How Are LDL, HDL and Cholesterol Related to Heart Disease?

Cholesterol Heart Desease

HDL to Cholesterol Ratio: How to Prevent Heart Attacks

When I first learned about Dr. Caldwell Esselstyn’s research and his seemingly outrageous statement that he can make any person, any patient, “heart attack proof” I was definitely skeptical. Heart disease will kill most of us, how can something that is so common in our culture be wiped out? After reading his research, watching his video documentary “Forks Over Knives” and finally interviewing him in person for my physician training program, I realized the truth of what he was saying. Integrative medicine, natural medicine, functional medicine, alternative medicine, whatever you want to call it, has many camps and many pre-set notions. On our radical fringe, which I know quite well, there is skepticism about everything conventional medicine embraces. As with all opposition movements whether they be political or academic or science based, there is a strong tendency to make blanket decisions as to the veracity of the other side’s arguments and an all too easy tendency to embrace arguments that vanquish your opponent. In the case of natural health, there has been a strong rebuttal to the “high cholesterol causes heart disease” argument from conventional medicine, a disdain for statin medications as a solution and a refusal to see dietary saturated fat and dietary cholesterol as a part of or as the entirety of the problem in the first place. I understand both sides of the argument; part of being a middle child (one older sister, one younger sister) is you get comfortable occupying the middle ground in a variety of ways.

Friend or Foe: Animal Protein and Animal Fat

There are many in the natural health camps that insist that animal protein, animal fat and dietary cholesterol and heart attacks bear no relationship. This is the “eat the meat” crowd. Meat is good, animal fat is a natural component to our diet and so long as it’s grass fed, antibiotic free and humanely slaughtered meat is our friend. There are also the “it’s the carbs” folks who believe that the main reasons people develop heart disease revolve around excessive sugar and carbs and that as we eat excess carbohydrates it’s converted to fat anyhow and ends up as a problem, meaning if you eat zero animal products and excess carbs you’re at higher risk for heart disease than you would be from the high fat, high meat lifestyle. All this ends up being pretty darn confusing and it’s a challenge to figure out what diet would work for a given patient. In addition, within a typical functional medicine practice like I have, many patients simply cannot eat grains or beans because they have such a compromised digestive tract that these foods make them sick. These folks are pushed toward a forced reliance on animal protein and animal fat since there’s a limit to how many vegetables one can eat. Then we have the emotional aspects to all of this. Some people like animals and don’t want to kill and eat them. Some people like meat and fat so much they’ll do anything to avoid giving them up. Some people feel better personally on a high meat or high plant diet. Everyone wants to lose weight so that clouds our judgement more than any other single variable. By that I mean we think whatever diet helped us drop a few pounds in a few weeks must by the right diet.

The Single Best Diet

Into all this confusion we must wade, and wade I have- more like swimming really. Let’s settle for now on the idea that there is no one diet and that what people eat will vary depending on their overall health. The most important point I’ve learned is that the diet that gets you healthy, the diet you have to eat when you are sick to recover, may not be the best long term diet for you. Once people eliminate all their food allergies, heal their leaky gut, once people can eat grains and carbs and feel great doing it, the rules change. I see many chronically ill patients that require animal fat and animal protein to heal simply because the other “healthy” foods they should be eating are not tolerated. However, once these folks recover and regain their health the quantities of animal fat and animal protein they eat should change to reflect what is a long-term healthy diet for an already healthy human being. Then there are patients of mine with a strong history of heart disease, perhaps they had a heart attack already, or had some type of surgery related to blocked blood vessels. Or they may have, like myself a strong family history of heart disease. My grandmother on my mom’s side of our family had eleven brothers and sisters. All twelve of them died of heart attacks! Pretty strong pattern there! People with this type of history have one clear solution in terms of diet and it’s been proven to make you “heart attack proof”. Should everyone eat this way, maybe, maybe not. Will everyone eat this way, definitely not. If you are primarily motivated to eliminate any chance of having a heart attack then read on.

Cardiac Risk- When Does It Start?

