First, I want to say that I am NOT a doctor. I am a petroleum geologist that was stricken with heart disease in 2007 at a very young age of 48. I exercised 5 days a week, I followed the American Heart Assoc. "low fat" eat healthy grains diet, limited my saturated fat, and I didn't even eat a cholesterol rich egg for over 20 years and still had major blockages in my heart. The big question was: Why did I and more than 25% of Americans each year, either die of a heart attack or find out that they have coronary heart disease? Well, take some time and listen to my story...
Developing heart disease has always been on my mind since my early twenties when I discovered that my total cholesterol was over 250! My grandfather on my mother’s side died of a heart attack when he was only 45, so I always thought that I might be carrying the same genetics.
For the next 25 years I exercised 4-5 days a week by jogging & I watched my diet (stayed close to the American Heart Association’s low fat diet). My cholesterol never went below 250 over the years. Then in 1998 my decided to go on a ultra low fat diet, which meant eating almost all carbs and very little meat. Guess what happened, my cholesterol shot through the roof to over 300! I quit that diet immediately.
About that time the fad diet was Sugar Busters which was low carb, low sugar but high meat and saturated meats. I tried this diet and my cholesterol dropped as well as my weight, however I still ate wheat cereals for breakfast, and did not eat any eggs for about 20 years. I would from time to time go off the diet and gain weight (10-15 lbs) but never was overweight for my height. During this whole time I tried various supplements to drop cholesterol but none of them really worked.
By the time I was 48 I was weighing around 184 (I’m 6’ tall) so I was not overweight but this was the heaviest I’d ever been. Then after returning from a summer cruise I went for my usual 3 mile run and had to stop at the first mile because I was out of breath. This had never happened to me before in all the years of running. I went to the doctor and he did not think it was heart disease. This continued for another 2 months, until I passed out after a 3 mile run.
I returned to the doctor and he referred me to a cardiologist. After doing a stress echo treadmill test he suspected that I had heart disease. I immediately had an Angiogram performed which concluded that I had serious coronary blockages on all three major arteries of over 90%! At first the doctors thought that I needed bypass surgery, however, my heart muscle was in such good shape due to all of the running, they opted to do complex stenting to open my blockages. A week later I had 6 stents put in.
What I learned about stents is that they DO NOT cure heart disease! (see diagrams) >>>>
All they did was mechanically open the blockages, however, the plaque is
still there and growing! The first thing after the stent procedure was done
was to put me on cholesterol meds which include Lipitor, Plavix, & Altace.
While I was in recovery at the hospital some of the young interns came and
checked on me and asked me if I understood the medications that the doctor
had prescribed. I then informed them that I had just read about particle size
of cholesterol and that my HDL (good cholesterol) was very low (HDL= 33).
They then added Niacin to my Med list. Niacin is one of the few drugs
(its really vitamin B-3) that will raise HDL and shift LDL small particle size
(the most dangerous) to the larger LDL particle size (not dangerous).
After starting my meds my total cholesterol went down to 134 and my
HDL rose to 40! I also resumed my running regime (3 miles a day) without
any breathlessness. (note: My HDL is now 56 due to Vitamin D normalization!)
Question: What caused MY heart disease?
Here are some facts that I learned:
- Over 50% of people who have heart disease and heart attacks have low cholesterol
(when looking at just the TOTAL cholesterol). There are also people with high total
cholesterol that never have heart disease! Small LDL particle size is probably the
missing link for who will develop heart disease and for those who wont.
- People who have low HDL tend to have more heart disease!
- Having “belly fat” is a heart disease risk!
- Exercising will strengthen your heart, develop collateral arteries around blockages, and
is great weight control. However, it will NOT stop plaque formation.
- Total cholesterol means nothing! Total LDL means nothing! Triglycerides mean a lot!
- Small LDL particles cause plaque. High HDL removes plaque. Plaque is just like belly
fat it comes and goes. Plaque is very dynamic, i.e. it is reversible or at least can be
halted. However, if you have soft plaque for many years it will be calcified (this is called hardening of arteries)
and if you are substantially blocked and plaque has calcified you may need a bypass. Once plaque is
calcified, you cannot reverse it. Older people tend to have calcified plaque. However, calcified plaque is
stable, soft plaque is not. Soft plaque can suddenly burst resulting in a heart attack!
