[00:00] If you ask 100 people what causes heart disease,&nbsp; the number one answer will be high cholesterol.&nbsp;&nbsp; The problem with that idea is that although it&nbsp; contains a nugget of truth, for many people,&nbsp;&nbsp;
[00:12] it's deeply misleading. Because when we obsess&nbsp; over cholesterol level, we risk missing the real&nbsp;&nbsp; cause of heart disease and the consequence can be&nbsp; lethal. So today we're talking about the real root&nbsp;&nbsp;
[00:25] cause of heart disease and how once you understand&nbsp; it, you can not only prevent the condition but&nbsp;&nbsp; even to some extent reverse it if you already have&nbsp; it. First, where does this idea of the cholesterol&nbsp;&nbsp;
[00:38] come from? Well, the main type of heart disease&nbsp; involves plaque in the artery walls and the&nbsp;&nbsp; primary component of plaque is cholesterol. There&nbsp; is no plaque without cholesterol in the artery&nbsp;&nbsp;
[00:51] wall. So that part is true. Also, in populations&nbsp; with higher cholesterol level, we see more heart&nbsp;&nbsp; disease. So that's also true. But many people have&nbsp; high cholesterol and don't have heart disease and&nbsp;&nbsp;
[01:03] many have heart disease with normal cholesterol.&nbsp; So how's that possible? Well, what almost never&nbsp;&nbsp; gets explained is how the cholesterol ends up&nbsp; inside the artery wall. Cholesterol is carried&nbsp;&nbsp;
[01:15] by microscopic vehicles that float around in&nbsp; our bloodstream. And it's those vehicles that&nbsp;&nbsp; carry it across the artery wall. When we have too&nbsp; many of these vehicles in circulation, they cross&nbsp;&nbsp;
[01:28] into the artery wall more often. They get stuck in&nbsp; there and plaque grows even if cholesterol level&nbsp;&nbsp; is completely normal. So you see how the tunnel&nbsp; vision on the level of cholesterol can be fatal&nbsp;&nbsp;
[01:40] because it misses this key distinction and this&nbsp; mismatch with the actual number of vehicles. And&nbsp;&nbsp; this mismatch where the cholesterol level is&nbsp; normal but the number of vehicles is high is&nbsp;&nbsp;
[01:52] incredibly common. We're not splitting hairs&nbsp; here. In some populations we see it in 70 to&nbsp;&nbsp; 75% of people. What causes this problem is our&nbsp; diet. Refined grains, purified added sugars,&nbsp;&nbsp;
[02:06] soda, alcohol, junk food. These products cause&nbsp; insulin resistance and type 2 diabetes. And they&nbsp;&nbsp; cause the number of some of these vehicles, the&nbsp; largest kind, we call them remnants, to go up,&nbsp;&nbsp;
[02:21] even if cholesterol level stays completely normal.&nbsp; One randomized control trial had people limit&nbsp;&nbsp; commercial bakery products and sweets and pastries&nbsp; to once a week maximum and also favor whole grains&nbsp;&nbsp;
[02:36] like steel cut oats or wild rice over refined&nbsp; grains. and also have fresh unprocessed fruits&nbsp;&nbsp; and vegetables daily. Over time, they saw a&nbsp; reduction in the thickness of the artery wall&nbsp;&nbsp;
[02:50] and the thickness of the plaque itself. This is a&nbsp; very striking result because we normally don't see&nbsp;&nbsp; this in Westerners unless they're on very powerful&nbsp; medication. But it turns out we can actually turn&nbsp;&nbsp;
[03:02] back the clock. We can reverse the problem to&nbsp; some extent by changing our diet. This is such&nbsp;&nbsp; a powerful concept and yet a lot of doctors still&nbsp; don't realize this is possible. I wasn't taught&nbsp;&nbsp;
[03:14] this in medical school. These large vehicles, the&nbsp; remnants, carry some cholesterol, but what they&nbsp;&nbsp; carry a lot of is triglycerides. So that's the&nbsp; typical presentation in type 2 diabetes, obesity,&nbsp;&nbsp;
[03:27] insulin resistance. Cholesterol isn't that high.&nbsp; It can even be perfectly in the normal range,&nbsp;&nbsp; but triglycerides are high and HDL is usually low&nbsp; because these vehicles will swap different types&nbsp;&nbsp;
