I'm back with the final post of this whole hypothesis of cholesterol and heart disease. I have to apologize for not able to complete the post as I was not up to it, as I was exhausted. I had to sleep and rest my brain that night after a hectic few days. Today I hope, I could finish off writing this post, and share with you guys about the real cause of heart disease. Bear with me, this will be a long post, and probably my last post ever, for this blog. I'm just don't see any reason to keep writing and sharing all these health information, well, unless something comes along to turn on my 'motivation' button.
Before I continue with this final post, I would like to express my apology to someone whom I was introduced recently by a friend. This girl, although I never had the real chance to get to know her personally yet, my instinct tells me that she is somehow rare, in a way of having the curiosity wanting to learn and absorb knowledge about health, fitness and nutrition. I give her a bonus point for these value in her, and I think she has a bright future in health and fitness industry, if she follows the right track, the right knowledge, and not to falls into the 'conspiracies' of food, pharmaceuticals and 'fradulent' health medias. If anyone who is in nutrition, fitness and health background, once you derails off track, it would be very difficult to make that big U-turn, as your believes and misguided learnings are cemented into your mindset for years.
I felt bad and didn't realized that I unintentionally 'hurt' someone with my thoughts and expression about health recently. My bad, I'm the type of person who is bluntly honest and realistic when it comes to nutrition, health and fitness. A lot of times I said things to people somehow may sound very blunt and 'difficult' for them to swallow, but even though those stuff that I said are facts and the truth, it turned out for them requiring some time to 'digest' what I tried to explain and share these knowledge in anyway I could. I meant no harm nor having any intention to offend anyone at all.
As I was having dinner tonight with my close friend, I was telling him of my early days before I was in the field of nutrition and health. I love sports and exercise, I played various types of sports and workout as much as I could, I thought I'm on the right path of optimum health, fitness and doing the right thing. My diet consists of protein shakes and 'eat whatever I can'. In laymen term, junk diet. I was bulky and muscular, accompanied with lots of body fat composition too. What does that tells me? Well, I was clueless, trying to find the missing puzzles to explain why I could not maintain 'peak' immune system, lean body mass, low body fat composition and feeling great. I occasionally falls sick, having occasional gut problems, and feeling burned out. I thought exercise as much as I could with different sports and loads of hours in gym will help my health and fitness. My body kept telling me otherwise, answer is NO. I used to love doing cardio, running, long hours of pumping iron, but when I learnt about the science of physical transformation and how our body response to different types of stressors (such as types of exercise), I had to admit, it took me some time to digest what I believed all this while, that what I was doing, is against optimum health and fitness. I love cycling everyday to my university and do cardio running before every workout session. I had to stop, when I realized these types of exercises DON'T actually burn fat, build muscles and stimulate our metabolism. Imagine all your life, you love to eat bread, and when the day you realized and found out that gluten is harmful to your body and digestive system, it would be very difficult to withdraw from eating food made of gluten, grains, wheat in particular. You feel sad for not being able to enjoy your usual cereals for breakfast and you thought the food pyramid guide is right all along this time, advising all of us to eat 4-8 servings of grain based food per day.
Before I continue with this final post, I would like to express my apology to someone whom I was introduced recently by a friend. This girl, although I never had the real chance to get to know her personally yet, my instinct tells me that she is somehow rare, in a way of having the curiosity wanting to learn and absorb knowledge about health, fitness and nutrition. I give her a bonus point for these value in her, and I think she has a bright future in health and fitness industry, if she follows the right track, the right knowledge, and not to falls into the 'conspiracies' of food, pharmaceuticals and 'fradulent' health medias. If anyone who is in nutrition, fitness and health background, once you derails off track, it would be very difficult to make that big U-turn, as your believes and misguided learnings are cemented into your mindset for years.
I felt bad and didn't realized that I unintentionally 'hurt' someone with my thoughts and expression about health recently. My bad, I'm the type of person who is bluntly honest and realistic when it comes to nutrition, health and fitness. A lot of times I said things to people somehow may sound very blunt and 'difficult' for them to swallow, but even though those stuff that I said are facts and the truth, it turned out for them requiring some time to 'digest' what I tried to explain and share these knowledge in anyway I could. I meant no harm nor having any intention to offend anyone at all.