- Each person has very unique genetics as it relates to heart disease. One person can
eat certain types of food and these foods can worsen your risks of increasing plaque
formation, while these same foods have no effect on some.
- After a certain age (men 45, women-post menapause) your plaque can grow very rapidly, probably due to natural hormonal decline.
- Eating wheat products (for a majority of Americans) will cause weight gain, but more
important, will increase the most dangerous small LDL particle size. Even “whole grain
wheat” products can be dangerous. The wheat we eat today has no resemblance to
- Having Triglycerides of over 140 guarantees that you WILL have a large number of
small LDL particle size. Having Triglycerides under 70 means you are probably safe
from small LDL particle size. If you have Triglycerides between 70-140 you must get
a VAP cholesterol test that will measure your small particles.
- There are other factors that may cause heart disease such as High Lp(a). This lipid is simply a LDL with a protein attached. This lipid can also be measured with a VAP. However, it is a genetic trait. Some people have this risk factor and some don’t. The only drugs known to lower Lp(a) is Niacin and high dose
fish oil (6000 mg omega 3, a good fish oil capsul has 600 mg of omega 3, = 10 capsules per day)
- The statin drugs such as Lipitor, Zorcor, Crestor etc. WILL lower total cholesterol,
however they DO NOT change your small LDL particle pattern! Niacin will shift a bad
small LDL particle pattern over to the larger LDL particle pattern. Elimination of
sugar, corn, and wheat products will also shift you to the larger, safer, LDL particles.
- High Fructose corn syrup and a high Sugar diet will cause your liver to produce small LDL particles.
These additives is in almost ALL packaged foods. Corn syrup and sugar are by far the worst additives in the
American diet today that causes obesity AND dangerous small LDL particle size. Click here to view a video
Answers: These are the items that “probably” led to my hidden heart disease:
- For 20+ years I ate a wheat based cereal every day, did not eat eggs, ate too much saturated fat from foods such as bacon or fatty meats. Today I avoid all grains and eat only very lean meats, nuts, fresh vegetables, and fruit. However, not all people will be affected by saturated fat, in fact, eating saturated fat affects only about 20% of the population causing the formation of small LDL. There are 3 major genotypes that saturated fats affect your lipids, Apo E2, Apo E3 and Apo E4. If you are an E4 then it is wise to avoid saturated fat. Saturated fats will raise the good HDL which is a good thing. However, if you fall in the 20% (Apo E4) it is best to stay with the lean meats. If you have not been tested for your Apo E Genotype you will know your are a Apo E4 if fish oil raises your LDL. However, the LDL raised in an Apo E4 person will be the safer large LDL. The chart below shows the treatment response for each Apo E Genotype.
- I have a high genetic Lp(a) pattern which now has been lowered with Niacin therapy.
- I am genetically Apo E3 whereas saturated fats DO NOT raise my small LDL but raises the good HDL
so, I personally am not very concerned over eating red meat and saturated fats.
- I probably had genetic and diet driven small LDL particle size due to eating a diet
high in grains, sugar, and corn syrup. All of these foods drive small LDL particle
- Always had “belly fat” even after running 3 miles per day for 30 years.
The following are my conclusions of how to prevent heart disease (plaque formation) and heart attacks (these are only my opinions):
- If you suspect you may have hidden heart disease get a Calcium Score. A Calcium
Test will tell you how much plaque is in your coronary arteries. Soft plaque
contains 20% calcium which can be detected on a simple X-ray. After you get this
test your doctor will tell you what your score means and if should you have further
treatment to prevent future build up of plaque which could lead to a heart attack.
You cannot get a Calcium Score if you have had stents, because stents mask the
calcium in the arteries. However, if you have stents, you can get carotid echo test each year to see if your
plaque in you carotid arteries is forming, static, or regressing. In most cases what is happening in your
carotids is happening in your coronary arteries feeding your heart.
