The Real Cause of Heart Disease and How to Reverse It

[00:00] If you ask 100 people what causes heart disease,  the number one answer will be high cholesterol.   The problem with that idea is that although it  contains a nugget of truth, for many people,  

[00:12] it's deeply misleading. Because when we obsess  over cholesterol level, we risk missing the real   cause of heart disease and the consequence can be  lethal. So today we're talking about the real root  

[00:25] cause of heart disease and how once you understand  it, you can not only prevent the condition but   even to some extent reverse it if you already have  it. First, where does this idea of the cholesterol  

[00:38] come from? Well, the main type of heart disease  involves plaque in the artery walls and the   primary component of plaque is cholesterol. There  is no plaque without cholesterol in the artery  

[00:51] wall. So that part is true. Also, in populations  with higher cholesterol level, we see more heart   disease. So that's also true. But many people have  high cholesterol and don't have heart disease and  

[01:03] many have heart disease with normal cholesterol.  So how's that possible? Well, what almost never   gets explained is how the cholesterol ends up  inside the artery wall. Cholesterol is carried  

[01:15] by microscopic vehicles that float around in  our bloodstream. And it's those vehicles that   carry it across the artery wall. When we have too  many of these vehicles in circulation, they cross  

[01:28] into the artery wall more often. They get stuck in  there and plaque grows even if cholesterol level   is completely normal. So you see how the tunnel  vision on the level of cholesterol can be fatal  

[01:40] because it misses this key distinction and this  mismatch with the actual number of vehicles. And   this mismatch where the cholesterol level is  normal but the number of vehicles is high is  

[01:52] incredibly common. We're not splitting hairs  here. In some populations we see it in 70 to   75% of people. What causes this problem is our  diet. Refined grains, purified added sugars,  

[02:06] soda, alcohol, junk food. These products cause  insulin resistance and type 2 diabetes. And they   cause the number of some of these vehicles, the  largest kind, we call them remnants, to go up,  

[02:21] even if cholesterol level stays completely normal.  One randomized control trial had people limit   commercial bakery products and sweets and pastries  to once a week maximum and also favor whole grains  

[02:36] like steel cut oats or wild rice over refined  grains. and also have fresh unprocessed fruits   and vegetables daily. Over time, they saw a  reduction in the thickness of the artery wall  

[02:50] and the thickness of the plaque itself. This is a  very striking result because we normally don't see   this in Westerners unless they're on very powerful  medication. But it turns out we can actually turn  

[03:02] back the clock. We can reverse the problem to  some extent by changing our diet. This is such   a powerful concept and yet a lot of doctors still  don't realize this is possible. I wasn't taught  

[03:14] this in medical school. These large vehicles, the  remnants, carry some cholesterol, but what they   carry a lot of is triglycerides. So that's the  typical presentation in type 2 diabetes, obesity,  

[03:27] insulin resistance. Cholesterol isn't that high.  It can even be perfectly in the normal range,   but triglycerides are high and HDL is usually low  because these vehicles will swap different types  

[03:42] of fats between them. So high triglycerides  usually go hand in hand with low HDL. And   those individuals are at high risk of heart  disease even though triglycerides don't form  

[03:54] plaque because our body is very good at  breaking them down and removing them from   the artery wall. The high triglycerides are  a red flag. They're an indicator. They point   the finger that there are too many of these  large vehicles that cause heart disease. Now,  

[04:11] some people have no diabetes. They're lean.  They have normal triglycerides, normal HDL,   but they still have heart disease because you can  have a normal number of these large vehicles, but  

[04:23] there are many other sizes in circulation as well.  And any of those are problematic if there's too   many of them. You can think of the large vehicles  as buses on the road and the smaller vehicles as   maybe Ubers on the road. And too many of either  kind will cause a traffic jam. These other sizes  

[04:40] of vehicles are also determined by our diet,  mainly by the types of fats that we eat. Healthy   fats like extra virgin olive oil and other liquid  vegetable oils, avocados, walnuts and almonds,  

[04:56] different seeds like chia seeds or sesame seeds  and some fermented dairy like unsweetened Greek   yogurt and fatty fish. The types of fats in these  foods help maintain these vehicles in the normal  

[05:10] range. In a randomized control trial conducted  in France, people who had suffered a heart attack   previously were given a diet where the main types  of fat in the western diet were replaced with  

[05:23] healthy fats like fish and olive oil or canola  and their risk of dying of heart disease was cut   by more than 70%. Okay, how can we tell how many  of these vehicles we have in circulation? There  

