Podcast Summary
Beyond Genetics: Personalized Approaches to Heart Disease: Consider personalized diet, lifestyle modifications, and comprehensive testing for heart disease prevention and management, going beyond traditional one-size-fits-all approaches.
Heart disease is a complex issue with various causes beyond just genetics and inherent lipid disorders. While supplements like AG1 can support overall health, personalized diet and lifestyle changes are crucial in preventing and managing heart disease. The food system plays a significant role, with many Americans relying on unhealthy options. Companies like Sweet Cream make it easier to consume nutrient-dense foods, providing a range of vegetable-rich salads and high-protein options. In addressing heart disease, it's essential to look beyond the traditional one-size-fits-all approach and consider personalized diet, lifestyle modifications, and comprehensive testing to understand the underlying causes.
Functional medicine offers a more comprehensive approach to heart disease: Functional medicine recognizes the complex interplay between diet, lifestyle, and advanced diagnostics to prevent or even reverse heart disease, making proactive healthcare essential.
The traditional approach to understanding and treating heart disease through a narrow focus on saturated fat and cholesterol is outdated. Functional medicine offers a more comprehensive and personalized approach by recognizing the complex interplay between diet, lifestyle, and advanced diagnostics. With the increasing availability of personal health data, individuals can now take ownership of their health and prevent or even reverse cardiovascular disease. This shift towards proactive healthcare is essential as chronic diseases like heart disease affect a large portion of the population and account for a significant portion of healthcare costs. Function Health, co-founded by the speaker, aims to make functional medicine accessible to everyone by providing easy-to-use lab testing and insights.
Heart Disease: A Silent Killer: 50% of Americans are metabolically unhealthy, yet only 6.8% are truly healthy. Advanced testing methods, like functional health assessments, can identify potential heart issues before they become life-threatening.
Heart disease is a major health issue in the US, with someone dying every 33 seconds and someone having a heart attack every 40 seconds. Despite this, many people are unaware they have heart disease until they experience a heart attack or sudden death. Conventional medicine often focuses solely on the heart and uses outdated tests, such as lipid panels, which do not provide a comprehensive understanding of heart health. In fact, 50% of Americans are considered metabolically unhealthy, yet only 6.8% are truly healthy. This is a concerning trend, as conditions like diabetes, obesity, and fatty liver disease are major risk factors for heart disease. The good news is that advanced testing methods, such as functional health assessments, can provide a more accurate picture of heart health and help identify potential issues before they become life-threatening. It's essential to prioritize heart health and advocate for more comprehensive testing and prevention strategies.
Assessing heart disease risk beyond LDL cholesterol: Focusing solely on lowering LDL cholesterol with statins may not be the most effective approach for preventing heart attacks. Considering triglycerides, HDL, insulin resistance, and prediabetes markers can provide a more accurate picture of heart disease risk.
Focusing solely on lowering LDL cholesterol with statins may not be the most effective approach for preventing heart attacks, as many heart attack patients have normal LDL levels but high triglycerides and low HDL, which indicate insulin resistance or prediabetes. These markers are more predictive of heart attack risk than LDL. Moreover, overly low LDL levels may increase the risk of hemorrhagic stroke. The medical field is evolving, with new technologies like AI-interpreted CT angiograms providing better preventive diagnostic tools. However, the practice of medicine has not kept pace, and doctors often rely on statins as the primary treatment for cholesterol. It's essential to consider the whole picture of a patient's health and biology when assessing their risk for heart disease.
Potential Negative Effects of Statins: Statins, while reducing cholesterol, can cause muscle pain, mitochondrial damage, and inhibit protein synthesis. Not all individuals benefit, and some may experience harm.
Statins, while commonly used to lower cholesterol levels, have potential negative effects on the body. These include muscle pain, soreness, and mitochondrial damage, even in asymptomatic individuals. Statins also inhibit the synthesis of important proteins like vitamin K2 and selenium-containing proteins, leading to mitochondrial injury. Furthermore, the number needed to treat with statins for primary prevention of heart attacks or strokes is high, with many people experiencing no benefit and some experiencing harm, including muscle damage and an increased risk of diabetes. While statins may be beneficial for those who have already had a heart attack, other approaches may be more effective. Overall, it's important to consider the potential risks and benefits before deciding to take statins.
Personalized cardiovascular treatment: One-size-fits-all statin approach outdated, personalized treatment using advanced testing and considering genetics, diet, lifestyle, and metabolic markers is essential for effective prevention and management of heart disease. Newer drugs like PCSK9 inhibitors and ZEDIA offer alternatives with fewer side effects and more targeted benefits.
