Eggs and fat are not the cause of heart attacks!

After a recent trip to Atlanta to attend a cardio-metabolic conference, I decided to take a one week pause in the micronutrient story to pass on this great information. This is iteration number one on this topic. More to come.

After going through the two and a half day juggernaut of cutting edge cardiac physiology, I have synthesized the voluminous data down in part in this article. I am going to try and present the data where the rubber meets the road for the average American.

It is clear to me now that the vast majority of cardiac deaths in this country are due diets that contain lots of flour and added sugar as well as an abnormal gut micro biota.

We have been preached to forever that the root cause of cardiac artery disease or heart attacks is from cholesterol in our diet and our parent’s genes. We have been told to shun fat in all its animal forms, take cholesterol lowering medicines, exercise and take blood pressure medicines where needed. 20 years ago this was sound advice based on the evidence at hand. Today, this is not entirely true.

Evidence has shown us in a study ( http://www.ahjonline.com/article/S0002-8703(08)00717-5/abstract ) in American Heart Journal that more than 50% of heart attacks occur in patients with normal LDL cholesterol levels. They looked at 136,900 patients and found that only 21% were on lipid lowering drugs and the normal LDL level was often not protective against disease. It turns out that the primary cause of disease is inflammation.

The heavily prescribed lipid lowering medicines are primarily in a class called HMG-CoA reductase inhibitors. This enzyme, HMG-CoA reductase, is necessary for our cells to convert acetyl-CoA to mevalonate on its way to becoming cholesterol. The medicine is used to block this activity and thus lower cholesterol levels in the blood. This makes sense on the face of it.

Let us look a little deeper. What turns on and off this enzyme in the first place? The hormones leptin and insulin drive the production of cholesterol while epinephrine and glucagon turn it off. What turns on insulin and leptin? The consumption of flour and sugar are the main signals to the body to release these hormones. Thus it would seem to pass that the typical American diet is turning on the hormones that are increasing the enzyme responsible for the natural production of cholesterol.

Then logically by adding in the enzyme blocking drug we would prevent lots of cardiac disease. The answer to this question is — it does not do this well. However, we have very few functional medicinal options so the use of statin drugs is still the primary mode of preventing stroke and heart attacks.

This is a heavily debated topic in the medical community right now because the statin guidelines have basically increased the number of people that meet criteria for use, to the majority of people over 60 years old plus many younger than that, especially if they have diabetes as a diagnosis.

A response to the current cholesterol guidelines was written by the Mayo Clinic Task Force. It is lengthy, but I took away this statement, “In this setting, some patients might decide that taking a pill every day for the next 10 years might not be desirable to them if only 2 or 3 patients of 100 will actually benefit from 10 years of statin treatment (i.e. a 2%-3% absolute risk reduction in people with a 10-year risk of an ASCVD event of 10%)”. This is not even taking into account the possible side effects of diabetes induction and mitochondrial muscle cell damage.

Unfortunately, outside of self-induced lifestyle changes, statin drugs are likely your only option today.

A study ( http://archinte.jamanetwork.com/article.aspx?articleid=1819573 ) in JAMA Internal Medicine looked prospectively at 40,000 people that suffered 831 heart attacks over 163,000 person years. They found that those persons with the highest added sugar intake had a 400% increased risk of heart attack over the lowest consumption group.

Lowering your intake of sugar and flour will reduce these enzymes and thus your production of cholesterol.

I used to meet criteria for statin drug therapy and had a strong family history of heart attacks. I went after lifestyle modification after a failed statin trial. My cholesterol went from abnormal with a high LDL (bad cholesterol) and a low HDL (good cholesterol) — to the exact opposite when I went gluten free and consumed almost no refined flour or added sugar. My diet is a vegetable heavy modified paleo style diet. This means that I consume mostly vegetables, fruits, nuts, beans, seeds and smaller amounts of meat and fish.

Sugar and refined flour are turning out to be the root causes of inflammation and most chronic diseases that plague modern man. From atherosclerosis to diabetes to Alzheimers, the link is now apparent.

My advice to all would be for cadiometabolic-risk people to aggressively trial a flour- and added-sugar- free diet. Consult with your heart doctor before changing or stopping any medications. Most cardiologists that I know do not think that patients will try an appropriate diet so statin therapy is the first discussion. Surprise them with your desire to be medicine free if possible.

And you may have the added side effect of significant weight loss, healthier testosterone levels in men and lower blood pressure. All of which are risk factors for disease.

Remember that we are all uniquely made and therefore unique in our response to any therapy. Be patient and learn how your body responds to diet interventions. They are, in my opinion, one of the most powerful tools in your toolbox for healing any disease.

That is step one in the process of avoiding inflammation and heart disease. Step two is to fix the abnormal micro biome.

More to come. Be well.

Dr. Magryta is a physician at Salisbury Pediatric Associates. Contact him at newsletter@salisburypediatrics.com