Our Heart Should Last Longer Than We Do

We can’t live without our heart, yet we systematically abuse it. Heart disease is the number one cause of death in most western nations. It doesn’t have to be that way.

My medical adventures began about twenty five years ago, but I didn’t realize it at the time. Driving to work, in my physical and mental prime, I suddenly felt ill, with tightness in my chest. I returned home, took an aspirin, relaxed a while and felt better. Called for an appointment with my HMO and visited them a few days later. Their quick diagnosis was I had a heart attack, which surprised me because I was way too young and very fit and active. And it wasn’t nearly as bad as I had heard.

They scheduled an angiogram, which I considered amazing because I had a monitor showing my insides while they were inspecting me. They declared there were no blockages needing attention, so go home and be more careful, or something like that. I don’t remember exactly, but I probably stopped for burgers on the way home, and collected a box of donuts. Just a fluke, I assumed. I blithely continued my happy lifestyle with little knowledge and little interest in the damage I was doing.

In 2012 I needed surgery for something unrelated, and the surgeon wanted a cardiac clearance. He referred me to a pleasant, overweight cardiologist who determined I would probably survive the surgery, but why don’t you come back later for a closer look. Thus began what is now nearly nine years of quarterly cardiology checks, with an amazing array of modern diagnostics, increasing bottles of pills, and eventually two more angiograms with stents placed in blocked arteries each time — first one stent in 2016, then two in 2018. Apparently I had been close to the edge.

I didn’t like the trend of the stents, and of all the medical attention in general, so I finally began researching my condition. I first found Michael Greger’s “How Not To Die,” which is a fascinating tour of all the systems in our bodies, with descriptions of what can go wrong and suggestions to deal with it.

The theme of his recommendations is vegetables.

I went through Colin Campbell’s “China Study” and Dean Ornish’s “”Program for Reversing Heart Disease” and “UnDo It” and Caldwell Esselstyn’s “Prevent and Reverse Heart Disease.” All had a similar theme — the standard American diet will kill you, and the standard American doctor won’t stop it. I was ready to consider a diet change, but not ready to believe my beloved doctors weren’t doing everything to keep me above ground.

Esselstyn should be required reading for every human on the planet when they turn 18, or earlier, before they have time to do too much damage. Esselstyn describes autopsies of soldiers in Korea and Vietnam — young, fit, and healthy until their final moments — but showed 80% of Americans had “gross evidence of coronary artery disease” while Asian soldiers were mostly clean and free of fatty deposits. Most of those who have already done some damage can recover following Esselstyn’s advice.

I read books on various conditions, and diet books, and began studying physiology and biology texts, amazed at the complexity of our systems. There are some very good nursing classes online, which I started initially so I could sound smarter to the nurses who I was increasingly encountering, but I found they helped me understand better what the doctors were telling me. I had high school biology back when they still trusted kids with scalpels, so I understood the basics. But I developed greater appreciation for the knowledge of doctors and nurses, and a desire to learn more. I became my own lab rat. I began recording my blood pressure, ECGs, food, water, bowel movements … anything that seemed relevant. The combinations were daunting, but I tried piecing my observations together and I began to reveal some things that worked, and some that didn’t.  But my numbers continued to get worse, and the doctors continued their enthusiasm.

In 2018, after my second and third stents, I changed my diet to vegan. Before converting, I asked my overweight cardiologist if vegan was legit, or nutty, or just another fad diet. He claimed ignorance of dietary questions, which I had discovered to be a common deficiency of all doctors, but he referred me to a “cardiac rehab” program at a local university hospital. I began a strict vegan diet monitored by weekly visits with cardiologists, dietitians, and exercise physiologists, and learned to manage and improve my new lifestyle.

One of the things we discovered during this period was that I have a genetic predisposition for Alzheimer’s. My dad had died of heart failure, but with very advanced Alzheimer’s, so that increased my interest. My cardiologist recommended Dale Bredeson’s “End of Alzheimer’s” which describes cutting edge research, and a detailed description of brain functions and malfunctions. Like the others, this author recommends vegetables and complains that medical orthodoxy resists consideration of his well researched and well tested solutions.