[05:37] is a blood test that can give you that reading.  It's called ApoB. It's a measure of the number   of these vehicles that can cause heart disease,  but you can also estimate that with a formula   without spending any money. It's free and it works  pretty well. I'll put it down here. You can pause  

[05:53] the video and write that down. We also have an  entire video going over that in detail and I'll   link that in the description. Now, some people  have normal cholesterol, normal triglycerides,   and even normal ApoB, and they still have  heart disease. So, what's going on there? Well,  

[06:10] we need to talk about the nastiest type of these  vehicles, a small subcategory called Lp(a). And   this is another big piece of the puzzle because  one in five people have a high concentration of  

[06:25] these vehicles. And it's genetically determined.  It runs in families. It runs in my family. And   often what we'll see is in a family where people  have heart attacks at a young age in their 30s,  

[06:38] cholesterol isn't that high. And yet they have  these massive heart attacks at a young age and   they just drop dead. Often that comes down to  high Lp(a). Now, there's nothing currently that  

[06:53] brings a high Lp(a) down to the normal range.  There are therapies being studied. Right now,   what we do is we try to control everything  else. All the other types of vehicles we   talked about and also some important factors  we'll talk about next. Generalized low-grade  

[07:12] inflammation is like throwing fuel on a fire.  It speeds up heart disease. It's not necessary.   You can have heart disease without generalized  inflammation, with normal inflammatory markers,  

[07:24] many people do, but it makes things a lot  worse. Inflammation promotes the transport   of the vehicles across the artery wall. People  often think that the wall creates cracks and  

[07:37] that's how the vehicles get in. And that can  happen and that makes things worse, but it's   not necessary. Vehicles are transported across an  intact, normally functioning artery wall. It's a  

[07:49] normal biological phenomenon. Normally that's not  a big problem if everything is working well. But   if that transport is sped up either because we  have an abnormal number of vehicles or because   we have this generalized inflammation then  it can become an issue, and we can control,  

[08:06] we can shut down inflammation very powerfully  using our food as well. Foods rich in tocopherols,   which neutralize free radicals and help shut  down inflammation: chia seeds and almonds and  

[08:19] cashews. Potassium is another important player.  It helps lower inflammatory markers in the blood.   So foods like sweet potatoes and lentils and  avocado and spinach and kefir which is a fermented  

[08:34] milk with probiotic effects that supports our  microbiome and helps shut down inflammation.   And catechins which have an anti-inflammatory  action as well and are concentrated in matcha  

[08:48] tea and cherries and dark chocolate and many kinds  of berries. And there's a natural supplement that   helps turn down inflammation called propolis. We  have a whole video going over that and I'll link  

[09:00] that below as well. It's also extremely important  to treat underlying inflammatory conditions like   inflammatory bowel and some autoimmune conditions.  Those diseases put your body in an inflammatory  

[09:12] state and they help accelerate heart disease.  Okay. Another crucial player is blood pressure   because high blood pressure damages the wall of  the arteries and accelerates heart disease. Foods  

[09:25] that help control blood pressure include leafy  greens like Swiss chard and kale. They're very   high in magnesium and nitrates which help relax  your blood vessel wall. And almonds and Brazil  

[09:39] nuts can help bring down blood pressure  as well. And legumes like beans, edamame,   and beets. A randomized controlled trial used  a DASH diet which is aimed at controlling blood  

[09:52] pressure. And over time, they saw a reduction  in soft plaque, which is the vulnerable type of   plaque that bursts and can cause heart attacks and  strokes. And in another large randomized trial,  

[10:05] switching just 25% of regular salt with potassium  salt, which is still salty, but helps bring down   blood pressure, effectively reduced strokes and  total deaths. Okay, what if you don't have high  

[10:21] Lp(a) or generalized inflammation or blood  pressure or diabetes? Well, then your risk   is much lower. But you can still have heart  disease if there are too many of these vehicles   in circulation and if your individual genetics  allows them to get through the artery wall. This  

[10:37] is why we can have two people with the exact same  blood work and one is clean as a whistle and the   other has massive disease. Genetics is always  a factor, just like some smokers never get lung   cancer. How can you know if you individually  are at risk or not? Well, one tool are imaging  

[10:54] techniques like a calcium score or a CT angiogram  or a carotid ultrasound. There's one workout that   has been shown in scientific studies to  help shrink the plaque in the artery wall  

[11:07] and we covered that in this previous video right  here. So check it out and I'll meet you in there