As I was having dinner tonight with my close friend, I was telling him of my early days before I was in the field of nutrition and health. I love sports and exercise, I played various types of sports and workout as much as I could, I thought I'm on the right path of optimum health, fitness and doing the right thing. My diet consists of protein shakes and 'eat whatever I can'. In laymen term, junk diet. I was bulky and muscular, accompanied with lots of body fat composition too. What does that tells me? Well, I was clueless, trying to find the missing puzzles to explain why I could not maintain 'peak' immune system, lean body mass, low body fat composition and feeling great. I occasionally falls sick, having occasional gut problems, and feeling burned out. I thought exercise as much as I could with different sports and loads of hours in gym will help my health and fitness. My body kept telling me otherwise, answer is NO. I used to love doing cardio, running, long hours of pumping iron, but when I learnt about the science of physical transformation and how our body response to different types of stressors (such as types of exercise), I had to admit, it took me some time to digest what I believed all this while, that what I was doing, is against optimum health and fitness. I love cycling everyday to my university and do cardio running before every workout session. I had to stop, when I realized these types of exercises DON'T actually burn fat, build muscles and stimulate our metabolism. Imagine all your life, you love to eat bread, and when the day you realized and found out that gluten is harmful to your body and digestive system, it would be very difficult to withdraw from eating food made of gluten, grains, wheat in particular. You feel sad for not being able to enjoy your usual cereals for breakfast and you thought the food pyramid guide is right all along this time, advising all of us to eat 4-8 servings of grain based food per day.
Anyway, back to where I left off few days ago. Visceral fat. Yes, the 'bad ass' fat which is a villain comparing to subcutaneous fat. Now, has anyone figure out what causes build up of visceral fat? Well, the answer is dysfunction of HPA axis and abnormal cortisol levels. Did you forgotten about Cushing's disease?
In addition to its effects on raising glucose and insulin levels, and its impact on muscle and fat distribution, a high cortisol level also causes the following abnormalities.
- Raised VLDL
- Low HDL
- Raised LDL
- Raised blood pressure
- Raised fibrinogen levels (clotting factor)
- Raised Lp(a) level (clotting factor)
- Raised Von Willibrand level (clotting factor)
Does anything seem familiar to you? Do not worry about the naming convention of these clotting factors. It will soon be familiar to you, IF you develop heart disease or even stroke. You will know why when the time comes.
You could say that people with Cushing's disease have accelerated atherosclerotic plaque growth, and dramatically increased risk of heart disease. You could in fact confident enough to say that cortisol level itself that is causing the damage, rather then some other factor.
Now, steroids, plays a role in this part as well. How? This drug is one of the most prescribed of all medications. They are also called 'corticosteroids', because the building block of all steroids is cortisol. What this means, is that you are effectively giving yourself Cushing's disease when you take steroids.
Why would anyone want to do this? Well, one effect of cortisol that is surprising is that it greatly inhibit the immune system. Because it does, it is used to treat diseases when you want to shut down an overactive immune response. For instance, autoimmune diseases such as asthma, rheumatoid arthritis, eczema, etc. Steroids are also used after a transplant, as they prevent the body from rejecting the 'new' organ. In situation like this, steroids is a powerful yet life saving drugs. However, if you keep taking them for a long period of time, you will end up with the same exact set of abnormalities found in Cushing's disease, high blood sugar and insulin levels, low HDL, high VLDL/LDL, whole range of blood clotting factor abnormalities and increased of visceral fat deposition.
What's more, people who take steroids long term, are at greatly increased risk of dying of heart disease. Even fit, young healthy people. And it can happen very fast too. We have bodybuilders taking anabolic steroids abusively, increasing the risk of cardiovascular disease. You can have a young healthy man with no risk of heart disease, and with 1-2 years of anabolic steroids consumption, he can develop severe occlusion of major arteries in the heart, as well as heart attacks.
