Cardiovascular Risk and Pathology

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Essential factors in restoration of cardiovascular membranes include the balance of essential fatty acids in the diet, restoration of healthy fatty acid metabolism, and restoration of the diurnal clock with healthy dietary habits

Essential fatty acid balance may be the most important part of this complex equation of cardiovascular health. Two essential fatty acids (EFAs) were first discovered in 1923, and designated Vitamin F, alpha-linolenic acid (ALA), now called an omega-3, and linoleic acid, now called an omega-6. Later, conditionally essential fatty acids ( were discovered, including gamma-linolenic acid (GLA), an omega-6, lauric acid (saturated), and palmitoleic acid (monounsaturated). The term conditionally essential refers to the fact that these fatty acids may become essential under certain developmental, metabolic, or disease process, and require dietary intake. These short-chain essential fatty acids were found essential to creating important long-chain polyunsaturated fatty acids (LC-PUFAs), including the fish oil omega-3 FAs EPA and DHA, as well as the important omega-6 EFAs arachidonic acid (excessive in the meat centered diet), GLA (gamma-linolenic acid), and DGLA. Omega-9 fatty acids are sometimes mentioned, but are not essential in the diet, as they are easily formed from carbohydrates and other fatty acids. Contrary to popular belief, it is not just the omega-3 fatty acids in fish oil that we need to maintain healthy biological processes, but rather a balance in the body (homeostasis) between our essential omega-3 and omega-6 fatty acids. The main functions served in our bodies from this balance are the balance of DNA expression of immune cytokines that regulate inflammatory processes, the forming of lipid rafts that regulate cell membrane signaling, and the creation of important molecules, such as eicosanoids (modulating inflammatory processes and cell functions), lipoxins (from omega-6) and resolvins (from omega-3) (downregulating inflammation in the presence of aspirin), endocannabinoids (affecting mood, behavior and inflammation), and the often ignored isofurans, neurofurans, isoprostanes, hepoxilins, epoxyeicosatrienoic acids, and Neuroprotectin D (many essential neuroprotective effects). Obviously, the term omega-3 does not refer to one substance, and the term omega-6 does not refer to a single entity, and the problem is not just a deficiency of a single thing called omega-3. It is also obvious that a balance of essential fatty acids, or dietary omega-3 and omega-6 types provides an array of important health benefits, providing important cardioprotective effects, as well as a host of other benefits to various systems.

While fish oil and omega-3 fatty acid dominate the talk in health reporting and published research, much research now points to the importance of plant-based fatty acids, and shows that plant-based omega-3, predominantly alpha linoleic acid (ALA) from nut and seed oils and other plants, algaes, and fruits are at least as beneficial. The debate over fatty acids started with the imbalance created by the "typical American diet", meaning a diet dominated by red meat, simple carbohydrates, and fast food. In this typical American diet, an excess of omega-6 arachidonic acid creates an imbalance of this type of omega-6 over the omega-3 fatty acids that is alarming, estimated at 10-30 times the amount of omega-6 over omega-3, thus fish oil, rich in omega-3 was heavily promoted. But now most Americans are reducing the red meat and simple carbohydrate intake in the diet, and this type of imbalance of excess arachidonic acid, which promotes chronic pro-inflammatory imbalance, is disappearing. What is unfortunate is that this one-size-fits-all reporting has led many health conscious individuals, who do not eat the "typical American diet" to load up on omega-3 fish oil. This does not help the end goal of the balance between omega-6 and omega-3 fatty acids. Plant-based oils and fats are most important in the equation.

