Ischaemic Heart Disease - what really causes it?

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At the BSEM June 2007 scientific meeting we discussed the issues of what really causes ischaemic heart disease. I have not gone through every lecture in detail, but enclose links for those people interested in pursuing this further.

This page specifically adresses causes of ischaemic heart disease, it does not address the medical management of established cardiovascular disease although some of these issues will be relevant in most sufferers.

Obesity and Carbohydrate Intolerance

Working through this chronologically, the first speaker of interest was Dr Atul Singhal, who is a paediatrician. A major risk factor for arterial disease is obesity. This arises because the fat cell is not just a repository for energy. It plays a whole host of other important functions. It is centrally important in production of hormones. The main problems with being overweight is firstly that subjects become leptin resistant. Leptins are the main way by which appetite is satisfied. This means that the fatter you are, the more hungry you are. The second problem is that being overweight makes one less sensitive to insulin and insulin resistance is, of course, the cause of type II diabetes. The problem with insulin resistance is that one tends to run high blood sugars and (see below - the problems of running high blood sugar), this is a major risk factor for arterial disease. Indeed, it was obvious from the day's lecture that running a high blood sugar is as dangerous to arteries as is smoking.

Dr Singhal demonstrated that a major risk factor for being obese in adult life is weight gain in very early life. The precise window of time when this is the greatest problem has yet to be identified for certain, but it almost certainly occurs within the first six months of life and possibly within the first few days of being born. This has been confirmed in many animal experiments. If there is rapid weight gain early in life, particularly before weaning, there is a greater risk of obesity in adult life. Dr Singhal's advice was that babies should be breast fed and solely breast fed at least until four months, preferrably six months and for as long as possible subsequently.

The problem is that modern baby's growth charts are set far too high. This has arisen from the current vogue for giving infants formula feed. The World Health Organisation has issued a completely new set of infant growth charts, which encourage a much slower rate of growth because we now know this to be highly protective against disease in the future.

High Blood Pressure

Dr Singhal demonstrated that the early lesions of atherosclerosis develop in childhood. These lesions do not develop uniformly throughout arteries, but they occur where there are areas of turbulence of the blood. So, for example, they occur where arteries kink, or where they divide into smaller arterioles. This explains why blood pressure is a factor in the development of arteriosclerosis. Increasing blood pressure increases the turbulence of blood, thereby damaging the arterial wall.

Indeed, there was an interesting hypothesis in The Lancet published by Yudkin who explained how running a high blood sugar can cause high blood pressure. The reason is that running a high blood sugar is damaging to muscles. Each muscle is supplied with blood controlled by a pre-capillary arterial and at the entrance of this arterial is a perivascular cuff of fat. This samples blood sugar levels from second to second and if the blood sugar rises too high, the arterial constricts thereby limiting the blood supply to the muscle. However, this has the effect of increasing the blood pressure.

The flip side of this is of course exercise.

Exercise

Exercise is highly protective against arterial disease because the blood sugar is burnt up, and the blood pressure reduced. Let's face it, if we take the evolutionary perspective, homo-sapiens was physically active constantly. He had to be to secure a food supply.

I suspect there is another important reason why exercise is helpful. If you see below we are all increasingly subjected to toxic stress. The skin is an important route of detoxing and in hot climates sweating helps to get rid of xenobiotic load. However, in cold climates we don't sweat unless we exercise hard. Sweat is a good way of getting rid of toxins. For people who are unable to exercise then I recommend Far Infra red saunaing.

Professor Cordain - The Potential Role of Dietary Lectins in Atherogenesis

Professor Cordain first demonstrated how tribes eating a primitive diet of foods with low glycaemic index, which are rich in fresh vegetables, fruit, nuts, seeds, eggs, meat and fish do not suffer heart disease at all. Indeed, the first professor of cardiology appointed during the 1920s commented that he did not see a myocardial infarction in Great Britain until the 1930s. Professor Cordain's advice was to eat a stoneage diet based on foods that had been minimally processed and ideally organic.

If you look at life from the point of view of a plant, it naturally does not want to be eaten. Many plants contain natural toxins called lectins, which protect them from attack by insects. Indeed, these could be considered to be natural pesticides for the plant. Over thousands of years, man has learned to eat plants which are relatively low in lectins. However, in the last six thousand years, the proportion of our diet coming from grains has increased, but not in parallel to our ability to deal with lectins in grains. Wheat germ has an extremely high level of lectins. In the bloodstream they have a pro-inflammatory effect and may well be implicated in atherogenesis. The main sources of lectins in Western diets are from wheat, pulses, tomato and peanut. It's not that we shouldn't eat these foods at all, but we should eat them in moderation. The problem is that wheat comprises a large proportion of the Western diet, and it is possible that this is one mechanism by which it may cause disease.