When it comes to managing cardiovascular health, a one-size-fits-all approach with statins is outdated. Instead, personalized treatment using advanced testing and considering various factors such as genetics, diet, lifestyle, and metabolic markers is essential for effective prevention and management of heart disease. Newer drugs like PCSK9 inhibitors and ZEDIA offer alternatives with fewer side effects and more targeted benefits for specific subgroups of people. It's crucial to go beyond traditional cholesterol testing and look at lipoprotein fractionation and other biomarkers to gain a comprehensive understanding of overall risk.
Functional Medicine: Beyond Traditional Cholesterol Testing: Functional medicine explores lipoprotein fractionation and examines LDL P, HDLP, APO-B, LP(a), and inflammation markers for a more detailed assessment of cholesterol quality and size, impacting cardiovascular risk.
Functional medicine approaches to cholesterol testing go beyond traditional methods by focusing on lipoprotein fractionation and examining markers like LDL P, HDLP, and apolipoprotein B (APO-B). These tests, such as NMR and CardioIQ, provide more detailed information on cholesterol quality and size, which can significantly impact cardiovascular risk. Additionally, considering biomarkers like lipoprotein(a) or LP(a) and inflammation markers is crucial for a comprehensive assessment of metabolic health. These tests and markers are not commonly used but can offer valuable insights for personalized treatment plans.
Beyond cholesterol: Multiple indicators for heart health: Regular testing from age 40 or 50, including advanced imaging technologies, helps identify heart disease risks beyond cholesterol levels.
Preventing heart disease goes beyond just measuring cholesterol levels. Oxidized LDL, markers of inflammation, liver function, kidney function, uric acid, and hormone levels are also crucial indicators. Advanced imaging technologies like CT angiograms, now enhanced by artificial intelligence, provide high-resolution insights into heart health. While older tests like coronary angiograms and calcium scores have limitations, the latest CT angiograms offer a safer, more comprehensive evaluation of heart conditions. Regular testing starting from age 40 or 50, especially for those with heart disease, can help identify and address potential risks.
Advanced Diagnostic Tests for Heart Health: Advanced tests like Clearer scan, carotid artery scans, and lipid genetics offer more comprehensive insights into heart health, revealing plaque type, inflammation, and personalized risk factors for informed decisions and potential drug therapy.
There are advanced diagnostic tests beyond the standard coronary calcium score that can provide more comprehensive information about your heart health. The Clearer scan, which uses a CCTA and data analytics to assess plaque type and inflammation, is considered the gold standard for evaluating cardiovascular risk. Additionally, other tests like carotid artery scans and lipid genetics can provide valuable insights into your risk factors and personalized treatment plans. For instance, a lean mass hyper-responder may experience high LDL cholesterol levels despite having a healthy lifestyle and normal lipid panel. Understanding these factors can help individuals make informed decisions about their health and potential need for drug therapy.
Identifying unique cholesterol profiles for personalized heart disease prevention and treatment: Genetic testing and cholesterol absorption and production tests help personalize heart disease prevention and treatment by identifying individual differences in cholesterol production and absorption.
Understanding individual's unique cholesterol profiles and root causes is crucial for effective and personalized heart disease prevention and treatment. Cholesterol is a waxy substance essential for human biology, primarily produced in the liver. Dietary intake is insignificant compared to the body's production. Cholesterol is transported through the body bound to proteins, such as LDL (low density lipoprotein) and HDL (high density lipoprotein). It serves numerous functions, including cell membrane structure, nerve sheath covering, hormone production, and bile production. Genetic testing and cholesterol absorption and production tests can help identify personalized treatment approaches, such as targeting absorption or production. Ignoring individual differences and relying on one-size-fits-all approaches can lead to ineffective or even harmful treatments. Personalized, nuanced diet and lifestyle interventions are necessary for managing conditions like resistance, prediabetes, and diabetes, which are significant contributors to heart disease.
Flaws in studies linking saturated fat to heart disease: Despite early studies suggesting a link between saturated fat and heart disease, subsequent research, including the Minnesota Coronary Experiment and the 2020 Cochrane Review, failed to find a significant association. These studies highlight the importance of considering overall food patterns, rather than focusing on individual nutrients.
The hypothesis linking saturated fat to heart disease, which led to the recommendation to minimize saturated fat intake, was based on epidemiological studies with design flaws and biases. These studies did not account for the role of sugar and starch as the real drivers of heart disease. A landmark study, the Minnesota Coronary Experiment, showed that replacing saturated fat with vegetable oil led to an increase in heart attacks, despite a decrease in LDL cholesterol. The inconsistent evidence regarding saturated fat and its effects on health highlight the importance of considering overall food patterns, rather than focusing on individual nutrients. The 2020 Cochrane Database Systematic Review also found that reducing dietary saturated fat had no significant effect on heart attacks, total mortality, or cardiovascular disease mortality.