And that uncovered one of the clearest dilemmas in my quest — Esselstyn recommends total cholesterol BELOW 150 (milligrams per deciliter) to avoid heart disease, while Bredeson recommends cholesterol ABOVE 150 to avoid Alzheimer’s. On the surface, it appeared to be a no-win situation.

Cholesterol is a steroid essential for cell functions. It is produced by the body, and is included with many of our favorite foods. It provides the structure for our cells. Without it, we would descend into a pile of mush. Overabundance of it is linked to atherosclerosis, which leads to heart disease and eventual failure. It seems to accumulate in plaques in the arteries, producing the blockages like those I had already encountered.

But the brain requires cholesterol to perform the housekeeping needed to prevent the brain plaque buildup that indicates Alzheimer’s. So I used statins and diet adjustments with frequent cholesterol tests to try to split the difference and hit 150 exactly, or as close as I could. Maybe I can have my vegan cake and eat it too?

Cholesterol has been a focus of cardiologists since the 1950s, when newspapers began preaching that we were facing an epidemic of heart disease, driven by the accumulation of fat and cholesterol in our arteries. A lot of clear evidence from the preceding decades that cholesterol was not the culprit was ignored, and popular opinion shifted to abhor fats, leading to a series of fad diets and FDA cartoons (“food pyramids”) that recommend high carb, low fat diets. But “low fat” has always allowed for fattening foods with strong lobbyists, leaving us with far greater levels of fat than are healthy, in bodies flooded with insulin from the continual carbohydrate overloads.

Bredesen shows that cholesterol is essential for brain health, and many with “high cholesterol” have no vascular disease, while many more with “normal” cholesterol have significant vascular disease. But those on western diets frequently have both high cholesterol and heart disease, so the medical industry lazily assumes they’re related and preach against fats and high cholesterol foods, and push pills to counter the effects of their malpractice. The evidence shows there’s not a direct correlation, as medical orthodoxy maintains. The most damning evidence of this failed standard of practice is the continuing growth of heart disease (still the number one killer in the US), and dementia, and a multitude of chronic diseases.

So, we have to look elsewhere for the root causes of our growing risks of those diseases. The clues were in Esselstyn, and Bredesen, and Gary Taubes “Good Calories Bad Calories,”, and many other reports of the problem. But the best analysis I have found is in Paul Saladino’s “Carnivore Code,” a detailed review and analysis of extensive research, citing 700 published papers, and describing the errors in interpretations of individual reports made without the context of broader evidence.

Saladino’s conclusion is the principle cause of heart disease is not fat, but insulin.

Insulin is an enzyme produced by the pancreas to support many cellular functions. Most important for diabetics, insulin is necessary to allow cells to absorb glucose from the blood to provide energy for the cells. When we eat, the food, especially carbohydrates, is converted to glucose and distributed through the body in the blood. The glucose is recognized, and we immediately produce insulin to manage it. Another enzyme, insulin degrading enzyme (IDE), then recovers and recycles the unused insulin, and we settle down to await our next meal.

The problem comes when we eat high carb foods, especially sugars, continually, producing a steady stream of insulin. The insulin overload numbs the cells so they begin refusing to accept glucose they don’t need, a condition called insulin resistance, which is at the core of many chronic diseases such as Type 2 diabetes and obesity. But insulin processing also diverts the IDE from another important task — removing amyloid plaques in the brain, which are always present in Alzheimer’s patients. So, excess insulin is bad for many reasons. Very bad.

