An end to heart disease click bait: How heart disease is REALLY caused and managed

You've seen the click-bait headlines: "Take this one supplement and dissolve plaque," or "Eat this one food every day to dissolve plaque." None of this true, any more than reducing cholesterol "dissolves plaque."

There is a logical and scientifically validated approach to gain control over coronary atherosclerotic plaque and thereby risk for heart attack and related cardiovascular events. It begins with identifying, then eradicating, small dense LDL particles. Think of small dense LDL particles as the first domino in a long line of dominoes that will fall just by knocking down the first domino. 

Transcript

Why I Left Conventional Cardiology

William Davis, MD 0:00

Hi, I'm Dr. William Davis. If you don't know who I am, I practiced cardiology for about 30 years. I stopped practicing when I wrote books like Wheat Belly and Undoctored and that more recently Super Gut and Superbody because I saw what was wrong in conventional healthcare. I saw that so much of what is done in healthcare is not for your benefit, it's for profit. It's to generate revenue for the healthcare system and the practitioner, doing things that were not often unnecessary, but sidestepping the things that truly worked. And so after 17 years, 17 years of education and training, a practice that started in an academic setting, and then I went into private practice where I practiced mostly interventional cardiology, that is, the uh putting in stents, opening arteries, aborting heart attacks. Later in my career, I prove I practiced preventive cardiology, and I learned what a joke. Most of the concepts in preventing heart disease prove to be, like treating cholesterol.

Why Cholesterol Gets The Blame

William Davis, MD 1:04

So let me go through that. I've done this many times before in videos, but you know what? So many people, including my colleagues, colleagues, have been so thoroughly brainwashed into thinking that cholesterol causes heart disease that it helps to hear this argument over and over again in slightly different ways. So it sinks in and you walk away with what I hope is understanding. So recall that cholesterol is a fat. Fats do not float in your bloodstream freely, because if they did, fats would coalesce. The analogy I draw often is your salad dressing. If your salad dressing is a mixture of oil and vinegar, vinegar and water, of course, it separates, right? You shake it and it mixes momentarily and then separates again within seconds. Because oils tend to coalesce, and that would be true in your body also. Cholesterol, fats like cholesterol would coalesce. And if they did, you would be dead within minutes because they would coalesce and block the blood flow to various arteries, like your brain or your liver, your muscle, your entire body. So fats cannot travel freely in the bloodstream. It's almost next to zero free fats in the bloodstream. They must be solubilized. That is, they must be attached to something that is uh soluble in an aqueous or water environment. That's what your blood is. You don't think of it that way, right? But if you remove the red blood cells, what you have left in blood is plasma, a clear liquid, a water-like liquid. So blood is an aqueous or water-based environment. So fats can't float freely in that. They must be solubilized.

Lipoproteins And How Fat Travels

William Davis, MD 2:46

And the way they're solubilized is a class of particles called lipoproteins, fat-carrying proteins, of which there are many kinds: different sizes, different surface charges, different contents, different susceptibility, various processes, and different capabilities of causing coronary atherosclerosis. So, you know, if you surf the web or if you spend any time on YouTube, you inevitably come across all this clickbait stuff about heart disease, stating things like take this one supplement and it dissolves plaque, caronary plaque, or eat this one food and plaque will dissolve. Is any of this true? No, of course not. No more true than reducing cholesterol regresses heart disease. It does not. Now, not to say that the drug industry hasn't tried to prove that and paid tons of money to try to prove that, including money paid to the people who perform the studies, because when somebody, when a company pays for a study, it almost always comes out in favor of the sponsor of the drug. Here's a way to think about this. So if I told you your LDL cholesterol is 180 milligrams per deciliter, which is kind of high, what does that tell me about you? Does it tell me anything about you, about your health? Well, it means that your total cholesterol is also higher, and that's because LDL cholesterol and total cholesterol are calculated from each other. And so that doesn't really tell you anything new, right? The only other piece of information you might get out of that is that you'll know that your apoprotein B is higher when your LDL cholesterol is high. And that's because all LDL particles, of which cholesterol is meant to be a gauge, contain one apoprotein B per particle. So a higher apoprotein B suggests that you have more LDL, low density lipoprotein particles. That's all you can tell from an LDL cholesterol of 180 milligrams per deciliter or whatever