Sugar and processed foods may be the real culprits for heart disease: Focusing on individual cholesterol particle sizes and ratios, rather than total cholesterol, is crucial for assessing cardiovascular risk. Sugar and processed foods contribute to insulin resistance and the production of atherogenic cholesterol, which increases heart attack risk.
The focus on saturated fat and dietary cholesterol as the primary causes of heart disease may be misguided. According to the speaker, two-thirds of heart attack patients have either diabetes or prediabetes, which is linked to insulin resistance. Insulin resistance is caused by a diet high in sugar and processed foods, and it leads to the production of "atherogenic cholesterol," which is the type of cholesterol that causes heart attacks. Therefore, it's essential to consider the whole picture, including the type and size of cholesterol particles, when assessing cardiovascular risk. The speaker emphasizes that total cholesterol is an imperfect measure and that focusing on individual particle sizes and ratios is more informative. In summary, the root cause of heart disease may be sugar and processed foods, not saturated fat and dietary cholesterol.
Understanding Triglycerides and HDL Cholesterol for Heart Health: Regularly monitor triglycerides and HDL levels, aim for HDL less than 70, and focus on large, fluffy HDL particles for heart health protection.
Understanding your triglyceride levels and the quality of your cholesterol particles, particularly HDL, is crucial for your heart health. Triglycerides are the most common type of stored fat in the body, formed when the body converts excess carbs and sugars into fat. High levels of triglycerides, especially large particles, can increase your risk of heart attacks, cardiovascular disease, and even non-alcoholic fatty liver disease. HDL cholesterol, often referred to as the "good cholesterol," plays a protective role by acting as an antioxidant, anti-inflammatory agent, and facilitating reverse cholesterol transport. However, the quality and size of HDL particles matter. Small, dense HDL particles can be harmful, while large, fluffy HDL particles are protective. Aim for an HDL level less than 70 and smaller, fluffy HDL particles. Regularly monitoring your triglycerides and HDL levels and addressing underlying issues like insulin resistance can help improve your heart health.
Assessing cardiovascular risk involves more than just HDL and LDL levels: Understanding HDL subtypes (HDL2 and HDL3) and LDL's role in heart disease, along with inflammatory markers and lifestyle factors, provides a more comprehensive approach to evaluating cardiovascular risk.
Understanding the quality and subtypes of your lipid levels, specifically HDL and LDL, is crucial for assessing your cardiovascular risk. Conventional measures, such as HDL levels above 40 for men and 50 for women, don't provide the full picture. HDL can be protective (HDL2) or dangerous (HDL3), and diet, lifestyle factors, and genetics can influence the balance between these subtypes. Similarly, LDL, often referred to as "bad cholesterol," is essential for various bodily functions but can contribute to heart disease when it becomes oxidized and inflamed. The Western Denmark Heart Registry study highlighted the importance of considering the overall pattern of lipid levels and inflammatory markers, such as calcium score and HDL quality, in evaluating cardiovascular risk. Additionally, lifestyle factors like smoking, diabetes, and a high-sugar, high-starch diet can negatively impact HDL quality and contribute to heart disease risk, regardless of calcium score.
Assessing Heart Disease Risk Beyond LDL Cholesterol: Understanding LDL particle quality through ApoB marker is crucial for heart disease risk assessment. High ApoB levels indicate a higher risk of heart attacks and strokes, even with normal or low LDL cholesterol.
Focusing only on total LDL cholesterol levels for assessing heart disease risk is insufficient. Instead, understanding the quality and size of LDL particles, specifically the ApoB marker, is crucial. A high ApoB level, which indicates a higher number of small, dense LDL particles, increases the risk of heart attacks and strokes. Conversely, having normal or low LDL levels but high ApoB levels also signifies an increased risk. The gold standard for measuring lipid particle quality is lipoprotein fractionation, a test that is rarely performed in routine checkups. By examining all relevant lipid biomarkers, metabolic markers, and imaging tests, we can better assess our cardiovascular risk and take appropriate steps to reduce it through diet and lifestyle modifications.
Understanding Lipid Profiles with Advanced Tests: Advanced tests like NMR or cardio IQ provide a more detailed view of heart health by measuring the size, density, and number of different types of cholesterol particles, helping identify insulin resistance, pre-diabetes, or diabetes, and guiding effective treatment approaches.