So, now we have two 'different' conditions where cortisol levels are significantly raised. Cushing's disease and steroids abuse. Clearly though, these two 'conditions' represent a very serious form of HPA axis dsyfunction indeed. Equally clearly, not everyone who died of heart disease, has Cushing's disease or abuse steroids.
There are also other factors which causes HPA axis dsyfunction. One of them is depression. Sounds surprise? Well, it has long been known that people with depression, are at great risk of developing heart disease. In addition to other metabolic problems, depression also increase build up of visceral fat. This observation, is to make clear that build up of visceral fat, is the result of underlying problems with the HPA axis dsyfunction and abnormal cortisol level. Again, this doesn't happen by genetics. No magic whatsoever.
Depression is a very good model to demonstrate that long term dsyfunctions of the HPA axis, is created purely by psychological stressors, works through the same mechanisms as Cushing's disease to cause heart disease. I could have presented chronic stress or anxiety, and both of them will shows exactly the same thing as well. It's all about psychological upset which messed with the HPA axis.
Next, smoking. I know you have heard about the relation between smoking and hypertension. Now, how about the effect of cortisol and DHEA levels? In addition to the affects on HPA axis, smoking also has major impact on blood clotting factors. According to a study which I've read previously, it is confirmed as below:
"In the controlled group subjects, cigarette smoking induced a striking increase in the circulation concentrations of ACTH and cortisol, with peak response of 1.4 to 1.5 times higher then the baseline of 20 and 30 mins respectively."
Coiro V et al, Alcohol Clin Exp Res, September 1999;23
I know some of you might not understand what the statement in the research means, basically in a nutshell, smoking increases both your ACTH and cortisol sharply, within a timeframe of less then 30 mins. But, with all the nasty ads in the cigarette box, smokers are still addicted to this dangerous substance, just like sugar, caffeine and MSG.
Moving on, spinal cord injury. Yes, doesn't make sense? How could spinal cord injury has anything to do with heart disease? Keep reading. Smoking and spinal cord injury may not initially seem to have anything to do with heart disease, especially HPA axis dysfunction. However, in reality, spinal cord injury has impacts with massive force on HPA axis . This is because when you break vertebrae and snap your spinal cord, you usually sever many of the sympathetic and non sympathetic nerves at the same time.
As a result, this leads to enormous disruption of the neurohormonal system. Based on statistics and research, spinal cord injury patients have low HDL and lipid abnormalities such as low VLDL. Spinal cord injury also raise cortisol levels. Patients with spinal cord injury, have sharply raised blood clotting factors such as Lp(a) and fibrinogen levels. Also, spinal cord injury leads to insulin resistance and visceral obesity as well. These patients are at greatly increased risk of heart disease.
Do these factors then go on to cause heart disease? Some of them may have a direct impact on heart disease, such as raised blood clotting factors. Others are probably just signs of an underlying problem, for instance, low HDL levels.
Meanwhile, I would like to discuss a bit about the INTERHEART study. In this study, there are a list of factors measured and found to have a close connection with heart disease. Some of them were associated with increased risk, and some were associated with reduced risk.
The factors associated with increased risk of heart disease were:
This study, treated each risk factor as acting in perfect isolation, having no relationship whatsoever to any other factors. These factors, can be directly linked to a dysfunctional HPA axis and raised cortisol levels. Two of them, smoking and psychosocial stress, are causes of HPA axis dysfunction. The rest of the factors result from HPA axis dysfunction, high blood pressure, abdominal obesity, diabetes and dyslipidaemia.
If any of you might have analyzed this study intensively, 52 countries involved, a raised LDL level or raised cholesterol level, was not identified as a risk factor. Meanwhile, this study indicates that approximately one third of the risk of heart disease could be due to psychosocial stress, if you look at the evidence in a different way, it could be argued that the entire risk of heart disease is due to a dysfunctional HPA axis, otherwise known as STRESS.
By now, you should be convinced that a whole range of different 'stressors' can upset the HPA axis. Question is, how do the metabolic abnormalities created go on to cause heart disease or atherosclerotic plaque growth? This is actually related to 'response to injury' hypothesis where it explains the first step in plaque formation is that a patch of endothelium becomes dysfunctional or damaged.