LDL Cholesterol Vs Particle Counts

William Davis, MD 4:46

value you have. What if I told you instead your small dense LDL particle number, low density lipoprotein particle, so a count of the actual lipoproteins, in this case the small dense lipoproteins. What if I told you your small dense LDL particle number was 1800 nanomoles per liter? And all that means is a particle count per, in this case, liter per volume. What does that tell me about you? And that's by the way a high number. Anything above really 200 or so is is concerning. So let's say your small dense LDL particle numbers, 1800 nanomoles per liter. What can I tell you about your health? Well, it tells me you have an excess of abdominal visceral fat in your abdomen and circling your abdominal organs. You might not see it on the surface, but it's in there. And that abdominal fat is emitting inflammatory signals to your liver and then exporting inflammation to the rest of your body, including your coronary arteries. And that's why C-reactive protein, other measures are higher in people with small LDL. People with that much small LDL are insulin resistant. That is, their body does not respond properly to insulin. Their liver, brain, muscle doesn't respond properly. The pancreas compensates by producing huge amounts of insulin, tenfold, thirty-fold, a hundredfold higher. So we know that you have insulin resistance in body-wide. We know that your blood glucose is going to be higher. We know that your fasting insulin will be much higher. We know that your hemoglobin A1C, that long-term measure of blood glucose, will be higher. We know that all those inflammatory markers like C reactive protein, interleukin 6, interleukin 1 beta, tumor necrosis factor alpha, are all higher. Even your white blood cell count is going to be somewhat higher than other people who don't have small LDL. We know that your liver markers, AST and ALT specifically, are going to be high, suggesting ongoing some degree of liver damage that's often labeled as fatty liver. We know that you're likely to be hypertensive, high blood pressure. We know that you have endothelial dysfunction, that is an abnormal constrictive tendency of your arteries, including your coronary arteries, and that situation accelerates the development of atherosclerotic plaque in your caronyl arteries. We know that your glycocalyx is dysfunctional. The glycocalyx is the hair are the hair-like projections that line your arteries that help control tone and control that process of endothelial dysfunction. We know that you likely have lipopolysaccharide endotoxemia. That is, that microbes in the colon that have likely migrated into the small intestine, that's very permeable and not very good at dealing with the invasion of these fecal microbes from the colon, and the breakdown products when they die. So microbes don't live very long, right? They live maybe a few hours. When they die, they release some of their toxic compounds into the intestines, into the small intestine, that then enters the bloodstream. And that's called endotoxemia. So endotoxemia is a really bad problem to people with sepsis. People often die of sepsis because of the endotoxemia that's much worse than normal. So when you have this process happen, endotoxemia, because you have a disrupted gastrointestinal microbiome, uh, the most common situation is called small intestinal bacterial overgrowth, or SIBA, we say SIBO. The level of endotoxin is about 200 to 400% higher, probably higher than that because the current measurement of endotoxin tends to underestimate the severity of endotoxemin. So there's a several fold higher level of endotoxin, and that drives the formation of small LDL particles. In other words, if we know that your small dense LDL particle number is higher than it should be, that is the thing that drives risk for carony disease, for heart disease, there's a whole constellation of other phenomena behind it. Inflammation, visceral fat, endotoxemia, uh, liver dysfunction, in resistance. So, how could one fruit or one supplement correct the whole universe of abnormal metabolic phenomena? Of course it does not. So now that sounds terribly complicated, but here's the great thing about this. Once you get this insight, once you understand that caronary disease, heart attack, sudden cardiac death, all that sort of thing, does not come from an isolated, silly value like LDL cholesterol, it comes from a whole universe of abnormal phenomena that altogether lead to the accumulation of carnary atheroscopic plaque and at some point allows plaque rupture, like a little volcano or pimple. And that's the process of heart attack that can cause closure of an artery and then heart attack or sudden cardiac death.

NMR Testing And The First Domino

William Davis, MD 9:58

But here's the thing: if all you focus on is that small dense LDL particle number, so you do have to get an NMR nuclear magnetic resonance lipoprotein test, widely available. I've been doing it for 35 years. It's about $100. It's not all that expensive. Your doctor may say something different. They may say things like, well, it's experimental, or we don't do that around here, or it's not covered by insurance. Those are all lies. That's nonsense. You can get it done. It's easy to do, it's not that expensive, it's almost always covered by insurance, been around for decades. There are 60 human clinical trials validating the use of this marker, and it's proven to be clearly significantly superior to silly measures like LDL cholesterol. But if all you do is forget about the insulin resistance, forget about the endotoxemia, forget about the all those other things I mentioned. Just think about risk for heart disease as an excess of small, dense LDL particles, which is almost universal in people who are at risk for heart disease or have heart disease. Focus on that, and that's another conversation. But what can you do to eliminate small dense LDL particles? And the great thing is, if you just follow a handful of strategies to do that, everything else follows. Your HDL will go up, HDL particles will become bigger and more protective, triglycerides will come down, fatty liver will recede, blood pressure will drop, endothelial dysfunction will reverse, the glycocalyx will rebuild. In other words, all those phenomena will follow suit. So I often say small dense LDL particles is the first domino. If you line up a bunch of dominoes on your kitchen table and you push the first one down, the whole thing follows, right? That's the same principle in addressing small dense LDL particles. You don't have to worry about all those other phenomena, the dozens of phenomena that accompany small dense LDL particles. Now, this comes from 30 years of practicing cardiology and dealing with heart disease in all different

Stopping Heart Disease Meets Profit

William Davis, MD 12:00

ways. And it was only the last decade or so of my practice that I saw heart disease put being put to a stop. You know, I used to have hospital executives come to me and say, hey, Dr. Davis, where are you hospitalizing your patients? I said, uh, here. And they said, uh, very funny, very funny. We see that you hardly hospitalize anybody. I said, well, you well, that's right, because I pretty much put a stop to heart disease. And the only people I have to hospitalize are the non-compliant people who don't follow the program, people who do silly things like continue to smoke, for instance, uh, and occasional other problems like aortic valve disease or atrial fibrillation or something like that. But people for coronary disease, the most dominant, most common form of heart disease, was put to a stop. I didn't need to put people in the hospital for heart attacks or angina or stent implantation or bypass surgery. It meant my need to do procedures suddenly came to a halt, came to a grinding halt. And the hospital executives, when I told them I don't hospitalize people, or rarely do, because there was no need. They would laugh. They thought I was joking. It did not compute. And of course, my colleagues didn't give a crap because that's how they make money. You can make very good money putting in stents, managing heart disease, heart attacks, angina, right? All the tests they do, stress nuclear tests, cardiac capitalization, implantation of defibrillators, all the stuff that is the number one money maker for the healthcare system would be put to a large largely to a stop. So there's this kind of benign indifference. They don't want to know. But that but you need to know you can put a stop to heart disease. Now, how to deal with small LDL particles, that's a conversation for another video.