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Heart Health and Lipids
Cardiovascular diseases remain a leading cause of death worldwide. Effective prevention strategies are ideal when age is on our side. Eating a healthy diet, not smoking, and regular exercise all help prevent heart disease. However, dealing with issues related to our heart health become more challenging as we get older and interventions may be more appropriate.
Lipids
Regular lab tests that just look at cholesterol, low-density lipoproteins (LDL) and high-density lipoproteins ((HDL) and triglycerides. However, these tests might not give the best picture of what you need to focus on when reducing your cardiovascular risks. Although the focus on elevated LDL is important, it may not give the best picture of your heart health.
Panels such as the NMR Lipid Panel (LabCorp) or the Cardio IQ Test (Quest Diagnostics), or the Boston Heart CVMap, which measure the number and size of LDL and HDL particles provide additional information that can better guide risks and
treatment.
Cholesterol
Cholesterol is required to maintain cell membranes, produce Vitamin D, brain and nervous system development and hormone production. Included in our cholesterol are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Traditional lipid panels provide a total number of LDL and HDL. So total cholesterol by itself
does not provide the whole picture.
Low Density Lipoprotein (LDL)
LDL is tagged in general to be “bad." However, there are subtypes that provide more
information. The size of the LDL particle is more valuable than just the LDL number.
Large, Buoyant LDL particles, often referred to as "Pattern A,” are generally considered less atherogenic (less likely to cause plaque buildup in arteries) than smaller particles. Small, dense LDL particles, referred to as “Pattern B” are highly atherogenic (contribute to plaque formation in arteries). These LDL particles are associated with an increased risk for heart disease.
Pattern B is associated with a high consumption of simple carbohydrates (sugars and starch), sedentary lifestyle and being overweight. Insulin resistance, diabetes
and prediabetes often are also present. Avoiding simple carbohydrates, regular exercise, and weight loss are the focus of treatment. Fish oil at 2-4 grams per day
can also help. Drugs may be used if needed to manage diabetes and improve
the body’s sensitivity to insulin (a hormone produced by the pancreas that regulates blood glucose by allowing cells to absorb sugar from the blood for energy).
Lipoprotein (a) or Lp(a) is a type of low-density lipoprotein (LDL) is a genetically inherited and independent risk factor for cardiovascular disease. High levels of Lp(a) can significantly increase a person's risk of heart attack, stroke, and aortic stenosis.
While lifestyle changes do not directly lower the inherited Lp(a) level itself, they are crucial for minimizing your overall risk of heart attack and stroke by managing other risk factors. Niacin can lower Lp(a) but has potential side effects that should be discussed before starting the B vitamin. There are drugs that can lower LP(a).
High Density Lipoprotein (HDL)
HDL is tagged in general to be “good.” However, there are subtypes that provide more information. As with LDL, the size of the HDL particle is more valuable than just the HDL number. Higher levels of large HDL particles are widely considered protective and associated with lower levels of visceral fat (belly fat) and better insulin sensitivity. Higher levels of small HDL particles are often seen in individuals with high triglycerides, abdominal obesity, and type 2 diabetes. A healthy diet, regular exercise and smoking cessation can all increase HDL.
Triglycerides
When you eat, your body converts unneeded calories (especially from sugar and refined carbohydrates) into triglycerides, which is the most common type of storage fat in your body. It stores excess calories from food. Triglycerides are the most common type of fat found in your blood and body. They function as a major energy source and are stored in fat cells for later use. High levels of triglycerides are caused by excess carbohydrates, starch and sugar which are in the body. Triglycerides are stored in the liver for future energy needs; however, high levels can
lead to fat buildup in the liver or “fatty liver.”
Lowering Your Risk of Heart Disease
Food
A healthy diet is defined as one that is low in saturated and trans fats, added sugars, and sodium, and high in fruits, vegetables, whole grains, lean proteins, and healthy fats.
Reducing inflammation in our bodies is a main focus in heart health. Ultra-processed foods such as high intake of red meat, refined and processed grains and sugar are inflammatory and can increase your risk of having heart disease. An
anti-inflammatory diet such as the Mediterranean diet, which incorporates herbs and spices usually used in Mediterranean-style cooking (e.g., cinnamon, turmeric, ginger, cumin, saffron) has been associated with lower risk for cardiovascular disease.
