In my last post I mentioned I would follow up with my thoughts on what, if not high LDL, does cause heart disease. What is funny is I just read several articles which attempt to show that HDL is not good cholesterol and it appears the new trend is going to be calling all cholesterol bad. This stems from the data that despite how effective cholesterol medications have been at lowering LDL heart disease is only slowly declining. So there must be something else wrong here, right? Either we double down on the idea that heart disease is due to cholesterol OR we realize that cholesterol isn’t the problem.
This post isn’t likely going to include any sources. I have read too much to piece together my understanding on this issue. Instead let me start by mentioning the sources I trust. First is the book the Paleo Cardiologist by Jack Wolfson, DO, FACC. This is the source of our heart health talk we do in the office. Wolfson’s book is referenced and a very credible source. The second is two books by Ray Strand, MD; Healthy for Life and What your Doctor Doesn’t Know about Nutritional Medicine. The third is Mercola.com, one of the largest sources of natural or alternative health topis on the internet. If you want a copy of the book the Paleo Cardiologist give us a call to find out when we are giving our Heart talk again.
So, the traditional thought is that cholesterol sticks to the arteries, causing plaques and narrowing the arteries. That narrowing restricts blood flow and contributes to a variety of cardiovascular conditions. Cholesterol sticks to the arteries because they become inflamed and we have to much cholesterol in our blood stream. The non-traditional thought is that the inflammation of our arteries is caused by too much insulin which is elevated because of a diet too high in carbohydrates. Insulin promotes the absorption of carbohydrates from the blood stream to the cells of the body. When we eat carbs more insulin is produces for those carbs to be broken down and used, or stored, in our body. The more carbs the more insulin.
When our society started to promote the low fat diet as the solution to heart disease, because fat is bad, what occurred was a replacement of more carbohydrates to offset the reducing in calories due to less fat. Foods started including more carbohydrates which means a larger insulin response. How much of your food includes high-fructose corn syrup? The use of that increased dramatically in the last quarter of the 20th century. Additionally, the fat in the foods we eat actually help to slow the digestion of carbohydrates in our body. This results in a smaller insulin spike. The overall combination of more carbs and less fat results in a larger insulin response. The thought is that the increase in insulin is inflaming our arteries making them less permeable to the fat which, instead of passing through the arterial wall, sticks and results in s plaque formation over a long period of time.
From what I have read and from how I understand the mechanism of heart disease, I think that the cause is not too much cholesterol but too much carbohydrates. I don’t think that all carbs are bad either though. Our bodies need and use carbohydrates but we need a balanced diet. We need to avoid processed foods and foods with high-fructose corn syrup. Dr. Ray Strand’s has a great lifestyle of healthy eating but it’s complex. You have to be mindful of eating “good” carbs over “bad” carbs. I don’t think that you should 100% eliminate carbohydrates, which is not possible anyway. I find that the Paleo diet, when done right, is a great healthy eating lifestyle that is easy to follow.