Coronary Artery Disease (CAD) is the single leading cause of death in the US and in industrialized countries. CAD develops when plaque builds up in the walls of the arteries, reducing blood supply to the muscles of the heart. A heart attack usually occurs when the plaque ruptures, causing sudden complete obstruction of the blood vessel, and the affected heart muscles die due to lack of oxygen.
Why does plaque build up in the first place? Most of us have heard of the traditional risk factors for CAD: advancing age, male sex, family history of CAD, smoking, hypertension, high cholesterol, and diabetes. However, what most of us do not hear about is that inflammation is the main process that causes these plaques to form! You might ask, inflammation where? The answer is, anywhere in the body! Yes, prolonged, recurrent, and frequently silent inflammation from various causes and places in the body damages the inner lining of our blood vessels called endothelium. This damage begins a cascade of events, eventually leading to plaque build-up.
Before I expound on this inflammation, let’s talk about cholesterol for a moment. Cholesterol is an essential fat that is used by the body to make hormones, vitamin D, bile acids, cell wall components, and others. Cholesterol helps neutralize toxins coming from the gut. When you have an infection, your total cholesterol level goes up. Because cholesterol deposits are found in plaque, it is blamed as the culprit but it is not. It is just another victim and sign of inflammation! Again, you may ask, inflammation where? Anywhere in the body! The coating that carries the cholesterol in our blood, called “lipoproteins”, can get “oxidized” by inflammation and become sticky, contributing to plaque build-up. So, just lowering your cholesterol number by taking drugs is not always the best strategy. The better approach is to lower or stop the inflammation, so the cholesterol does not become sticky and the numbers go down!
So now, let’s talk about this inflammation some more. Inflammation is a normal process that our body mounts to protect us from bad things – injury, microbes, allergens, etc. Short-lived or acute inflammation is usually not a problem. However, prolonged or chronic inflammation IS a big problem, and IS indeed a proven cause of coronary disease! To make things worse, most of these chronic inflammatory processes are silent! To understand this concept better, I will cite examples.
The food we eat can cause inflammation. In fact, the Standard American Diet (SAD for short), consisting of burgers, hotdogs, fries, pizza, cereals, pasteurized milk, cookies, and many processed foods, are pro-inflammatory. Each time we eat such a meal, our bodies become silently inflamed for 4-6 hours. Thus, eating 3 pro-inflammatory meals a day is enough to inflame the body for most of the day!
Poor lifestyle choices, like smoking, drinking too much alcohol, inadequate sleep, and lack of exercise also contribute to inflammation. Prolonged stress is another big cause of inflammation thru the action of cortisol.
As I am a functional medicine physician, and I specialize in finding the hidden causes of diseases, let me tell you about the lesser known, but common causes of inflammation, of coronary or vascular disease in general. I will enumerate some of them:
1. Hidden infections. I would say the most common sites are the teeth and gums, and the gut. Unhealthy gums and tooth decay have actually been shown to be highly associated with coronary disease! People with history of root-canal treatments have also been shown to have more coronary disease. The gut can easily hide a low-grade infection or infestation. Loss of enough good bacteria also allows the bad ones to predominate and weaken our immune system.
2. Food sensitivities. Foods like gluten-containing grains (wheat, rye, barley, etc.), dairy, soy, and others, cause inflammation in the gut, and eventually in other parts of the body. These sensitivities may present as gut-related symptoms like bloating, pain, or as non-gut-related symptoms like fatigue, achiness, depression, thyroid problems, arthritis, arrhythmias, etc. They cause autoimmune disease and vascular disease.
3. Toxicities, including heavy metals and other environmental pollutants. We live in a toxic world. Many of our produce and packaged foods are full of pesticides and additives that disrupt the actions of our hormones, and burden our liver. Heavy metals like mercury, lead, cadmium and arsenic, disrupt energy production in our mitochondria and are common causes of vascular and neurologic diseases. Dental amalgams contribute to your body burden of mercury.
4. Nutritional deficiencies and excesses. For the most part, we are an overfed but undernourished society. We eat too much sugar and starch, trans-fats, and not enough vegetables and fruits. Nutritional deficiencies reduce our ability to fight inflammation and repair damaged tissues. Excessive carbohydrate intake leads to insulin resistance, a metabolic state that promotes inflammation even prior to reaching the diagnosis of “diabetes”. Many drugs that are commonly prescribed also bring about vitamin and mineral deficiencies. A great example is magnesium and potassium deficiency from use of diuretics.
5. Genetic weaknesses. Some of us have difficulties in methylation and detoxification, making us more susceptible to inflammation than others. Some have genetically elevated levels of lipoprotein (a), a protein that can increase the stickiness of the cholesterol particle. These genetic weaknesses, and others, can be tested for and measures can be taken to reduce their impact on our health.
Now, that I’ve listed several hidden causes of CAD, it is no wonder why it is so prevalent. Our blood vessels are just innocent victims of infinite insults happening in our bodies!
Our current healthcare system is excellent in handling acute cardiac emergencies, using clot-dissolving drugs, stents, and surgeries. However, when it comes to chronic management of coronary disease, we often fail to halt the progression, what more reverse it. With a list of causes such as above, reversing it is clearly no easy task. M.D.’s or D.O.’s practicing conventional medicine are usually not trained to investigate these hidden causes, and do not have the time to address them, so they usually use pharmaceutical drugs and procedures, which can be life-saving. However, these drugs and procedures carry risks, are expensive, and do not necessarily stop disease progression, therefore the need for more interventions in the future. Functional medicine physicians, on the other hand, have had extra training to find and help the patient eliminate these hidden root causes of inflammation, therefore also reducing risk for future maladies. I say, if you have coronary or any vascular disease, you need to have both kinds of doctors to help you.
Happy Valentine’s Day!