While traditional cholesterol tests provide important information, they don't give a complete picture of heart health. A more detailed test, like lipoprotein fractionation using technologies such as NMR or cardio IQ, can reveal the size, density, and number of different types of cholesterol particles in your blood. Small, dense LDL particles are particularly harmful and can't be accurately measured by just looking at your LDL or total cholesterol numbers. These tests can help identify insulin resistance, pre-diabetes, or diabetes, and guide more effective treatment approaches. Aim for a low number of small and medium LDL particles, and a high number of large, fluffy HDL particles, which help remove excess cholesterol and reduce heart disease risk. The optimal reference ranges for LDL-P, HDL-P, and LDL pattern can be found in the show notes. Remember, a healthy diet is crucial, and excessive starch and sugar intake can contribute to unhealthy lipid profiles.
Assessing Heart Disease Risk: Beyond LDL Cholesterol: Pattern B and Lp(a) are important lipid markers for heart disease risk assessment, as they can indicate an atherogenic risk profile despite normal LDL cholesterol levels. Non-HDL cholesterol, a better predictor of heart attack risk, should be under 100 for optimal levels.
While LDL cholesterol is often the focus when assessing heart disease risk, other lipid markers such as pattern B and lipoprotein(a) (Lp(a)) are also important. Pattern B, associated with a high starch and sugar diet, can indicate an atherogenic risk profile even with normal total and LDL cholesterol levels. Lp(a), which carries cholesterol similar to LDL, plays a role in wound healing but can also contribute to blood clots and atherosclerosis. Both pattern B and high Lp(a) levels are inherited and are independent risk factors for heart disease, heart attack, stroke, and aortic valve stenosis. Non-HDL cholesterol, which includes all forms of cholesterol not bound to HDL, is a better predictor of heart attack risk than LDL or total cholesterol. Optimal non-HDL cholesterol levels are typically under 100, and high levels are linked to atherogenic dyslipidemia caused by insulin resistance and poor metabolic health. Overall, a comprehensive evaluation of various lipid markers, along with other biomarkers, is crucial for accurately assessing heart disease risk.
Unhealthy lifestyle and diet contribute to atherogenic dyslipidemia: Focus on reducing starch, sugar, and refined carbs, prioritize exercise to improve lipid markers. Consider genetics, age, stress, and meds in your approach.
An overall unhealthy lifestyle and diet, specifically high intake of starch, sugar, and ultra-processed foods, contribute to poor metabolic health and the development of atherogenic dyslipidemia. This condition is characterized by small LDL and HDL particles, high triglycerides, and a low HDL level. A high triglyceride-to-HDL ratio and high levels of belly fat are also indicators of this condition. To improve these markers, focus on reducing starch, sugar, and refined carbohydrates in your diet, and prioritize regular exercise. Additionally, genetics, age, stress, lifestyle factors, and certain medications can also impact lipid levels. It's essential to consider your unique biology when making lifestyle changes and prioritize a balanced approach to health.
Traditional blood tests don't give a complete picture of heart health, additional tests are necessary: Blood tests alone don't reveal all heart health risks. Additional diagnostic tests like ultrasounds, angiograms, and CT calcium scores help identify plaque buildup, blockages, and narrowing of arteries, providing valuable information for effective heart care.
While traditional blood tests are important indicators of potential heart health risks, they do not provide a complete picture. There are various conditions, such as thyroid issues and autoimmune diseases, that can contribute to heart problems but may not be detected through blood tests alone. Therefore, additional diagnostic tests like carotid ultrasounds, coronary angiograms, and CT calcium scores are necessary to identify the health of your blood vessels and arteries. These tests can help detect plaque buildup, blockages, and narrowing of arteries, providing valuable information for preventative and precision heart care. The use of AI-enabled coronary CT angiograms, such as those offered by Clearly, can provide a more comprehensive assessment of heart health by identifying non-calcified soft plaque, which is dangerous and not picked up on other imaging methods. These tests are essential for accurate diagnosis and treatment, as relying solely on risk factors from blood tests can lead to unnecessary prescriptions and invasive procedures. With the advancements in AI technology and imaging techniques, we can now gain a more complete understanding of heart health and provide effective preventative and precision healthcare.
Personalized Approach to Cardiovascular Disease Management: A comprehensive approach to managing cardiovascular disease includes various tests, addressing insulin resistance, minimizing processed foods, and making necessary lifestyle changes.
