of it. But if you take in less, your liver makes more. That’s why many people on a low-cholesterol diet still have high blood-cholesterol levels.
Actually, all cells in the body — including those of the heart — make cholesterol every day. That’s because cholesterol is necessary for many essential processes that keep us healthy. For example, the outer surfaces of cells contain cholesterol, which helps regulate which chemicals enter and exit. Cholesterol is also used to make many hormones, including sex hormones and those that control stress. Cholesterol is also a key component of the brain and nerve structure throughout the body, and a key compound in the skin allowing us to make vitamin D from the sun. As you can see, cholesterol is necessary — and good — for optimal health. It’s only bad when out of balance.
The Good Cholesterol
HDLcholesterol — high-density lipoprotein — is called “good” cholesterol because it protects against disease by removing accumulated deposits of cholesterol and transporting them back to the liver for disposal. So higher HDLnumbers are generally healthier. It’s best if you can divide your total cholesterol figure by your HDLnumber and get a ratio below 4.0, which is about the average risk for heart disease. Aerobic exercise, monounsaturated fats, fish oil and moderate alcohol can increase HDL. Excess stress and anaerobic exercise, hydrogenated fats and excess consumption of saturated fats and refined carbohydrates lower HDL.
More importantly, the recommendation that people substitute polyunsaturated fats for saturated can be devastating for HDLlevels. If the ratio of polyunsaturated fat to saturated fat exceeds 2 (a ratio of 2:1), HDLlevels usually diminish, raising your cardiac risk. If your A, B and C fats are balanced, as discussed in Chapter 10, you avoid disturbing this ratio. Due to the heavy marketing of polyunsaturated oils since the 1970s, American diets now contain twice the polyunsaturated oil compared to diets of the 1950s and 60s. In addition, body-fat samples today show that levels of linoleic acid (an Afat) are at twice what they were 40 years ago
The ‘Bad’ Cholesterol
LDLcholesterol — low-density lipoprotein — is known as the “bad” cholesterol. Arecent trend in preventative medicine is to stress lowering LDL cholesterol with drugs. But it’s really not the LDL itself that causes the potential harm or risk. It’s only when LDLoxidizes that it deposits in your arteries. Oxidation of LDLresults from free radicals, in much the same way that iron rusts. While lowering LDLlevels can make less of it available for oxidation, antioxidants from vegetables and fruits can help prevent oxidation. In addition, many of the factors just mentioned that raise HDLalso lower LDL, the reason these plant foods can significantly lower your risk of heart disease. LDL is best measured when blood is drawn after a 12-hour fast for an accurate evaluation
Excess dietary carbohydrates can especially adversely affect LDL levels. This is due to excess triglycerides from carbohydrates producing more, smaller, dense, LDLparticles, which are even more likely to clog arteries.
In addition, a lower intake of dietary cholesterol is linked to an increase of these more dangerous LDLparticles. And to make matters worse, these types of LDLparticles are also associated with the inability to tolerate moderate to high levels of dietary carbohydrates (i.e., insulin resistance) even in relatively healthy individuals.
Factors that Affect Cholesterol Ratios
One of the worst scenarios for your cholesterol is if the HDL is lowered and the LDL and total cholesterol are elevated. Hydrogenated and partially hydrogenated fats (trans fat) do this, and that is the reason trans fat is a risk factor for heart disease. So read labels and avoid all products containing this dangerous substance. Eating too much saturated fat can raise LDLand total cholesterol levels. The worst offenders are dairy foods such as butter, cream, cheese and milk. Red meat such as beef, while it does contain saturated fat, can actually improve cholesterol levels. This is partly because, just as in eggs, about half the fat in beef is monounsaturated. Grassfed beef has the best balance of fats compared to most beef which is corn fed and contains higher levels of stearic acid, a saturated fatty acid that won’t raise cholesterol and may actually help reduce it. (The fat in cocoa butter also contains high amounts of stearic acid.)
The Fiber Factor
Fiber and fiber-like substances are also an important factor in decreasing total cholesterol and improving total cholesterol/HDL ratios. Most people don’t eat enough fiber, especially from fresh vegetables and fruits, as discussed in Chapter 15. Eating at least one large raw salad daily in addition to other raw and cooked vegetables and one to three servings of fresh fruit or berries — totaling 10 servings — will provide significant amounts of fiber. These foods also provide natural phytosterols, which help reduce cholesterol, and may be the reason early humans, who ate very large amounts of saturated fat, may have been well protected.
Studies also demonstrate that more-frequent eating lowers blood cholesterol, specifically LDL cholesterol. This means eating healthy snacks, of course, as was discussed in Chapter 20.
Fred had a long history of high blood cholesterol. His many blood tests revealed some interesting numbers. When first tested three years previous, his total cholesterol was 288, and his HDL was 52. That’s a ratio of 5.5 — too high a risk factor. Fred tried lowering his dietary cholesterol for six months, then had
his cholesterol tested again. This time, the total was very similar, 276, but the HDL diminished too much, down to 41. That drastically increased his risk to 6.7. His doctor recommended taking a cholesterol-lowering drug. Six months later, the tests showed his total cholesterol down to 213, along with his HDL, which decreased to 31. Now his risk was even worse, with a ratio of about 6.9. Fred was finally convinced to try another approach. After six months of easy aerobic exercise, lowering his carbohydrate intake and eating the right fats, including eggs, his blood test showed total cholesterol of 191, and HDL of 58, giving a much better ratio of 3.3. A year later, Fred’s test was even a little better.
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