Well, when this happens, a section of the underlying arterial wall is exposed. This, in turn, acts as a very powerful stimulus to the clotting system to form blood clot to plug the gap. By the way, blood clot is also known as thrombus. Once the thrombus has covered over the area of the damage, the clotting process is brought to a halt. This is the basic of 'response to injury' concept.
Then what happens? Well, for a moment, I would like you to think about what happens to your skin if you scratch or cut it. Blood escapes for a bit, then clot forms, which turns into a scab. After a while, the skin regrows to seal up the scratch under the scab, and the scab falls off. If the same process were to happen to your arteries, then any blood clot that formed on a damaged bit of endothelium would eventually fall off, travel a bit further down the artery, and then jam solid once the artery narrowed. This would cause catastrophic problems, including strokes.
Clearly, this is not a good thing. Therefore, blood clots forming on arteries cannot be allowed to fall off when the endothelial healing process is complete, unlike scabs on your skin. In order to stop blood clots breaking off artery walls, and causing downstream havoc, they have to be drawn into the artery wall and then disposed of. How does this happens? Answer is, your bone marrow creates millions upon millions of 'pre-endothelial' cells that travels about in your bloodstream. When they see breach in the endothelium, it's their job to cover it up.
Normally, however, a blood clot will have got there first, so these pre-endothelial cells stick to the surface of the blood clot, grow into full blown endothelial cells, and cover over the damage with a new layer of endothelium. In this way, blood clots are, effectively, drawn into the arterial wall behind a new layer of endothelium. Usually, they are then broken down and removed, leaving no trace that they were ever there in the first place.
I hope by now, it all these explanations makes perfect sense to you. It may sound a bit complex and hard to swallow at first, have some time, think it through, use some of your many years of health and medical knowledge and background ( to those who study health science, sports science, science or degree in medicine), and connect the dots by yourself. For those who have no medical or health knowledge or background whatsoever, these explanations will prove to be a very good piece of health information for your own self. Whether you accept it or not, it is entirely up to you, as I have hard time trying to convince some of my family members and friends about this cholesterol and heart disease topic.
Once again, I warned patients on cholesterol lowering drugs, DO NOT put your health or life, on the hands of a single 'doctor'. It is simply true, that doctors who is lack of knowledge, WILL kill you! Good luck and I wish everyone best of health. I truly hope, this ridiculous cholesterol hypothesis will die off soon, will it? We will have to wait and see.
"In the controlled group subjects, cigarette smoking induced a striking increase in the circulation concentrations of ACTH and cortisol, with peak response of 1.4 to 1.5 times higher then the baseline of 20 and 30 mins respectively."
Coiro V et al, Alcohol Clin Exp Res, September 1999;23
I know some of you might not understand what the statement in the research means, basically in a nutshell, smoking increases both your ACTH and cortisol sharply, within a timeframe of less then 30 mins. But, with all the nasty ads in the cigarette box, smokers are still addicted to this dangerous substance, just like sugar, caffeine and MSG.
Moving on, spinal cord injury. Yes, doesn't make sense? How could spinal cord injury has anything to do with heart disease? Keep reading. Smoking and spinal cord injury may not initially seem to have anything to do with heart disease, especially HPA axis dysfunction. However, in reality, spinal cord injury has impacts with massive force on HPA axis . This is because when you break vertebrae and snap your spinal cord, you usually sever many of the sympathetic and non sympathetic nerves at the same time.
As a result, this leads to enormous disruption of the neurohormonal system. Based on statistics and research, spinal cord injury patients have low HDL and lipid abnormalities such as low VLDL. Spinal cord injury also raise cortisol levels. Patients with spinal cord injury, have sharply raised blood clotting factors such as Lp(a) and fibrinogen levels. Also, spinal cord injury leads to insulin resistance and visceral obesity as well. These patients are at greatly increased risk of heart disease.