For effective cardiovascular disease management, a comprehensive approach is necessary. Relying solely on LDL cholesterol levels is outdated. A personalized diagnosis and treatment plan, based on various tests including metabolic assessments, inflammatory markers, oxidative stress measures, and biomarkers, are essential. Focusing on addressing insulin resistance is crucial, as it's a significant driver of cardiovascular disease. Diet plays a significant role, with a need to minimize processed foods, trans fats, sugar, and refined carbohydrates. Adopting a personalized approach, regularly monitoring biomarkers, and making necessary lifestyle changes can significantly improve cardiovascular health.
Diets high in inflammatory foods increase health risks, focus on veggies, fruits, whole grains, and high-quality protein: Focus on a diet rich in veggies, fruits, whole grains, beans, high-quality protein, omega-3s, probiotics, and blood sugar regulating foods for optimal health
A diet high in inflammatory foods, such as fried foods, refined oils, and processed meats, can increase the risk of cardiovascular events, higher blood sugar, and unfavorable cholesterol levels. It is recommended to focus on a diet rich in low glycemic, non-starchy vegetables, fruits, whole grains, beans, and high-quality protein sources. Omega-3 fatty acids from sources like small fish, nuts, and seeds are also essential for heart health. Probiotics and blood sugar regulating foods, such as bitter melon and spices like turmeric, ginger, and cinnamon, can help improve overall health. It's important to note that individual metabolism and genetic factors may influence food choices. A diet rich in healthy fats, such as olive oil and avocados, and avoiding saturated fat in the absence of starch and sugar, can help manage blood sugar levels.
Eating in rhythm with your body's clock and regular exercise improve cholesterol health: Aligning meals with body's natural rhythm, eating veggies, protein, and healthy fats first, and regular exercise boost insulin sensitivity, lower triglycerides, and improve overall cardiovascular health.
Maintaining a healthy cholesterol profile involves more than just diet and medication. Eating in alignment with your body's natural circadian rhythm, specifically eating veggies, protein, and healthy fats before refined carbs and alcohol, can significantly improve insulin sensitivity, blood sugar control, and overall cardiovascular health. Regular physical activity, particularly 150 minutes a week of moderate-intensity aerobic exercise or 30 minutes a week of high-intensity interval training, can boost HDL levels, lower triglycerides, and improve cholesterol ratios. Additionally, lifestyle factors such as avoiding smoking and managing stress through practices like meditation have been shown to positively impact cardiovascular health. However, even with these healthy habits, no amount of alcohol consumption is protected against heart disease risk.
Alcohol's Negative Impact on Cardiovascular Health: Moderate alcohol consumption increases risk of hypertension, heart disease, and other cardiovascular issues. Alcohol negatively affects cholesterol levels, leading to high blood pressure, heart failure, stroke, and more. Personalized approaches, including lifestyle changes, supplements, and advanced testing, can help improve cardiovascular health.
Drinking alcohol, even in moderate amounts, significantly increases the risk of hypertension, heart disease, and other cardiovascular issues. Alcohol negatively affects cholesterol levels, contributing to high blood pressure, heart failure, stroke, and other conditions. For those looking to improve their cardiovascular health, personalized approaches are key. This may involve lifestyle changes, supplements, and advanced testing. Functional medicine offers a democratized, data-driven approach to healthcare, empowering individuals to take ownership of their health through comprehensive testing and personalized treatment plans. Function Health provides an all-in-one set of lab tests, including advanced cardiometabolic testing, to help individuals assess and address their cardiovascular risk. By understanding and addressing underlying health issues, individuals can reduce their risk of cardiovascular events and enjoy a long, healthy life.
Join Dr. Mark Hyman's Function Health waitlist for personalized health testing: Sign up for Dr. Mark Hyman's Function Health waitlist for regular lab tests and secure control over your health for $499 annually. Also, join his weekly newsletter, Mark's Picks, for health-enhancing recommendations.
Dr. Mark Hyman is inviting people to join his waitlist for Function Health, a service that aims to help individuals control their health with regular lab tests, for an annual fee of $499. The waitlist is currently open in the US and will soon expand globally, with over 100,000 people already signed up. Dr. Hyman emphasizes the importance of taking charge of one's health and encourages listeners to secure their spot on the waitlist by visiting functionhealth.com. Additionally, Dr. Hyman shares about his weekly newsletter, Mark's Picks, where he shares his favorite health-enhancing foods, supplements, gadgets, and tools. He encourages listeners to sign up for the newsletter by visiting drheiman.com/picks. Dr. Hyman reminds listeners that this podcast is for educational purposes only and should not be considered medical advice. He emphasizes the importance of seeking professional help when needed and encourages listeners to visit ifm.org to find a qualified functional medicine practitioner. Finally, he expresses gratitude to the podcast sponsors for making the podcast possible.