My vegan diet worked pretty well. In two years I dropped 45 pounds despite eating everything to satiety. My angina stopped completely, indicating my blockages were abating. My blood pressure dropped enough that I went from two large pills to one small one. My blood tests improved, though my HDL remained low and triglycerides high. More on that in a moment. My lipids decreased — cholesterol and LDL especially — though still above normal. The doctors cut back my statins, which I independently stopped completely in order to manage my highest priority of brain health, and to simplify the ongoing research on my lab rat (me). But my insulin remained high, and insulin resistance became my cardiologists’ main concern. My glucose was in prediabetic range. And my home ECG (Kardia) began indicating possible atrial fibrillation. None of my doctors suggested I was eating too many carbohydrates.

AFIB! I envisioned yet another reason for the doctors to continue abusing me, with new pills and new procedures. So I continued my research. Along the way I found Carolyn Dean who teaches that heart arrhythmias are often due to magnesium deficiency, something that can’t be definitively tested. Magnesium is a nutrient obtained from plants and plant-eating animal foods, but has been depleted from the soil by industrial farming practices, so it’s likely most people are deficient. Apparently the best test is our stools, with overdose of magnesium indicated by diarrhea. I had long been mildly constipated, so I began adding magnesium supplements. I got up to 2000 mg per day and my stools became fairly loose, so I dialed it back a little. Magnesium users should note that different formulations are absorbed differently, so depending on which type you use, your results will vary. My current dose is 800 mg of magnesium glycinate and 400 mg of magnesium oxide. It treats my bowels well and my ECGs are much more regular.

Then I found Saladino, and decided to give carnivore a try.

I get comprehensive blood tests every six months. My tests during my vegan phase continued to show lipid and metabolic problems, despite my strict vegan diet, medicines, and exercise. My first blood test after the carnivore conversion was impressive. My lipids went up, as expected, since I had stopped all meds except a small blood pressure pill, Lisinopril, an ACE inhibitor. But HDL rose to my highest in 20 years of test records, and triglycerides the lowest, and most other markers also improved. Saladino has become my favorite doctor, to the frustration of my other doctors. I gave them all copies of Saladino’s book, but they haven’t told me their opinions. Hmmm…

Let’s review some basics.

We’re born with an assembly of parts, mostly important. Quite a few are critical for our survival. If the heart stops, we die in minutes so it’s among the most critical systems. Aside from the typical trauma of knife or bullet wounds that have sent many people to their just rewards, there are other actions that cause slower termination of heart functions.

The heart and associated plumbing are remarkably simple in concept, just a muscle that contracts continuously from birth until death. The arteries that send blood to the body reach every cell in the body, with a companion set of veins that return the depleted blood to the heart for replenishment with oxygen and nutrients. The blood delivers nutrients and removes waste products.

The most pernicious defect in cardiovascular health is atherosclerosis — the clogging and stiffening of the arteries that provide blood to all our cells, including the heart itself. Esselstyn describes the problems as accumulation of fat and cholesterol deposits on the lining of the arteries, called the endothelium layer. These deposits become plaques, which grow and solidify, eventually blocking the flow of blood and causing chest pains often seen in heart disease patients But the greater problem is younger, fatty plaques, too small to cause complaints, which can suddenly rupture. This starts the immune process, with clotting to seal the breach, which causes sudden closing of the artery, and a heart attack. The body parts fed by this artery, often a part of the heart, then die from oxygen starvation, reducing the heart function, and progressively leading to eventual heart failure. Esselstyn has found that people with total cholesterol measured less than 150 seldom have this problem. So he recommends a strict low fat diet, wanting around 10-15% of dietary calories from fats, to reduce the plaque accumulations. No oils. No avocados. Nothing with a mother.

I followed this for two years, and my symptoms disappeared, and my tests improved. But Esselstyn also identifies LDL, or “bad cholesterol,” as a component of plaque formation. He states that fats in the diet make LDL sticky, which initiates plaque formation. My LDL remained stubbornly high, even with my very low fat diet, and I was prescribed a series of meds to reduce it, including a monthly injection (PCSK9 inhibitor) that targets LDL without reducing cholesterol. They have an expensive drug for every taste.

