Heart Disease- Gut

The gut appears to be the root of many problems, including heart disease. This may be a result of increased bacteria and their toxins crossing the gut and affecting heart function.

Unfortunately...
"In recent research, the gut has received very little attention from cardiologists as its role in the pathogenesis of cardiovascular disease is poorly understood." Eur Heart J 2005 Nov;26(22):2368-74. Epub 2005 Jun 24.

However, we are beginning to understand that when you have a leaky gut, you experience ...

"chronic inflammation and malnutrition....therefore, future studies need to address the pathophysiology of the intestinal barrier whose reactivity seems to be crucial for heart function." Curr Opin Clin Nutr Metabl Care 2008 Sep;11(5):632-9.

While leaky guts may adversely affect heart health, the bacteria that live in the gut also play a role. Microbiota that normally reside in our gut have profound implications on many aspects of human health; the heart is no exception.

"Understanding these microbial activities is central to determining the role of different dietary components in preventing or beneficially impacting on the impaired lipid metabolism and vascular dysfunction that typifies coronary heart disease and type II diabetes."
Curr Med Chem 2006;13(25):3005-21.

An important point to make here is that people who have problems with their gut often have absolutely no gut symptoms! Common extraintestinal manifestations include,

"symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level." European Journal of Surgery Volume 164, Supplement 583, 31 December 1998 , pp. 29-31(3)

If you have heart disease, be sure to ask your doctor about underlying gut dysfunction that may be making your heart condition even worse.

Heart Disease- Testosterone

The hormones in our body play a significant role in heart health. Boston University researchers say, "the evolving role of androgens in metabolic syndrome and cardiovascular disease is of paramount importance."

Testosterone, the most famous androgen, has a protective effect on the heart (at least in men). Atherosclerosis tends to increase as testosterone levels drop. Low testosterone was once considered to be relatively rare phenomenon since men don't have the dramatic fall in sex hormones that women experience during menopause. But we now understand that low testosterone levels are "frequently unrecognized but also common." Int J Clin Pract 2007 Feb;61(2):341-4.

This doesn't meant that older men should run out and begin testosterone replacement therapy. In fact, the use of testosterone therapy is still a matter of large debate because of mixed findings in clinical studies. A better method may be to identify the reason for the drop in testosterone. These previous entries in this blog identify some reasons for loss of testosterone.

A large part of the problem is insulin resistance and poor blood sugar regulation. Insulin resistance will drive down testosterone levels in men. The result? A relatively unprotected heart.

If you have heart disease, has your doctor talked to you about your testosterone levels?

$147 billion per year

$147 billion per year. That's how much we spend on obesity each year. A new report released today found that nearly 10% of our health care dollars go toward direct care of obesity related diseases. Obese people spend $600 more per year on prescription medications compared to normal weight individuals. Medicare expenditures are $1700 for obese individuals compared to normal weight individuals. Drug costs alone are $1400 higher for obese Medicare patients. Keep in mind that this does not include overweight... just obesity.

We're currently in a political climate where health care is a primary issue. I know we want drug companies to lower costs... insurance companies to care less about money and more about their clients. We talk about greed, bureaucracies, regulating insurers etc. But let's change the conversation from how we've been hurt to how we can help. Let's take ownership over our own health. There are costs that our lifestyle decisions collectively put on the health care system.

Let's put a new spin on 'political activism' and get physically active to do our part at chipping away at this health care crisis.

Heart Disease- CoQ10

It is well known that while statins block the production of cholesterol, they also block the body's own production of Coenzyme Q10, an important player in energy production. As recently as 2007, some doctors argued that although that may occur, it's really not a big deal. This illogical reasoning was balanced by rational voices that raised concern and pointed to the possibility of CoQ10 deficiencies causing muscle pain. If you dig deep into this issue, you'll find that 2 sides are shouting at the other...

"Statins cause muscle pain!"
"No- they don't!"
"Yes they do!"
"No they don't!"

Folks- whether or not it directly causes muscle pain is not the issue. The issue is that CoQ10 levels go down. This is bad. CoQ10 levels are associated with:

1. Parkinson's disease Neurosci Ltrs 2008 Dec 5;447(1):17-9. Epub 2008 Sep 30
2. Cerebellar ataxia Cerebellum 2007;6(2):118-22.
3. Diabetes Nutrition Research 2008 Feb;28(2):113-21.
4. Breast, Lung, Pancreatic, Skin Cancers J. Amer Acad of Derm 2006 Feb;54(2):234-41.
5. Allergies Allergy 2002 Sep;57(9):811-4.