- Get a VAP (Vertical Auto Profile) This simple blood test in my opinion should replace
all conventional cholesterol tests. A VAP will show you the breakdown of all of your
cholesterol sub-particles. If you have a large proportion of small particles this test will
show that. A VAP will also tell you if you have high genetic Lp(a) lipid which can be
corrected with Niacin and/or High dose Fish Oil (6000 mg Omega 3)
This test cost only $100. If you don’t do anything else, have this test done. This test can be purchased online
and blood can be drawn at your local LABCORP testing center. To order this test go to:
- Should your Calcium Score be High (bad) or several of your VAP lipid fractions be
abnormal, your doctor can prescribe various drugs that can help you from forming
future plaque in your arteries. For instance, if your overall LDL cholesterol is high
AND the LDL is all small particles, he may prescribe a Statin (Lipitor or Crestor) which will bring
down your overall LDL Plus start you on Niacin to shift your LDL pattern to large
particles. Lipitor by itself WILL NOT change your particle size distribution. This if why
many heart patients that take ONLY A STATIN will have plaque build up several years later and
need additional stents. Remember, stents DO NOT cure heart disease.
Also, low HDL can be corrected with Niacin therapy. Niacin will also lower triglycerides.
Should you have small LDL pattern, have your doctor prescribe a high dose fish oil. In my case
3600 mg of omega 3 fish oil changed my pattern from B to A (B is small LDL and A is safer large LDL).
This would require 2 fish oil capsules per meal or 6 per day. Just make sure each capsule contains at
least 600 mg of EPA/DHA omega 3 oil). Weight loss is will also raise your good HDL cholesterol.
- If you have diabetes or high blood pressure or are overweight you must get these in
control with medications, diet, or both. I have found by eliminating most wheat, corn &
sugar products and replacing with nuts, fresh fruit, vegetables and lean meats (turkey,
shrimp, chicken, lean beef, seafood etc.) my weight has dropped to nearly my high
school weight (I am now 52 years old and weight 168 lbs, 6’ tall) and now my blood
pressure has dropped to 100/60.
- Check your Vitamin D levels. Most people slowly lose the ability to make Vitamin D from sun exposure after age 40. If you supplement, use D-3 and your doctor must test every 6 months. You want your level to be in the 60-70 range. It takes different amounts of D-3 to raise your level depending on your genetics. It took 10,000 iu/day to raise my level from 29 to 60. Often your good HDL cholesterol will also rise when your D level rises. After getting my D level to 60 my good HDL rose to an all time high of 56!
- For most people to halt, or even regress heart disease you must get as close to this cholesterol profile:
1. LDL must be less than 60 2. HDL must be higher than 60 3. Triglycerides must be lower than 60 4. Vitamin D levels should be normalized to 50-70 ng/mL (60 ng/mL would be ideal) 5. LDL should be the large variety instead of small (you want to be pattern A)
Action Plan- To halt plaque formation and heart disease
If you have been diagnosed with heart disease and have the following issues,
here are some ideas on how to correct each issue:
PROBLEM POSSIBLE SOLUTION
- High LDL(over 70) - Low(or no) grain, Low sugar diet, lean meat diet. Statin drug i.e. Lipitor, Crestor etc.
- Low HDL (under 40) - 500-1500 mg Niacin (prescription Niaspan or overcounter Slo-Niacin...note: no flush niacin does not work), Vitamin D-3 - 2000-10,000 units. Exercise, Moderate Alcohol. Weight loss raises your good HDL.
- High Trigylcerides(over 70) - Low (no) grain,Low(no) sugar diet. Fish Oil (Omega 3 - 3600 mg EPA/DHA)
- Small LDL(pattern B on VAP) - Low (no) grain, Low (no) sugar diet. 500-1500 mg Niacin
- Low Vitamin D(under 40) - more sun & 2000-10,000 iu vitamin D-3 (test every 6 mos)
- High Lp(a) - 1000-2000 mg Niacin, 6000 mg EPA/DHA Fish Oil
These are just my conclusions after reading and learning about heart disease and these seem to be the most common causes. I hope my experiences and conclusions can help someone prevent and avoid heart disease.