Although medical orthodoxy recommends low fat, Esselstyn is considered an outlier, with “low” fat more generally being considered around 30%. White meat. Lean beef, if at all. Potatoes. Olive oil. The food pyramid we’ve all been raised with. This was my diet for decades before my undetected deterioration grew.

Saladino provides analysis of the chemical processes of plaque formation which exonerates LDL, and fats, and cholesterol. He provides considerably more detail, and extensive research support for his conclusions, which are mainly that fat isn’t our problem. It’s the combination of fats with insulin. Insulin is the enzyme that enables cells to absorb glucose extracted from our foods to provide energy to the cells. The major source of glucose is carbohydrates. Most people have way too much, but don’t realize it, and aren’t told about it until it becomes a clinical problem like diabetes.

LDL is incorrectly described as “bad” cholesterol, but it’s neither bad, nor is it cholesterol. The blood is a water based system, and fats and cholesterol are not water soluble, so a transport vehicle is needed to distribute it to the cells. LDL and HDL are constructed of water-soluble fats and proteins and serve as containers to move triglycerides and cholesterol through the bloodstream to every cell in the body, and to remove waste products for processing in the liver and kidneys. It’s essential for our survival. LDL also plays a big role in immune function. Those hoping to survive Covid-19 will benefit from having a lot of LDL. The LDL is slippery, and can slide through the endothelium membrane to feed the cells that need its contents.

Problems arise when, as Esselstyn teaches, the LDL gets stuck in the artery tissues, becomes oxidized by reactions of the immune system, and attracts healthy LDL and macrophage immune cells, primarily white blood cells, which congregate as a frothy pus in plaques. Autopsy identification of these molecules in the plaques led to their blame for heart disease, but it is actually the response to protect against the offending sticky LDL, not the cause. Saladino states that there is “exactly zero research that conclusively shows that the amount of LDL retained is directly related to the amount of LDL in the circulation,” and he provides many studies that show the opposite is true.

One of the most important studies that forms the basis for a lot of current cardiology wisdom was an extensive study done in the 1970s in Framingham, Massachusetts. The conventional interpretation of this data is a curve showing the overall risk for cardiac artery disease increases slowly with LDL until 160, then turns sharply higher. So conventional wisdom blithely interprets this simplified result as evidence that LDL is the root cause of heart disease, and thus was born the multi billion dollar statin industry.

But a more careful reading of the Framingham data shows the LDL risk is dependent on HDL levels. Low HDL levels, even as low as 45 which I was never able to attain, does give substantial LDL risk. But HDL at 65 reduces LDL risk to very low levels. Low HDL is primarily caused by insulin resistance, which we earlier described as excess insulin in circulation causing cells to reject the insulin to escort glucose into the cells for energy. Insulin resistance has the double whammy of making LDL stick to the artery walls, starting plaques, and of reducing the HDL in circulation to clear out the excess cholesterol. And it has been estimated that 88% of the American population has some degree of this metabolic dysfunction — early stages of type 2 diabetes, increasing atherosclerosis, and general inflammation that leads to arthritis and some cancers.

This is a complex topic, and I won’t try to duplicate it here. But I invite interested readers to read The Carnivore Code, especially Chapter 11, titled “Myth IV Red Meat Causes The Heart To Explode.” It’s a convincing explanation.

I’m currently completing my first year of my personal exploration of the Saladino approach, after a mostly successful two year trial of the Esselstyn approach. Since I’m in the 25% of the population with a single Alzheimer’s gene (APOE4), I am less willing to follow the Esselstyn prescription and his adoring army of cardiologists to the letter. It also produced some heart rhythm irregularities that I was able to reduce with the Salidino approach. My results so far look good, except for my lipids. My doctors still worry that my cardiovascular system will return to its old deterioration due to my elevated cholesterol and LDL. But it hasn’t yet. I’ll post here if anything changes.

If anyone here has contrary experiences, I would be grateful for your advice. Others might too. I suspect the final chapter hasn’t been written on this subject yet. But, take heart -- cardiovascular disease is not a necessary ending.