A 2005 study by the Hormone Research Laboratory, in Milan, Italy (link below in additional information) found that a plant-based diet rich in plant-based omega-3 fatty acids significantly improved the fatty acid balance, increasing the omega-3 in the body by over 20 percent, and not affecting the omega-6, resulting in a balanced fatty acid profile, and a decrease in reactive oxygen metabolites (oxidants) of 6 percent. This was a dramatic improvement in health and oxidative stress, seen in just 18 weeks of improved dietary habits, that would translate into very significant reduction in cardiovascular risk, and overall health, especially hormone quality and health, and neurological health. To achieve this goal, one can get most of these healthy types of omega-6 EFAs from plant food and oils, and supplement when needed, in times of increased stress or disease, with supplements such as CLA from black currant seed oil, as well as Chinese herbs rich in these omega-3 EFAs. Grass-fed animal meats, eggs from healthy chickens fed plant sources of conjugated linoleic acid, raw milk and butter from grass-fed cows, wild mushrooms, pomegranate, and various unprocessed plant oils. Other Omega-6 healthy EFAs ar obtained from most cold-pressed plant oils, many fresh seeds and nuts. Sesame, sunflower, soy, and olive, as well as avocado are rich sources. Meats contain an omega-6 EFA called arachidonic acid that has created an unhealthy imbalance, and so eating foods rich in Omega-3 EPA and DHA, as well as healthy Omega-3 EFAs is important, and when one is a vegetarian, consuming walnut oil and flaxseed helps with Omega-3, and the above sources with the healthy Omega-6. Supplements and herbs help when needed, and the body is programmed to absorb and maintain a balance if supplied the right essential EFAs. Imbalance mainly occurs when an unhealthy diet or increased stress and disease occurs. Cofactors important in fatty acid conversion and balance include Vitamins B6 and B3 (P5P and niacinamide), as well as magnesium and zinc monomethionine. A lack of dietary sources of Omega-6 and excess consumption of Omega-3 can lead to a poor ratio of 6 to 3 (less than 1:2) and in some individuals could cause deficient conversion and Omega-6 relative deficiency, characterized by skin problems, dry eyes, dry hair and nails, poor wound healing and susceptibility to infection. There is no one-size-fits-all balance of Omega-6 and Omega-3 in the diet, but studies have indicated that a dietary ratio of between 1:4 and 1:1 is needed. One example of advice, from a Registered Dietician in 2010, is available by clicking here: http://www.todaysdietitian.com/newarchives/020810p22.shtml .

In addition to the intelligent analysis of essential fatty acid balance in your body, the metabolism of fatty acid synthesis is also an important consideration. Simply taking a fish oil supplement does not address the whole issue of this important homeostatic balance in the body. Important cofactors in the metabolism of essential and conditionally essential fatty acids include Vitamin B5 Pantothenic acid, Vitamin C citric acid, N-acetyl cysteine, and biotin. The ATP cofactors, Vitamins B2 and B3, or riboflavin and inositol hexacotinate, may also be needed in a sluggish metabolism. By restoring fatty acid balance with a more complete protocol, the need for continued supplement is reduced or eliminated, and chronic dependency on these supplements is not needed. Simply taking a multivitamin every day for years, a common practice, does not achieve these goals, and may be a waster of money. Of course, incorporating healthy fats and oils into the diet is an essential ingredient for maintenance of the fatty acid metabolism, and intelligent adoption of healthy diet and lifestyle habits is the most important consideration in a program of prevention of cardiovascular risk and disease death. Intelligent decisions in diet, simple lifestyle changes, and utilization of Complementary Medicine in the form of acupuncture and herbal medicine, provide a comprehensive base for this sensible preventive protocol.

Besides the adoption of healthy fats, a plant-based diet, and the consumption of plant-based phytosterols and stanols, research has also confirmed the importance of resetting the diurnal clock to improve metabolic function and health maintenance. In the 1960s, an important pioneering public health study conducted in Alameda county, California, in the greater San Francisco Bay Area, was published, and showed that 7 simple diet and lifestyle habits were highly associated with physical health and longevity. The pioneering young woman who presented this research, Charlotte A. Schoenborn, certainly didn't become famous, but her 7 habits, which became known as the Alameda 7, have been revisited time and again over the subsequent decades in public health, and have been the subject of important research in the last few years demonstrating that adopting a diet and lifestyle that adheres to Nature, and follows a few sensible rules, a longstanding concept in Traditional Chinese Medicine, and Daoist science, is most important. These 7 simple habits, eating a healthy breakfast, sleeping 7-8 hours a night, avoiding snacks, maintaining a desirable weight for the individual, exercising daily or regularly, never drinking more than 5 drinks in a setting, and not smoking cigarettes, are very simple, and were highly associated with decreased cardiovascular risk and death.