[03:42] of fats between them. So high triglycerides&nbsp; usually go hand in hand with low HDL. And&nbsp;&nbsp; those individuals are at high risk of heart&nbsp; disease even though triglycerides don't form&nbsp;&nbsp;
[03:54] plaque because our body is very good at&nbsp; breaking them down and removing them from&nbsp;&nbsp; the artery wall. The high triglycerides are&nbsp; a red flag. They're an indicator. They point&nbsp;&nbsp; the finger that there are too many of these&nbsp; large vehicles that cause heart disease. Now,&nbsp;&nbsp;
[04:11] some people have no diabetes. They're lean.&nbsp; They have normal triglycerides, normal HDL,&nbsp;&nbsp; but they still have heart disease because you can&nbsp; have a normal number of these large vehicles, but&nbsp;&nbsp;
[04:23] there are many other sizes in circulation as well.&nbsp; And any of those are problematic if there's too&nbsp;&nbsp; many of them. You can think of the large vehicles&nbsp; as buses on the road and the smaller vehicles as&nbsp;&nbsp; maybe Ubers on the road. And too many of either&nbsp; kind will cause a traffic jam. These other sizes&nbsp;&nbsp;
[04:40] of vehicles are also determined by our diet,&nbsp; mainly by the types of fats that we eat. Healthy&nbsp;&nbsp; fats like extra virgin olive oil and other liquid&nbsp; vegetable oils, avocados, walnuts and almonds,&nbsp;&nbsp;
[04:56] different seeds like chia seeds or sesame seeds&nbsp; and some fermented dairy like unsweetened Greek&nbsp;&nbsp; yogurt and fatty fish. The types of fats in these&nbsp; foods help maintain these vehicles in the normal&nbsp;&nbsp;
[05:10] range. In a randomized control trial conducted&nbsp; in France, people who had suffered a heart attack&nbsp;&nbsp; previously were given a diet where the main types&nbsp; of fat in the western diet were replaced with&nbsp;&nbsp;
[05:23] healthy fats like fish and olive oil or canola&nbsp; and their risk of dying of heart disease was cut&nbsp;&nbsp; by more than 70%. Okay, how can we tell how many&nbsp; of these vehicles we have in circulation? There&nbsp;&nbsp;
[05:37] is a blood test that can give you that reading.&nbsp; It's called ApoB. It's a measure of the number&nbsp;&nbsp; of these vehicles that can cause heart disease,&nbsp; but you can also estimate that with a formula&nbsp;&nbsp; without spending any money. It's free and it works&nbsp; pretty well. I'll put it down here. You can pause&nbsp;&nbsp;
[05:53] the video and write that down. We also have an&nbsp; entire video going over that in detail and I'll&nbsp;&nbsp; link that in the description. Now, some people&nbsp; have normal cholesterol, normal triglycerides,&nbsp;&nbsp; and even normal ApoB, and they still have&nbsp; heart disease. So, what's going on there? Well,&nbsp;&nbsp;
[06:10] we need to talk about the nastiest type of these&nbsp; vehicles, a small subcategory called Lp(a). And&nbsp;&nbsp; this is another big piece of the puzzle because&nbsp; one in five people have a high concentration of&nbsp;&nbsp;
[06:25] these vehicles. And it's genetically determined.&nbsp; It runs in families. It runs in my family. And&nbsp;&nbsp; often what we'll see is in a family where people&nbsp; have heart attacks at a young age in their 30s,&nbsp;&nbsp;
[06:38] cholesterol isn't that high. And yet they have&nbsp; these massive heart attacks at a young age and&nbsp;&nbsp; they just drop dead. Often that comes down to&nbsp; high Lp(a). Now, there's nothing currently that&nbsp;&nbsp;
[06:53] brings a high Lp(a) down to the normal range.&nbsp; There are therapies being studied. Right now,&nbsp;&nbsp; what we do is we try to control everything&nbsp; else. All the other types of vehicles we&nbsp;&nbsp; talked about and also some important factors&nbsp; we'll talk about next. Generalized low-grade&nbsp;&nbsp;
[07:12] inflammation is like throwing fuel on a fire.&nbsp; It speeds up heart disease. It's not necessary.&nbsp;&nbsp; You can have heart disease without generalized&nbsp; inflammation, with normal inflammatory markers,&nbsp;&nbsp;