... and many more problems. Perhaps you don't experience muscle pain while on your statin. For this reason, many physicians are unwilling to say you should be on CoQ10. Muscle pain is a "red herring." There are bigger problems with statins as listed above.

But specifically for the heart....how important is CoQ10? A 2008 study showed that in patients who already had heart disease, it was an independent predictor of mortality. In other words, the less CoQ10 you have, the more likely you are to die.

If you are on a statin, you should be taking Coenzyme Q10.

Heart Disease- Old School

In the old days, the biggest predictor of heart disease was elevated cholesterol levels. The standard of care was to do everything possible to lower cholesterol levels. At times, lifestyle and dietary changes were recommended but the emergence of statin drugs made the task so much easier. Statins (like Lipitor, Crestor, Zocor) generally do an excellent job of lowering cholesterol levels.

Then, data emerged that nearly 50% of people who have heart disease actually have normal levels of cholesterol. It appears that inflammation may play a more important role in promoting heart disease; regardless of cholesterol levels. Regretfully, rather than thoroughly re-examining our understanding of heart disease and seeking imaginative solutions for it, we simply found new rationale to keep doing what we've been doing. More statins, more statins and more statins.... because not only do statins reduce cholesterol, they also reduce inflammation!

Let me quote something from a WebMD article referencing a 2008 New England Journal of Medicine article (I generally like WebMD... but this was just a little too crazy).

" Millions of Americans take statins to lower their cholesterol, but dramatic findings from a study of the statin drug Crestor suggest that millions more might benefit from treatment...The study was funded by Astra-Zeneca, which makes Crestor."

Is it just me or does that sound like a line from a low budget infomercial? It goes on...

"This study was designed to identify new groups of patients who could benefit from statin therapy, and it did that," Mayo Clinic cardiologist and American Heart Association past-president Raymond Gibbons, MD, tells WebMD"

Imagine that! A study paid for by the makers of Crestor, deliberately designed to see if more people should take Crestor, finds that more people need to take Crestor.

Yes- this kind of science has a certain stink about it. But just because it smells a little bit doesn't meant that there isn't some truth hidden in the pile of money-driven, self-serving hogwash. In the coming series on heart disease, we'll dissect heart disease and show ways for you to think about it. There is more to it than statins.

Like most chronic diseases, it is incredibly complex. Multiple variables that influence the pathogenesis and progression have been identified. I hope that when you're through with the series, you'll feel empowered and equipped to open up meaningful lines of dialogue with your doctor.

Vitamin D and Heart Disease

The number 1 killer in the United States is still heart disease. The cholesterol model for heart disease has shown some cracks in its logic, we need to turn our attention in other directions. While heart disease is certain to have many causes, one simple thing we can do is make sure we have adequate vitamin D levels. This article shows how valuable vitamin D research is in advancing the clinical management of heart disease.

In the near future, I'll do a series on heart disease and dissect the problem beyond cholesterol and conventional management of this killer.

Undiagnosed Celiac Disease

A new study published in the July 2009 edition of Gastroenterology found that young people today are 4.5 times more likely to have celiac disease than young people 50 years ago. Another alarming fact is that people with undiagnosed celiac disease have a 4 fold increase of death than in patients without celiac disease.

One of the study authors comments, "Celiac disease has become much more common in the last 50 years, and we don't know why."

He goes on to state, "This study suggests that we may need to consider looking for celiac disease in the general population, more like we do in testing for cholesterol or blood pressure."

Immune responses to gluten are not uncommon. Get checked.

Vitamin D Deficiency

Vitamin D has been all over the news lately. Vitamin D deficiency was once considered to be a rare occurrence. But recent research has shown that many of us are actually deficient in this important nutrient (it's actually a hormone for you nutritional purists).

A 2009 study found that 75% of Americans were deficient in vitamin D. This is a frightening statistic! Low vitamin D levels are associated with everything from autoimmune disorders, neurodegenerative problems, heart disease, chronic pain and some cancers. Another recent study showed that vitamin D levels are inversely related to progression of multiple sclerosis.

As usual, let's exercise a bit of common sense as we interpret these findings. This does not mean that low vitamin D causes these problems. But it is clearly an identifiable risk factor. Most (if not all) diseases are multifactorial. In other words, there are usually multiple variables that interact and cause disease. For example, what causes heart disease... a bad diet or lack of exercise? The answer is; both. Each are risk factors that cooperate to kill your heart. The more effectively we can reduce these risk factors, the better off we'll be.

Please talk to your doctor about your vitamin D levels. Now that we're in the middle of summer, it's the best time to 'stock up' on vitamin D. Get out in the sun (exercising caution in preventing burns) to load up on vitamin D.