Dr Anne Dawnay - The Glycation Hypothesis

Dr Anne Dawnay - Consultant Clinical Scientist, Honorary Senior Lecturer and Examiner for the Royal College of Pathologists - described the process of glycation where sugars stick on to proteins to create advanced glycation end-products (AGEs). The best example of this is glycated haemoglobin, which is used as a measure of blood sugar control in diabetes. AGEs are not just caused by high blood sugar levels. They can also be caused by poor antioxidant status (routine tests for frontline antioxidants are superoxide dismutase, glutathione peroxidase and Co-enzyme Q10). AGEs stimulate their receptors called RAGEs and when activated this causes the development of arteriosclerosis.

One can inhibit the production of AGEs by eating a low sugar diet, by avoiding foods which are cooked at high temperatures and by ensuring good antioxidant status. Again this supports the need to eat a good stoneage diet, which has a low glycaemic index, but is high in natural antioxidants. People who are diabetic die younger than the normal people because these advanced glycation endproducts accelerate the normal aging process. Hence the importance of keeping glycosylated haemoglobins at a low level.

Dr Nicholas Miller - Biochemistry of Ischaemic Heart Disease

Dr Nicholas Miller, Laboratory Director of Biolab Medical Unit, made the point that atherogenesis is only half the story when it comes to ischaemic heart disease. Possibly equally important is the role of mitochondria in the heart. The idea here is that for the heart to work not only must it have a good blood supply of oxygen and fuel, but the mitochondria must be functioning normally in order to convert that oxygen and fuel into energy to power the heart muscle cells. He identified the four major biochemical bottlenecks that occur which impede this process, but which can be improved by taking supplements, namely Co-enzyme Q10, D-ribose, Acetyl L-carnitine and niacinamide.

Dr Uffe Ravnskov, Sweden - The Nonsense about cholesterol and fats

Dr Ravnskov demonstrated that there is no link whatsoever between eating saturated fats and the development of atherosclerosis. He also showed that there was no link whatsoever between eating saturated fats and cholesterol and levels of cholesterol in the blood. He was also highly sceptical about the link between high cholesterol in the blood and arterial disease, although there was some evidence to refute this from Professor Bennett from the Department of Medicine at Addenbrooke's Hospital, Cambridge. The best advice about diet that Dr Ravnskov could come up with and this was universally agreed by the audience was that we should aim to be eating a stoneage diet based on vegetables, nuts, seeds, fruits, pulses, eggs, fish and meat. The problem seems to arise from processed foods. As soon as foods are processed, they are exposed to oxygen and become oxidised and it is this process that produces oxidised fats and hydrogenated fats, which are so dangerous. If fats come from natural unprocessed sources and are free from contaminants such as pesticides, then they can only do good.

Indeed, Ravnskov produced some very interesting data showing how running a high cholesterol is highly protective against infectious diseases. This is particularly pertinent to patients with chronic fatigue syndrome, who may well have symptoms because of chronic low grade undiagnosed infections.

Further information on The International Network of Cholesterol Skeptics

Dr David S Grimes, Consultant Surgeon at Blackburn, Lancaster - Statins and Vitamin D

There is a huge amount of evidence to show that statins do indeed reduce the risk of arterial and cardiovascular disease. However, what was so interesting about Dr Grimes's presentation was that the effect of statins has nothing to do with their ability to lower cholesterol. This appears to be a side effect. David Grimes hypothesised, and this has been published in The Lancet, that statins have their effect because they are vitamin D analogues. He went on to present a whole host of fascinating data about the ability of vitamin D to protect one from getting heart disease. For example, cholesterol levels are consistently higher during the winter months, the further away from the Equator one is, then the higher the risk of arterial disease, cardiovascular mortality is much higher in the winter than the summer and in a study of his own he demonstrated that the risk of cardiovascular death in Blackpool was significantly lower compared to Preston, which is a little further inland, compared to Blackburn where Dr Grimes lives compared to people living in the Peak District. This directly relates to the amount of sunshine and cloud cover in these different areas. His view, therefore, was that we should all be getting daily sunshine and in the absence of that, we should be taking a daily dose of vitamin D. His recommendation was for 1,000 units of cholecalciferol. However, a normal day's summer sunshine should produce roughly 10,000iu of cholecalciferol and the general feeling of the audience was that a daily dose of at least 2,000iu and possibly 5,000iu of vitamin D was most desirable.

