CORONARY HEART DISEASE: THE REAL CAUSE

Whenever someone speaks of coronary heart disease (CHD) people think of cholesterol. In the past decade or so people have become more conscious of the so called evils of cholesterol and even though on an average people’s cholesterol levels are declining thanks to the consumption of billions of dollars of statin drugs, the rate of heart disease is still on the rise.  Baffling isn’t it? Also half the number of people that die of a heart attack have either normal or low cholesterol. Again baffling? Studies all across the globe of dietary habits of the Italian (predominant cheese eaters), French (cheese and organ meat eaters) and most tribes in Africa (beef eaters) haven’t been able to correlate the intake of dietary cholesterol with the incidence of heart disease. Baffled again?  The consumption of saturated animal fats since WW II has fallen steadily, thanks to the low fat crusade and yet the rates of CHD have risen dramatically. Baffled yet again? So obviously something is wrong with the hypothesis (yes it’s only a hypothesis because it’s never been conclusively proven to any statistical significance) that saturated fat or cholesterol cause CHD. So what does cause CHD? What causes the plaque formation in the arteries if cholesterol isn’t the cause?

To understand this we’ll have to dig deeper into the mechanism of plaque formation. While cholesterol does deposit on the artery walls to form plaque, the mechanism and the reason behind it is a bit more complex. Just the simplistic assumption that high cholesterol in one’s blood leads to more plaque formation and vice versa is not true. The blood vessels are constantly bombarded by free radicals and other oxidizing agents in the blood. This causes inflammation in the micro capillaries that if not controlled would cause a micro pore or a lesion in the wall. This will cause blood to leak out of the artery if the lesion opens up. When a lesion like this forms on the artery wall the role of protein is to repair and regenerate the wall so the leak can be plugged, but in the case of diabetics and people that eat too many simple carbs, the excess blood glucose floating around binds to protein and doesn’t let it do its job of repairing the lesion. The body’s next line of defense is to deposit some cholesterol on the lesion as a stopgap or band-aid. But it doesn’t stop here since the integrity of the capillary is compromised at that location, the next free radical attack happens preferentially at the same site over and over again. Even though I have simplistically described this process in discrete steps, it happens continuously in our blood vessels, 24/7. Over a period of several years this little inflammation band-aid plug grows and grows until it forms hardened plaque that eventually ruptures and causes a complete clog and stroke.

So we can see that the real reason for the formation of this plaque is not cholesterol but the inflammation that is happening in our arteries and our body’s inefficiency to repair it. So in essence cholesterol is just a symptom of an underlying problem and not the problem in itself. To give an analogy it would be silly to label a certain part of the town, which has a lot of police on patrol, as bad and as an area of high crime rate. The police are not the cause of the high crime rate but rather a result of the high crime rate in that area. Similarly the presence of cholesterol as plaque is not the cause of the hardening of arteries but rather the result of inflammation in the arteries. So as long as you have inflammation in your arteries you will form a plaque no matter what your cholesterol levels are. This explains the other half of the puzzle with people dying of heart attack in spite of their normal or low cholesterol levels.

In order to address the problem of plaque formation one needs to address the root cause of inflammation.  Inflammation is caused by free radicals and oxidative agents in our blood and if we can reduce the intake and formation of these free radicals then we would prevent the inflammation in the first place. Some of the obvious things that cause inflammation are most synthetic food agents, trans-fats, food fried in vegetable oils (frying in saturated fat or coconut oil is best). Also people that are diabetic and people on a high GI carb diet are pro-inflammatory as their protein repair mechanisms are impaired. Also people with stress have been shown to have higher levels of inflammation in their bodies. Smoking is another high risk practice that constricts and hardens blood vessels and increases the likelihood of plaque formation.

So my advice is to consume plenty of anti oxidants to counteract the free radicals. Fruits are high in anti-oxidant content but be careful to watch out the GI of some of the fruits like pineapples that are also high in sugar. Also the omega-3 fatty acid found in fish and olive oil is a strong inflammation antagonist. So have plenty of it. Mono-unsaturated fat found in nuts and certain vegetables like avocados are also anti inflammatory. And lastly stay away from deep fried things that are fried in vegetable shortening, margarine or even plain vegetable oils as they either have free radicals in them or release free radicals at temperatures required for frying. If you have to fry something, try butter, ghee or coconut oil as saturated fats are stable at high temperatures and don’t oxidize. And lastly remember to keep your weight under control by eating small frequent meals of low GI foods. This way you can keep your sugar levels and hence insulin levels in check and that way you will ensure that any inflammation in the body is repaired with proteins. This way you will avoid developing type II diabetes which the research community is fast finding out to be the real cause of heart disease. A high carb low fat diet with a stressful lifestyle is a surefire way to develop CHD even if you never go near saturated fat and have record low cholesterol levels. Keep in mind though that if your cholesterol levels are rising from year to year then it’s a symptom of some underlying inflammation in your body. Doctors are now looking for markers of inflammation in the blood like C-reactive protein (CRP) that is a better predictor for the risk of CHD than cholesterol. So be sure to ask your doctor to check your CRP levels the next time you have blood work done. And lastly to all my smoking friends out there, please stop smoking ASAP if you love your friends and family.