Heart disease risk starts early. Children as young as ten years of age have been found with fatty streaks in their blood vessels that will progress on to become plaque and when that plaque builds up enough and breaks off, we’re in the middle of having a heart attack. Should the plaque build up and block an artery sufficiently one may experience angina. Good LDL levels between 50-70 mg/dL make us as Dr. Esselstyn says “heart attack proof” this ends up being a total cholesterol of around 150 mg/dL. If we could as a country keep everyone’s cholesterol below 150 we would essentially eliminate the main killer of our time. Maintaining normal LDL and HDL levels, again LDL of 70 or less and HDL LDL ratio of under 3.5. Maintaining a chol hdl ratio under 3.5 is easy if you eat the right foods. Another factor to take into account is keeping your triglyceride levels under 150 mg/dL, again by reducing processed foods and excess sugars like sodas and sweets. The Mayo Clinic website helps you understand cardiac risk ratio concepts and other issues, here is a link to their calculator: Heart Disease Calculator

Benefits of Eating Plants

It’s abundantly clear from decades of research that if one leaves in, for example, Nigeria, and eats a plant based diet, that your risk for dying from heart disease drops to one in a thousand. If you move from Africa to the United States and adopt a typical American diet, your risk of death from heart disease skyrockets immediately. Just one breakfast sausage sandwich on your first morning here in the U.S. will stiffen your arteries. Numerous studies have shown plant based diets can not only prevent heart disease but also reverse it. One could of course also use statins to lower cholesterol. Statins come with a host of problems, they can trigger muscle damage or liver damage and brain related issues such as confusion and memory loss. Plus the additional benefits that accrue from a plant based diet such as lower risk of cancer, diabetes and GI disorders seem to make the choice obvious.

Vegetarian Diets

I started out at age sixteen adopting a vegetarian diet as I began my studies in clinical nutrition. I worked on organic farms including one in Japan. While in Japan, I felt the best health wise of any period of my life, we ate a plant based diet with minimal meat and fish and no dairy. We grew our own rice and vegetables and traded for other types of food with local farmers. In my 20’s I developed chronic fatigue and had major blood sugar problems and found that a vegetarian diet just made me spacey and even more tired so I shifted back to eating meat, albeit with an emphasis on healthy fats and farm raised animals. As I studied more about nutrition I became convinced animal protein was a requirement of a healthy diet and would coach vegans and vegetarians to start to eat meat again. I did see animal protein help others heal as it had helped me. Then about two years ago my spiritual teacher suggested I try a plant based diet. I thought “no way” I’ll get sick, spacey and exhausted like before. I’ll have blood sugar problems and be unable to work like before. I’ll have food cravings and it’s impossible for me to eat without meat. Despite my reluctance I tried the updated modern version of my diet from my teens and early 20’s, what is now called a whole foods plant based diet. Remarkably I felt incredible, like when I lived in Japan. I was already quite healthy but now I took a leap forward in terms of energy, physical fitness and just general happiness. My blood sugar became more stable (that’s impossible with all these carbs I thought to myself), I had zero cravings, in fact my well established and nationally recognized addiction to Haggendaas Butter Pecan ice cream disappeared. My digestive system improved like 14 notches and my muscle definition and muscle tone became much improved. All of these changes without animal protein. All of these changes I had thought required animal protein. So my take away from all this is: #1 the diet that heals you may not be the diet you need long term, #2 read the science on food and nutrition and stay current because we are experiencing a major paradigm shift towards understanding the benefits of plant based eating, #3 try things even if you are convinced they are a bad idea and see what the wisdom of the body tells you. I now prescribe plant based diets for my patients with history of heart disease and cholesterol related problems and am amazed by the consistently positive feedback I receive from them. Blood pressure lower, off my statin medications finally, energy increased, I can digest now and my sex drive is finally back. Many things improve with the improvement of blood flow and many areas suffer from its restriction. Eat vegetables and many of them with every meal and I always recommend you eat your vegetables first, prior to any other portion of the meal. I follow a simple regimen of a cereal bowl size of veggies with breakfast, lunch and dinner, ½ of the time raw, think salad, and half of the time cooked. Works wonders, look at my photo, I’m 52 and don’t I look great!