Generous amounts of fruits and vegetables, healthy fats such as olive oil, avocados, nuts (e.g., walnuts, almonds), seeds (e.g., flaxseeds, chia seeds), can lower your risk of heart disease. Eating lean protein such as salmon, skinless poultry, legumes, tofu, eggs and low-fat dairy is recommended. And whole grains such as oats, brown rice, whole grain bread and pasta in moderation is a part of a heart healthy diet.
Exercise
The recommended amount of exercise required to help lower heart disease risk include 150 minutes a week of moderate exercise (e.g., brisk walking, cycling at a light pace and swimming); or 75 minutes per week of vigorous exercise (e.g., running, swimming laps or cycling at a fast pace). Try and spread out this weekly exercise routine into 5 days per week. You can do a combination of both, such as
30 minutes of moderate-intensity exercise five days a week or 15 minutes of vigorous-intensity exercise five days a week.
Weight
Body Mass Index (BMI) is a simple screening tool, but it has limitations because it doesn't differentiate between fat and muscle mass or indicate fat distribution (e.g.,
belly fat). A BMI of greater than 35 kg/m, which is considered extreme obesity,
is consistently associated with increased death related to heart disease. You can calculate your BMI by searching the internet and use an online calculator.
A waist circumference of more than 35 inches for women or more than 40 inches for men increases the risk for heart disease and type 2 diabetes. To find your waist circumference, wrap a flexible tape measure horizontally around your natural waist, which is typically midway between your hip bone and the bottom of your ribs (often at the belly button level).
The general recommendation is to aim for a sustained weight loss of 5% to 10% of your current weight over about six months through a combination of diet and exercise. The fat around your internal organs (belly fat) is the most critical factor impacting health and heart disease risk, more so than overall body weight. Excess
fat tissue, especially abdominal fat, releases pro-inflammatory markers and hormones that contribute to atherosclerosis (plaque buildup in arteries), high blood pressure, and insulin resistance.
Conventional Approach to Treatment
Conventional treatment approaches include the use of medications, such statins, which can lower total cholesterol and LDL. This pretty much the “gold standard” for most patients walking in to the office for high cholesterol and LDL. Drugs known as fibrates are used for high triglycerides.
Naturopathic Approach to Treatment
Lifestyle changes mentioned earlier are the key to getting to the root cause of the problem. There are supportive supplements can be used to replace the use of medications along with lifestyle changes discussed earlier in this newsletter.
Emsculpt Neo, a non-invasive body contouring treatment that uses high-intensity
electromagnetic (HIFEM) technology to build muscle and burn fat simultaneously. The procedure induces thousands of powerful muscle contractions in a 30-minute session, similar to an intense workout, without the need for surgery or downtime.
Four 30-minute treatments over a 4-week period can reduce belly fat and waist size.
Red yeast rice (RYR) has been used as an alternative to statin drugs; however, the
quality of the supplement is of concern. In addition, the dosing of the red yeast rice must be individualized. We at this clinic use a RYR product that has been tested for quality. I have patients that do well with RYR when not able to tolerate statin drugs.
Lifestyle changes are a must when using RYR; they are not a replacement for weight loss, dietary changes and exercise. The recommended dose of RYR is 1,
200 mg a day, but I have used as much as 3,000 mg a day with my patients.
Fish oil is a very good way to reduce triglycerides. The dose of fish oil ranges from
2 to 4 grams per day. Capsules can be quite large, so liquids are an option.
Bergamot is a flavonoid that has been shown to reduce LDL. It can also be used with statin drugs to improve your lipid profile. The dose is 1,000 to 1,500 mg per day.
Fiber in the form of PGX® or Glucomannan is a type of fiber that can reduce the absorption of fats and sugars in the bloodstream, potentially lowering LDL cholesterol by up to 20%.
Semaglutide
Semaglutide has been shown to reduce the risk of cardiovascular events in individuals who are overweight or who are obese, both with and without type 2 diabetes. Semaglutide is a prescription medication in the class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. It is FDA-approved for the treatment of type 2 diabetes and for chronic weight management in eligible adults and some adolescents.
It is also used to reduce the risk of major adverse cardiovascular events (heart attack, stroke, or death) in patients with these conditions. It requires weekly shots similar to the way insulin is given. This medication can be obtained from local compounding pharmacies and be injected at home or in our office.
Yours in Health,
Dr. Timothy Schwaiger
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