Professor Gerard Stansby, Newcastle upon Tyne - Homocysteine in the Heart

Again, there are a whole host of studies which clearly show that running a high homocysteine is a major risk factor for arterial disease. Homocysteine is a sulphur containing peptide which is normally metabolised as a result of enzymes dependent on vitamin B12, folic acid and vitamin B6. There is a very clear relationship between levels of homocysteine and risks of arterial disease and the lower one can get one's homocysteine then the lower risk of arterial disease. Running a raised homocysteine is as risky as smoking or suffering from diabetes.

Professor Stansby then presented the results of intervention studies into treating homocysteine, which showed disappointingly poor results. However, it was clear from those studies that the doses of folic acid, B12 and B6 used were not sufficient to reduce levels of homocysteine significantly and therefore there was no therapeutic effect. The general feeling of the audience was that levels should be reduced to below 8 and this could be achieved by 100mg of vitamin B6, together with 5mg of folic acid daily, together with at least 2mg of sublingual B12 daily. However, it is important to follow up and re-check levels because some people need injected B12 in order to achieve the ideal.

Doctor Dick Van Steenis and Mr Michael Ryan - Toxic Stress as a cause of Ischaemic Heart Disease

This arguably is the most worrying cause of ischaemic heart disease because for many people this is something which is out of their control. This issue has been brought to light by the brilliant detective work of Dr Dick van Steenis and his colleague Michael Ryan. They have used official figures to map out the incidence of ischaemic heart disease, cancer, and perinatal mortality by postcode. This has been a long and arduous task, but the result is truly frightening. The incidences of all these conditions are substantially raised in people who live near to or down wind of incinerators, power stations and other such polluting industry.

Indeed, I have known Dick van Steenis for over 15 years now, during which time he has advanced our knowledge of these issues considerably. The problem is that all these industries are burning materials, which are then discharged directly into the atmosphere. These materials include radioactive waste, heavy metals, organochlorines, organobromines, volatile organic compounds and other such nasty toxins. Indeed, Britain has become the dirty man of the world - we import many of these industrial waste products from other countries such as Canada, Japan and some European countries because those countries will not permit these chemicals to be disposed of in their own country. We use them as cheap fuel sources. The industry makes lots of money at this - firstly through disposing of the nasty toxic waste and secondly because it generates energy to fire our industry.

These toxic waste products come out of chimneys in which there is no filtration system. We do have technologies to clean up these wastes such as electrostatic precipitators and these have now become mandatory in America. In this country they are not used.

The pollution comes out of chimneys as such fine particles that they cannot be seen. We are talking about particles of 2.5 microns or smaller. The problem with particles of this size is that when we inhale them, they are not trapped in the nose or the bronchi and coughed out or excreted. They travel right down into the depths of the lungs where they are readily absorbed by the body. They pass into the bloodstream and get distributed widely throughout the whole body. This is why this toxic pollution has such a broad range of effects from heart disease and cancer through to birth defects. It is very likely that they contribute to many other illnesses as well.

A terrifying statistic that Dick told us was that there are at least 30 incinerators in this country that he knows about that are burning radioactive waste. This does not include hospital incinerators. Most people live within a few miles of some sort of incineration, which may be from a hospital, crematorium, power station, manufacturing industry, or whatever. Even I, living in the middle of Wales but just a few miles from a dump of tyres which was maliciously set alight ten years ago and continues to burn today, am exposed to toxic organochlorines, dioxins and so on from the atmosphere.

At present there are no maps of the whole country to show what may be your local problem. However, Dick has promised to make these maps available as soon as is possible - see links to Country Doctor and look for articles by Dick van Steenis.

Many of these toxins can be got rid of by doing sweating regimes. Indeed when I do fat biopsies on people, almost invariably I find organochlorines and volatile organic compounds. If I do Kelmer tests or sweat samples, almost invariably I find a cocktail of heavy metals. Whilst one of these toxins in isolation may be tolerable, it is the cocktail effect that I am worried about. Overall this cocktail of chemicals and heavy metals has the effect of accelerating the normal ageing process so that people get diseases before their time.

Sweating regimes are effective at offloading these chemicals and the most physiological way to sweat is to exercise. The idea here is that the exercise mobilises chemicals from the fat onto the lipid layer on the surface of the skin and they can then be washed off in the shower. However, people who cannot exercise, or who are natural lounge lizards can use Far Infra red saunaing, which achieves the same. My experience is that fifty saunas, which may last just five or ten minutes each will reduce the load to roughly 25% of what it was. The load of toxins comes down exponentially, so slower progress afterwards - but all movement in the right direction.

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