In essence, the Alameda 7 could be the most important factors in the reduction of cardiovascular disease and death from its peak in the United States, a phenomenon that occurred from 1965 to 1995. Charlotte A. Schoenborn MPH continues to publish research in public health today, working for the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), and in 2012 reported that her current studies show that even in 2012, less than half of adult patients in the United States do not receive such simple advice, such as regular participation in exercise and other physical activity as an important preventive therapy, by U.S. Medical Doctors (PMID: 22617014). In 2013, Eric Rimm, of the Harvard School of Public Health, published a new study that clearly demonstrated that eating a healthy breakfast significantly reduced the risk of heart attack, and that skipping breakfast increased the risk of heart attack and death by 27 percent. This 16-year study involved 27,000 men, and factored out all other contributors to risk. Breaking the nightly fast at sunrise resets the natural diurnal mechanism of metabolic regulation, and without this diurnal reset, adverse metabolic effects occur that lead to strain on the heart, poor inflammatory control, insulin insensitivity, and hormonal dysregulation. Of course, eating a healthy breakfast is most important, and starting the day with complex carbohydrates, healthy fats, and a predominantly plant-based diet, such as a variety of whole grains in porridge, corn grits and eggs, etc., instead of processed carbohydrates, sugars, and fatty meats, or the typical American breakfast, is especially important. Adopting the Alameda 7, with restful sleep, a healthy breakfast, avoidance of snacks, performing a little daily exercise, maintaining a healthy weight, and avoiding heavy drinking and smoking, may be the most important considerations in cardiovascular health, and should be the basis for further proven habits and healthcare routines. Ignoring these diet and lifestyle habits and simply depending on cholesterol lowering drugs and inhibitors of blood pressure to prevent cardiovascular disease and death is the ticket for failure.

Cardiovascular maintenance, not cholesterol level, is the key factor in assessing cardiovascular risk

While high cholesterol has some oblique association with atherosclerotic plaque, we now know that it is certainly not responsible for the buildup of arterial plaques. High cholesterol itself produces no symptoms, and is not a disease mechanism. There is an association between persons with a high total cholesterol in circulation and cardiovascular disease, but many experts question whether this association points to a shared underlying disease mechanism rather than high cholesterol as a cause of cardiovascular disease. Low cholesterol, on the other hand, may be a disease mechanism. Children born with a genetic defect that prevents adequate mevalonic acid metabolism and results in low cholesterol, have many related health problems, including mental handicaps, poor growth, anemia, acidosis, immune problems, and cataracts.

Cholesterol is the most abundant steroid hormone in our bodies. Cholesterol, as a steroid hormone, plays many important roles in the body, including maintenance of brain function. Besides being a precursor to the sexual steroid hormones, cholesterol is also a precursor to all of the adrenal glucocorticoid hormones, which include cortisol, and important mediator of stress and inflammation, as well as a precursor to Vitamin D3, cholecalciferol, the prohormone precursor to the Vitamin D3 hormone that so many people are now deficient in. In addition, statin drug inhibition of the mevalonic acid pathway of cholesterol also inhibits the production of prenylated proteins, which include G-proteins, a subject of much research in recent years related to neurodegenerative disease, mood disorders, subclinical hypothyroid conditions, and immune disorders. Finally, an important antioxidant chemical found in all cells, ubiquitone, or Coenzyme Q10, is also inhibited when the mevalonic acid pathway is inhibited by statin drugs. The reasons for a reconsideration of cholesterol lowering as the main, or only, therapy to counter atherosclerosis and cardiovascular disease are mounting. Large groups of medical doctors and researchers around the world are now heavily questioning a cholesterol emphasis in cardiovascular health.

