What caused my heart disease - Part 2
Two competing theories about heart disease
In part one of this series I introduced the two competing theories behind the formation and progression of heart disease, and described the Diet Heart Hypothesis. The Diet Heart Hypothesis holds that too much cholesterol transported in small particles (LDL) in our blood causes plaque to build up in our blood vessels. This hypothesis prevails in modern medicine and is the basis for most medical treatment today. I have conducted extensive research into this hypothesis and concluded that it likely does not explain how I developed advanced heart disease.
“…blood clotting is our body’s natural repair process in reaction to blood vessel wall damage. The clotting process can become harmful, however, when we lead an unhealthy lifestyle”
The thrombogenic hypothesis of heart disease
In this post I’ll describe the competing thrombogenic (clot forming) hypothesis.
Before we go there, let’s dispense with the fancy terminology. A thrombus is the technical term for a blood clot and genesis means the start or cause of. This simply means that according to this theory, heart disease starts with a blood clot. I’ll describe below how blood clotting is our body’s natural repair process in reaction to blood vessel wall damage. The clotting process can become harmful, however, when we lead an unhealthy lifestyle.
More about blood vessels
Our blood vessels (veins and arteries) are composed of two components that matter for this topic. Between our circulating blood and the actual wall of the vessel we have a very slippery layer called glycocalyx. This layer is like the slippery outside of a fish and it is designed to stop our blood sticking to and damaging our blood vessel walls. The blood vessel walls beneath the glycocalyx are called the epidermis composed of cells arranged like tiles on a wall.
If the slippery layer on top of the blood vessel wall is damaged or if the blood vessel wall is also damaged, our body immediately reacts to form a blood clot. The blood clot is our body’s way of trying to stop us bleeding out. Under normal conditions, the single blood clot eventually allows the endothelial cells and glycocalyx to repair and the clot is removed. Heart disease develops when the process is disrupted and the rate of damage exceeds the rate of repair and clot removal as described above.
How might heart disease start with a blood clot?
Let’s start by considering what happens naturally in our blood vessels when we encounter a need to repair damage. The normal three-stage process proceeds as follows:
The inner layer of an artery (glycocalyx, epidermis or both) is damaged
A small clot is formed over the damaged area to protect the inner layers of the artery
The small clot is broken down and eventually removed as the artery wall is repaired
This natural process occurs when our blood vessels are damaged by things like an infection, smoke particles, and high blood pressure. Damage is more likely to occur as we age.
However, problems occur when the damage-blood clotting process occurs faster than the repair and removal processes. In this scenario, blood clots form on top of existing clots. Plaque is basically a buildup of repeated blood clotting without enough of the repair and removal steps. Plaque can gradually grow until it eventually thickens the artery wall to the point when a final blood clot, on top of the existing plaque causes a heart attack or stroke.
According to this theory, plaque is likely to form if at least one of the following things happen:
Blood vessel wall damage occurs frequently in the same place
Multiple clots build upon each other before the last one can be repaired
The repair process is damaged
This theory is described most extensively by Malcolm Hendrick [1].
“Contemporary research has confirmed that [insulin resistance] is a strong and independent predictor of [heart disease], with compelling evidence that [insulin resistance] is a major causal influence on the pathophysiology of [heart disease].”
Root causes
The published literature on the cause of repeated blood clotting and heart disease can be quite confusing because it mentions many potential causes and many potential orders of events. To make matters worse, sometimes, the difference between association and cause is not clear.
From my research, I’ve concluded that the most likely root cause of heart disease is insulin resistance. This is a subject that I have covered before in my post on human metabolism. The best summary I’ve found on the subject is a review paper by scientists in America and Australia [2].
Re-stating the authors’ conclusions, the most recent literature on the subject shows that if you have insulin resistance, you may develop heart disease, because insulin resistance has been shown to cause heart disease.
In addition to this important review paper, a number of authors point to insulin resistance as the root cause of heart disease [1, 3-5] and cite the following factors:
Insulin resistance causes obesity and type 2 diabetes which are associated with heart disease
Insulin also has an independent role when present in high amounts over time
Damages blood vessel endothelium
Exhibits pro-clotting effects
Inhibits the body’s ability to break down blood clots
Reduces the number of cells in the blood available for cell wall repair
Exhibits pro-inflammatory effects – chronic inflammation is associated with heart disease
Reduces nitric oxide synthesis – nitric oxide helps to keep blood vessels open and to produce new blood vessel wall cells for repair
High levels of glucose in the blood (caused by insulin resistance) damages glycocalyx (slippery protective layer covering blood vessel wall)
Adding weight to our conclusion, scientists in 2009 [6] stated that:
“Insulin resistance is likely the most important single cause of [heart disease]”
How to avoid and arrest the progression of heart disease
If, like me, you are late to realise the importance of diet for good health and longevity, there are things you can do arrest and even reverse the development of a disease. Equally, if you’re younger or otherwise haven’t contracted chronic disease, the same principles apply to avoidance.
My daily good practice triad includes eating healthily for my body and my microbiome, exercise, and good sleep. I also practice time-restricted eating and hot/cold therapy most days of the week.
My extended list includes:
01. Eliminate harmful “food’
I describe this in my first post on modern malnutrition
02. Avoid all processed ingredients
See detailed lists in my post on human metabolism
03. Particularly avoid processed carbohydrates and seed oils
04. Avoid starchy vegetables
05. Eat healthily for your body and your microbiome
Eat a range of natural and nutrient dense foods
Eat a range of microbiome-accessible-carbohydrates
Consume fermented food and drink
Exercise every day
Get enough good sleep every day
“My daily good practice triad includes eating healthily for my body and my microbiome, exercise, and good sleep. I also practice time-restricted eating and hot/cold therapy most days of the week”
Summary
After reviewing the two competing hypotheses for the formation and development of heart disease, I favor the blood clotting (thrombogenic) alternative. I reach this conclusion from two directions. Firstly, through a process of elimination in which the Diet Heart Hypothesis has been so thoroughly discredited that the Thrombogenic Hypothesis is the only one left standing. Secondly, after considering insulin resistance as the likely root cause, it seems that run away blood clotting and plaque formation is likely to ensue.
Arriving at this conclusion is important from a practical point of view because it provides a path for us to follow to avoid, arrest, and perhaps even reverse heart disease. Avoid ”foods” that lead to insulin resistance, and adopt a healthy, balanced lifestyle.
As always, remember that we’re all very different. Experiment with what works for you and adopt your own daily practice for good health and longevity.
References
Kendrick, M. (2021) The clot thickens: The enduring mystery of heart disease. London: Columbus Publishing
Diamond, David M. Bikman, Benjamin T. Mason, Paul (2022) Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet. Current Opinion in Endocrinology & Diabetes and Obesity 29(5):p 497-511. | DOI: 10.1097/MED.0000000000000764
Malhotra, A (2021) A statin free life: A revolutionary life plan for tackling heart disease – without the use of statins. London: Hodder and Stoughton
Kendrick, M (2007) The great cholesterol con: the truth about what really causes heart disease and how to avoid it. London: John Blake Publishing
Bikman, B (2020) Why we get sick: The hidden epidemic at the root of most chronic disease – and how to fight it. Dallas, TX: BenBella Books, Inc.
Eddy, D, et al (2009); Relationship of Insulin Resistance and Related Metabolic Variables to Coronary Artery Disease: A Mathematical Analysis. Diabetes Care; 32 (2): 361–366. https://doi.org/10.2337/dc08-0854