[07:24] many people do, but it makes things a lot&nbsp; worse. Inflammation promotes the transport&nbsp;&nbsp; of the vehicles across the artery wall. People&nbsp; often think that the wall creates cracks and&nbsp;&nbsp;
[07:37] that's how the vehicles get in. And that can&nbsp; happen and that makes things worse, but it's&nbsp;&nbsp; not necessary. Vehicles are transported across an&nbsp; intact, normally functioning artery wall. It's a&nbsp;&nbsp;
[07:49] normal biological phenomenon. Normally that's not&nbsp; a big problem if everything is working well. But&nbsp;&nbsp; if that transport is sped up either because we&nbsp; have an abnormal number of vehicles or because&nbsp;&nbsp; we have this generalized inflammation then&nbsp; it can become an issue, and we can control,&nbsp;&nbsp;
[08:06] we can shut down inflammation very powerfully&nbsp; using our food as well. Foods rich in tocopherols,&nbsp;&nbsp; which neutralize free radicals and help shut&nbsp; down inflammation: chia seeds and almonds and&nbsp;&nbsp;
[08:19] cashews. Potassium is another important player.&nbsp; It helps lower inflammatory markers in the blood.&nbsp;&nbsp; So foods like sweet potatoes and lentils and&nbsp; avocado and spinach and kefir which is a fermented&nbsp;&nbsp;
[08:34] milk with probiotic effects that supports our&nbsp; microbiome and helps shut down inflammation.&nbsp;&nbsp; And catechins which have an anti-inflammatory&nbsp; action as well and are concentrated in matcha&nbsp;&nbsp;
[08:48] tea and cherries and dark chocolate and many kinds&nbsp; of berries. And there's a natural supplement that&nbsp;&nbsp; helps turn down inflammation called propolis. We&nbsp; have a whole video going over that and I'll link&nbsp;&nbsp;
[09:00] that below as well. It's also extremely important&nbsp; to treat underlying inflammatory conditions like&nbsp;&nbsp; inflammatory bowel and some autoimmune conditions.&nbsp; Those diseases put your body in an inflammatory&nbsp;&nbsp;
[09:12] state and they help accelerate heart disease.&nbsp; Okay. Another crucial player is blood pressure&nbsp;&nbsp; because high blood pressure damages the wall of&nbsp; the arteries and accelerates heart disease. Foods&nbsp;&nbsp;
[09:25] that help control blood pressure include leafy&nbsp; greens like Swiss chard and kale. They're very&nbsp;&nbsp; high in magnesium and nitrates which help relax&nbsp; your blood vessel wall. And almonds and Brazil&nbsp;&nbsp;
[09:39] nuts can help bring down blood pressure&nbsp; as well. And legumes like beans, edamame,&nbsp;&nbsp; and beets. A randomized controlled trial used&nbsp; a DASH diet which is aimed at controlling blood&nbsp;&nbsp;
[09:52] pressure. And over time, they saw a reduction&nbsp; in soft plaque, which is the vulnerable type of&nbsp;&nbsp; plaque that bursts and can cause heart attacks and&nbsp; strokes. And in another large randomized trial,&nbsp;&nbsp;
[10:05] switching just 25% of regular salt with potassium&nbsp; salt, which is still salty, but helps bring down&nbsp;&nbsp; blood pressure, effectively reduced strokes and&nbsp; total deaths. Okay, what if you don't have high&nbsp;&nbsp;
[10:21] Lp(a) or generalized inflammation or blood&nbsp; pressure or diabetes? Well, then your risk&nbsp;&nbsp; is much lower. But you can still have heart&nbsp; disease if there are too many of these vehicles&nbsp;&nbsp; in circulation and if your individual genetics&nbsp; allows them to get through the artery wall. This&nbsp;&nbsp;
[10:37] is why we can have two people with the exact same&nbsp; blood work and one is clean as a whistle and the&nbsp;&nbsp; other has massive disease. Genetics is always&nbsp; a factor, just like some smokers never get lung&nbsp;&nbsp; cancer. How can you know if you individually&nbsp; are at risk or not? Well, one tool are imaging&nbsp;&nbsp;
[10:54] techniques like a calcium score or a CT angiogram&nbsp; or a carotid ultrasound. There's one workout that&nbsp;&nbsp; has been shown in scientific studies to&nbsp; help shrink the plaque in the artery wall&nbsp;&nbsp;
[11:07] and we covered that in this previous video right&nbsp; here. So check it out and I'll meet you in there