Do these factors then go on to cause heart disease? Some of them may have a direct impact on heart disease, such as raised blood clotting factors. Others are probably just signs of an underlying problem, for instance, low HDL levels.
Meanwhile, I would like to discuss a bit about the INTERHEART study. In this study, there are a list of factors measured and found to have a close connection with heart disease. Some of them were associated with increased risk, and some were associated with reduced risk.
The factors associated with increased risk of heart disease were:
- Smoking
- Diabetes
- Psychosocial stress
- High Blood Pressure
- Abdomimal Obesity (increased visceral fat)
- High ApoB/ApoA-1 ratio
This study, treated each risk factor as acting in perfect isolation, having no relationship whatsoever to any other factors. These factors, can be directly linked to a dysfunctional HPA axis and raised cortisol levels. Two of them, smoking and psychosocial stress, are causes of HPA axis dysfunction. The rest of the factors result from HPA axis dysfunction, high blood pressure, abdominal obesity, diabetes and dyslipidaemia.
If any of you might have analyzed this study intensively, 52 countries involved, a raised LDL level or raised cholesterol level, was not identified as a risk factor. Meanwhile, this study indicates that approximately one third of the risk of heart disease could be due to psychosocial stress, if you look at the evidence in a different way, it could be argued that the entire risk of heart disease is due to a dysfunctional HPA axis, otherwise known as STRESS.
By now, you should be convinced that a whole range of different 'stressors' can upset the HPA axis. Question is, how do the metabolic abnormalities created go on to cause heart disease or atherosclerotic plaque growth? This is actually related to 'response to injury' hypothesis where it explains the first step in plaque formation is that a patch of endothelium becomes dysfunctional or damaged.
Well, when this happens, a section of the underlying arterial wall is exposed. This, in turn, acts as a very powerful stimulus to the clotting system to form blood clot to plug the gap. By the way, blood clot is also known as thrombus. Once the thrombus has covered over the area of the damage, the clotting process is brought to a halt. This is the basic of 'response to injury' concept.
Then what happens? Well, for a moment, I would like you to think about what happens to your skin if you scratch or cut it. Blood escapes for a bit, then clot forms, which turns into a scab. After a while, the skin regrows to seal up the scratch under the scab, and the scab falls off. If the same process were to happen to your arteries, then any blood clot that formed on a damaged bit of endothelium would eventually fall off, travel a bit further down the artery, and then jam solid once the artery narrowed. This would cause catastrophic problems, including strokes.
Clearly, this is not a good thing. Therefore, blood clots forming on arteries cannot be allowed to fall off when the endothelial healing process is complete, unlike scabs on your skin. In order to stop blood clots breaking off artery walls, and causing downstream havoc, they have to be drawn into the artery wall and then disposed of. How does this happens? Answer is, your bone marrow creates millions upon millions of 'pre-endothelial' cells that travels about in your bloodstream. When they see breach in the endothelium, it's their job to cover it up.
Normally, however, a blood clot will have got there first, so these pre-endothelial cells stick to the surface of the blood clot, grow into full blown endothelial cells, and cover over the damage with a new layer of endothelium. In this way, blood clots are, effectively, drawn into the arterial wall behind a new layer of endothelium. Usually, they are then broken down and removed, leaving no trace that they were ever there in the first place.
I hope by now, it all these explanations makes perfect sense to you. It may sound a bit complex and hard to swallow at first, have some time, think it through, use some of your many years of health and medical knowledge and background ( to those who study health science, sports science, science or degree in medicine), and connect the dots by yourself. For those who have no medical or health knowledge or background whatsoever, these explanations will prove to be a very good piece of health information for your own self. Whether you accept it or not, it is entirely up to you, as I have hard time trying to convince some of my family members and friends about this cholesterol and heart disease topic.
Once again, I warned patients on cholesterol lowering drugs, DO NOT put your health or life, on the hands of a single 'doctor'. It is simply true, that doctors who is lack of knowledge, WILL kill you! Good luck and I wish everyone best of health. I truly hope, this ridiculous cholesterol hypothesis will die off soon, will it? We will have to wait and see.
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