Cardiovascular disease (CVD) is one of the leading causes of death in older adults, while hypertension, a risk factor for CVD, is the most common chronic disease in the same population. Once believed that a high intake of fats, in particular saturated fats and foods high in cholesterol, was the main culprit, the consequential replacement of dietary fats with a higher refined carbohydrate and sugar content led to even higher incidences of CVD, along with other diseases like diabetes and obesity.

So what then is the underlying trigger for cardiovascular disease, what is one to eat and do to preserve heart health? In this article we will take a dive into the current research on atherosclerosis, cholesterol, dietary fats and more, and debunk any myths related.

What is atherosclerosis and cardiovascular disease, and why is it so deadly?

Atherosclerosis is a disease in which plaque builds up inside your arteries.

Healthy arteries are flexible, strong and elastic. Their inner lining is smooth so that blood flows freely, supplying vital organs and tissues with nutrients and oxygen.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

Atherosclerosis can lead to serious problems, including heart attacks and strokes, if one of the plaques breaks off, forms a clot, and travels to either the heart or the brain, gets lodged in smaller blood vessels and cuts the blood supply, and with it oxygen, to that part of the brain (stroke) or heart (heart attack) off. The resulting lack in oxygen can damage that part of the brain or heart with serious (and sometimes deadly) effects.

As plaques are made up of cholesterol, researcher used to believe that a diet high in cholesterol and saturated fats, whose excessive consumption have been shown to increase cholesterol levels in our blood, were the main culprit. However, over the past 2 decades, with advances in research equipment and knowledge, scientists have been able to gain more clarity on the topic. Here is what they found.

What new research has to say about cardiovascular disease

1. The cholesterol in our blood is made up of both cholesterol ingested from food and internally produced in the liver.
2. Our body needs cholesterol to make sex hormones such as testosterone, estrogen and progesterone, bile, and functions as a building block of our cell walls.
3. Cholesterol is more likely to get stuck on our blood vessel walls (endothelial lining) if the walls or the cholesterol particles have been damaged, or the cholesterol is made up of a particular make up (VLDL, LpB, high density LDL, low particle LDL, more on these later) making it more sticky.
4. Excess free radicals, inflammation, and the wrong composition of dietary fats are generally the culprits why this happens, and that is where we see the biggest benefits when addressing them.
5. High blood sugar and insulin directly damage the blood vessel walls, directly increase cholesterol production by upregulating an enzyme (the same one that statins suppress) that is the rate limiting step in the cholesterol production, and indirectly by turning excess carbohydrates into fats for storage.
6. Lowering overall intake of fats and cholesterol in the diet or taking statins which have as their goal to lower total cholesterol, has not been correlated with cardiovascular disease prevention in studies. However, in people that already have signs of cardiovascular disease on testing, or a small minority of people that have a genetic predisposition to high cholesterol despite healthy lifestyles (‘hyperresponders’), temporarily lowering dietary fat intake or statins may be needed and life-saving until the triggers have been corrected.

What are LDL particle size, LDL density, LpA and LpB, HDL cholesterol and why do they matter?

LDL cholesterol is a lipoprotein (a fat and protein complex), that transports cholesterol from the liver to different parts in the body. LDL cholesterol can be large and fluffy, or small and dense. Where we used to believe that all LDL is bad and will stick to our blood vessel walls, we now know that it depends on its size, density, and whether it has been damaged (oxidized). The large and fluffy LDLs appear to not cause much damage, where the small, dense and damaged LDLs do.

It is true that eating saturated fats increases LDL (the ‘bad’ cholesterol). However, saturated fat intake tends to increase the amount of large, fluffy LDL particles, but decrease the amount of smaller, denser LDL particles that are linked to heart disease (S).

Plus, research has demonstrated that certain types of saturated fat may increase heart-protective HDL cholesterol.

In fact, numerous large studies have found no consistent association between saturated fat intake and heart disease, heart attack, or heart-disease-related death.

In Functional Medicine, we are more interested in looking at, and addressing the underlying issue, than to work with drugs that may have other side effects in the long run. Statins for example have been shown to damage mitochondria, the part in our body producing energy, and are crucial for long-term health and anti-ageing, and potentially lower cholesterol that low that the body is having trouble making adequate hormones, cell walls and bile, with a slure of resulting trouble.

What you should test for in your next blood panel:

• Cholesterol, HDL, LDL, triglycerides,
• Inflammatory markers: HsCRP, homocysteine, ferritin
• Glycation and blood sugar balance: HbA1c and fasting insulin
• Fatty acid profile including omega 3 index
• Optional: Salivary cortisol profile (4 measurements in one day)

If your LDL is elevated, you may also want to check for: oxidized LDL, LDL particle size and number

Other markers that tell you how happy your heart is at the moment, but not much about the underlying causes- you can test these at home with simple self test kits:

• Heart Rate Variability (such as with an Oura Ring)
• Resting Heart Rate (such as with an Oura Ring)
• Blood Pressure

Simple tricks to support your cardiovascular health, starting today

• Intermittent fasting and intermittent ketosis
• Low glycemic index (GI) diet
• Whole foods Mediterranean style diet rich in heart healthy plant nutrients such as sterols and anthocyanins, fiber, anti-inflammatory and cardioprotective omega 3s and low in inflammatory and oxidized fats
• Look after your gut- kill off any bad guys that may be in there (for example with Biocidin, a potent anti-microbial that has been shown to destroy the biofilm that protects many pathogenic bacteria and yeasts in the body), and repopulate it with good guys, then look after the good guys by eating lots of plant foods (prebiotics!)
• Stress reduction and vagus nerve stimulation
• Sleep
• Exercise
• Saunas
• Check for heavy metals and remove where need be
• Nitric oxide rich foods like beets

Let me know if you found this to be helpful in the comments below!