Dr. Dan Kalish

Dr. Daniel Kalish is dedicated to teaching doctors Functional Medicine philosophy and practices. Through The Kalish Institute’s educational programs he has trained over 1,000 practitioners worldwide in The Kalish Method which solves patient challenges through a proven lab based approach.

  • Charlotte Kooistra

    I’m about to embark on a ketogenic diet that includes lots of fat and grass fed or pasture raised animal protein to lose weight. What do you think of ketosis and a ketogenic diet? If I’m successful losing weight I will adopt a mostly plant based diet laced with wild fish and some pasture raised meat which I will gradually reduce consuming in my diet.

    • Frances

      I would suggest considering the 5:2 Fast Diet developed by Dr Michael Mosley, BBC medical journalist. One restricts calories 2 non-consecutive days a week and eats normally the other 5. The Facebook groups are inspirational and motivational.

      • S. Kramer

        You might also want to check out the Kenzen Heart Health supplements.

    • S. Kramer

      You might also want to check out the Kenzen program
      http://bit.ly/Everyday_Organic_Based_Weight_and_Lifestyle_Management_Program

  • Michael Karp

    Thanks for the thoughtful article. What would be your thoughts about Peter D’Adamo’s Genotype Diet? He documents 6 different dietary types of people who have (sometimes completely) different food requirements and aversions.

  • subduedjoy

    I totally agree. A person’s ideal diet can change over time. I have Ulcerative Colitis. What I can eat even depends on whether or not I’m having a colon flareup and the condition of that colon flareup at the time.

    I also agree that whether or not animal products, including meat, are beneficial to a healthful diet depends on the condition of the individual. I was a vegetarian for 10 years. I went back to consuming meat after loosing a ton of blood with my last serious colon flareup. I also got systemic inflammation of the muscles and tendons, which is an uncommon complication of Ulcerative Colitis. When it comes down to it, I lost a substantial amount of nutrients that are found in blood, muscle, and tendons. The best way to get those nutrients back is by consuming blood, muscle, and tendons. Therefore, I’m consuming a lot of bone broth soups. I’m also consuming fatty fish too because it’s anti-inflammatory.

    In regard to macronutrients, I’m not concerned with my macronutrient intake right now. I’m more concerned with my micronutrient intake and in getting plenty of micronutrients to replace the ones I lost, which include micronutrients that my body couldn’t absorb during my last Ulcerative Colitis flareup. Vegetables and fruits are very high in micronutrients, so I consume plenty of those. I usually consume a breakfast made entirely of whole vegetables in the morning. That way I know I’m getting enough vegetables with fiber every day. Later, I tend to have vegetables made in a variety of ways: raw, cooked, dehydrated, blended, juiced, and/or fermented.

  • Laura Macdonagh

    Hi Dr. Kalish,

    Thank you for your insightful blog. What else do you eat with each of your meals besides vegetables?

  • Adrian Ward

    Hi Dr. Dan,
    Love your work.
    I suppose the ‘plant based/animal protein free diet’ that heals the heart issue patients may not be the best long term diet for them either. I do question your use of the term ‘plant based’ when you actually seem to mean vegetarian. Personally I believe a diet can be ‘plant based’ and not vegetarian. Could it be that once healed most people would do quite well on a diet that included a good mix of animal and plant based foods? – with a high plant based content.
    I would like it if you could also delve into the issues of:
    Omega-3 to Omega-6 ratio in the diet and in cell membranes and the effects on heart health (and all health actually) – I refer to the work of Bill Lands and associates.
    The impact of the Vitamin A, Vitamin D, and Vitamin K2 combination on cardiovascular health – calcium out of arteries and into bones.
    The differences between ApoE3 and ApoE4 genes and the different effects on artery health on different diets – what’s good for one isn’t necessarily good for the other. E.g. you can lower the LDL cholesterol of an ApoE3 patient on a low fat diet but increase their cardiovascular event risk via increasing atherogenic pattern B LDL – http://jn.nutrition.org/content/131/2/340S.long
    The impacts on cholesterol studies of lumping all genetics – including those with familial cholesterolemia, ApoE4, and ApoE4 – in the same boat.
    Best Regards, Adrian

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