In 2011, researchers at the University of Texas Southwestern Medical School, and the Cooper Institute in Dallas, Texas, released data from long term studies that shows that cardiovascular maintenance, not cholesterol levels, is the key factor in assessing future cardiovascular risk. Two reports, published in the medical journals Circulation and the Journal of the American College of Cardiology, found that the level of aerobic cardiovascular fitness maintained between the ages of 40 and 50, was the greatest indicator of cardiovascular risk. A person in the higher realm of cardiovascular fitness during this phase of life had a 10 percent lifetime risk, while those that fell into the lower realm of cardiovascular fitness had a 30 percent lifetime risk. Those persons in the higher realm of fitness were not always high level athletes, as any man that could run a 8 or 9 minute mile was in the moderate to high level of cardiovascular fitness, and this was mainly maintained by increased walking and stair climbing, and general activity. The recommendations were not to start running miles as fast as you can, the lead researchers stated, which could lead to strain and injury, but to increase the daily aerobic activities, get up from the desk and the couch, use the stairs, walk to work, and start a weekly routine of modest exercise. This may be the reason why populations, such as those mentioned in Spain, had such a lower incidence of cardiovascular disease. In addition to these lifestyle changes, dietary improvements, especially concerning healthier fats, whole grains and beans, and a more plant-based diet, as well as the utilization of health maintenance in the form of herbal and nutrient medicine, acupuncture and physiotherapy, are the keys to a simple but dramatic decrease in overall cardiovascular risk.

So we see from reliable study that modest cardiovascular fitness has a profound effect on cardiovascular risk. In 2013, a study at Duke University Medical Center, Durham, North Carolina, U.S.A., found that statin drugs actually impair the ability of patients with Metabolic Syndrome from gaining the benefits of aerobic exercise. In the first study published that actually investigated whether the chemical effects of statin drugs on muscle health, both muscles of our organs, such as the heart, and of our skeletal muscles, could actually impair muscle fitness, patients with Metabolic Syndrome and/or obesity were randomly assigned to either take a statin or not as they went through a 12 week aerobic fitness program. Scientists measured whether cardiorespiratory fitness and skeletal muscle gains and found that the group taking the statins had most of the benefits of this cardio workout routine nullified (see study link below). This study followed the negative findings of the JUPITER trial of statin benefits at Harvard Medical School, the 2012 findings that statins created fatigue at the University of California San Diego, and a 2012 FDA update on statin warnings that noted that statins actually increased the risk of developing diabetes in patients with Metabolic Syndrome, commonly called a pre-diabetic state. As studies all over the world affirm the amazing benefits of a plant-based healthy diet and modest exercise routine, as well as the significant benefits from researched herbal and nutrient medicines on cardiovascular health and reduced risk of stroke and heart attack, more and more studies are now showing how the standard protocol for treating cardiovascular risk have perhaps been introducing more risks than benefits. Why this information is just now coming out, over 30 years after the wide introduction of statin drugs into the protocol, and just as the patent protections of these drugs expire, is a question of some merit.

While the many potential adverse effects of chronic statin drug use are not dramatic, and occur slowly over time, with chronic use, they still are a large concern for many patients, once these effects are studied. Statin drugs not only affect the pathway of expression of cholesterol in the liver, but exert cellular effects as well. While these peripheral cellular effects have generated interest in statin drugs to treat peripheral diseases, as always, there are two sides to this subject, the good and the bad. Statin drugs have been shown to induce changes in cell shape and actin/myosin cytoskeletal organization in peripheral cells (Song et al, Duke University School of Medicine). While this is touted as a potential treatment for such diseases as glaucoma, the implications for statin drugs affecting musculoskeletal function and cell health imply that the chronic side effects of musculoskeletal pain may be tied to more than just accumulation of protein fragments in tissues. To see a recent analysis of the doubts of benefits of widespread statin prescription, click on this link: http://www.express.co.uk/life-style/health/554503/Warn-patients-dangers-statins-experts. This analysis of benefits versus risks that found little evidence supporting the widespread prescribing of these drugs was presented in 2008 by the conservative Bloomberg News as well: http://www.bloomberg.com/bw/stories/2008-01-16/do-cholesterol-drugs-do-any-good. Of course, research on statins is producing both support for increased use of the drugs as more physiological mechanisms are found, as well as a healthy skepticism of the use or need for the drugs for most patients. In the end, the choice is an individual one that each patient makes.