Take This to Heart

Did you ever notice how we use the heart to describe almost everything about ourselves? It’s built into the way we talk. If you’re close to someone they’re “near to your heart.” You can want something “with all your heart.” If you say what you feel you “get to the heart of the matter.” When you’re happy and carefree you’re “young at heart,” and when you see something uplifting it “warms your heart.”  You can use it to paint a picture of almost anything good, happy and inspiring.  The heart is at the core of our health, wellbeing, fitness and love.  Sadly, diseases of the heart are collectively also the leading cause of death among men and women in the US and worldwide.  Fret not; 80-90% of heart or cardiovascular diseases are preventable. And contrary to popular beliefs, it has little to do with cholesterol or saturated fats.

For the last several decades, prevailing medical wisdom has advocated the reduction of dietary fat and cholesterol to combat the epidemics of obesity and heart disease.  What are the results of that effort?  Heart disease remains the leading cause of death and Americans are fatter than ever.  The low fat craze just has not worked, except to line the pockets of food manufacturers that produce low fat versions of nearly everything.  The problem is when fat is taken out, sugars are typically substituted in.  The excess consumption of sugars—inclusive of natural and artificial sweeteners— has had a far more detrimental effect on your health than having eaten the natural full fat version of those foods.  A recent meta-analysis found any evidence to support the current dietary recommendations was lacking.  In fact, researchers now believe that the recommendations should never have been made.  Some studies do link saturated fats with heart disease risk, but many do not.  There is mounting evidence that dairy fats do not increase cardiovascular risk, and may actually improve an individual’s overall metabolic profile.  It is complicated.  The senior investigator, Dr. James DiNicolantonio, suggests “…instead of arbitrarily focusing on limiting one macronutrient perceived to increase the risk of heart disease, individuals should simply “eat real food.”  Amen to that.

Looking at all of research to date, the majority of people who have heart attacks have normal cholesterol.   Does that mean that cholesterol has no role in heart disease?  No, it is just not the main factor.  Although arterial plaque is composed of cholesterol, it is more like the symptom than the cause of heart disease.  Current research points squarely at inflammation as the culprit which damages the arterial lining, the endothelium, and creates the environment in which plaque can form.  It is this endothelial dysfunction that is the earliest, clinically detectable stage of cardiovascular disease.   Until recently, there was no reliable way to measure endothelial function but that has changed.  A study done at the Mayo Clinic in 2010 found that a non-invasive measure of endothelial function was a better predictor of cardiovascular risk than the traditional risk factors in the Framingham Risk Score (age, blood pressure, cholesterol, smoking).  In that study, among the group of individuals considered low risk by Framingham Score, but had endothelial dysfunction, nearly 45% had a major cardiovascular event over about a 6 year period.

How can you improve endothelial function?  By improving nitric oxide (NO) production.  Many, even healthcare professionals, remain largely unaware of NO and its complex, diverse biochemistry and the principal role NO plays in cardiovascular function.  NO has been extensively studied and its discovery resulted in the Nobel Prize for three US scientists.  NO is essential for a healthy endothelium.  It regulates the factors associated with vascular inflammation and atherosclerosis.  NO lowers blood pressure, improves circulation, lowers triglycerides, improves athletic performance and erectile quality in men.   The primary pathway for NO production in those young with a healthy endothelium uses L-arginine as a precursor.  In older individuals or those with endothelial dysfunction, the necessary enzymes for converting L-arginine may not work efficiently.  There is a secondary pathway using dietary consumption of nitrate rich foods, such as beets, kale and other leafy green vegetables.  An assessment of your individual needs, endothelial function and nitric oxide production can help you put a plan in place to minimize your risk of being one of the 2150 people that die of cardiovascular diseases every day.

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