The Dr. Hyman Show - Longevity Roadmap: The Functional Medicine Approach To Heart Disease

Episode Date: January 14, 2021

In this special episode, you will hear a sneak peek into episode 2 of my new docu-series, Longevity Roadmap. In this episode we’ll discuss the biggest killer of our time: cardiovascular disease. There is so much misinformation out there about what causes cardiovascular disease. We’ll talk about innovative testing and recommendations around prevention. Learn more and sign up to watch the Longevity Roadmap docu-series at longevityfilm.com In the Longevity Roadmap docuseries, we will walk you through the latest research on longevity, healthspan, and how to live better, longer. We also dive into the science behind preventing the most prevalent diseases of aging, and we’ll talk about what it means to build a resilient body. Each episode will take on a specific focus to help you understand the diseases of aging and what Functional Medicine teaches us about prevention, testing, nutrition, and more. 

Hi everyone, my name is Kea Paroit and I'm one of the producers of the Doctors Pharmacy Podcast and I'm also the director of Dr. Mark Hyman's new Longevity Roadmap docuseries. I'm so excited to announce that Dr. Hyman's docuseries is now live and today we wanted to give you a sneak peek of episode two. In today's episode, Dr. Hyman and his team at the Ultra Wellness Center discuss the functional medicine approach to the biggest killer of our time, heart disease. Is cholesterol the enemy we've made it out to be? Is fat actually important for our health? What is the true cause of heart disease and how can we address it? You'll learn more in this episode. The biggest killer in the world is heart disease.

But our traditional approach is pretty misguided and addresses the symptoms, not the causes. High blood pressure, high blood sugar, high cholesterol don't just happen out of the blue. There are signs of imbalance, of underlying dysfunction that can be fixed. We've all been told, you know, why are we seeing more cardiovascular disease? The number one killer worldwide is cardiovascular disease. And cardiovascular disease is not just about the heart. It's about the whole vascular system, the whole endothelial system. The heart is the pump that pumps out to the arteries, goes to the small arterioles, then goes to the veins, then goes through the capillaries, and then back through

the lymphatic system. And that whole system is intimately tied in with our health. It delivers oxygen, it removes waste, and when we get inflammation in that system or gumming up of the pipes, that's when we get cardiovascular disease. So our endothelium is one cell layer that lines the inside of our arteries and this endothelial layer is critical for our health. We want that endothelium working really well and it needs to be able to relax to allow blood to get to all the different tissues in the body. And we know we can impact the endothelium. If the endothelium is not able to relax, that causes our blood pressure to go up. What we know is we start to see endothelial dysfunction and inability for that endothelium to relax even before, years before somebody actually goes on to have the diagnosis of

hypertension. So, you know, it's important for that endothelium to be able to relax. And there's many things we can do that can help with that. We know, for example, that blueberries are amazing because they're rich in these anthocyanins, these phytonutrients that can contribute to improvement in the endothelium. And we know that when people have what's equivalent to one cup of blueberries twice a day, within four weeks, studies have shown that you can drop systolic blood pressure, that top number on your blood pressure, by as much as a blood pressure medication. There's many things that can be damaging to the endothelium. Oxidative stress, for example, we know can cause damage to that endothelial layer. We definitely know that

inflammation is a trigger for damage to that endothelium. We know that that may be coming from the visceral adiposity. When people hold on to too much weight around their belly, that weight around the belly is not just sitting there. It is an active endocrine organ. That means it's secreting inflammatory markers like interleukin-6 and tumor necrosis factor, which goes on and causes inflammation throughout the whole body. We know this because when men gain too much weight around their belly, they have a higher risk for erectile dysfunction. And erectile dysfunction is definitely caused by endothelial dysfunction. So we need that endothelial, those blood vessels, to be able to relax.

And that's really important for everything from prevention of erectile dysfunction to keeping your blood pressure nice and low. And what we see with research is when men are able to lose the belly fat, they have improvements in erectile dysfunction. We see that all the time. The one thing that I need to tell everyone out there is that cardiovascular disease is not about cholesterol. Let me repeat that. Cardiovascular disease is not about cholesterol. Cardiovascular disease is about inflammation in the setting of cholesterol. And the standard cholesterol test that a lot of doctors do is, in my opinion, pretty much worthless. risk as well. How are they going to potentially develop heart disease or cardiovascular disease down the road? You don't want to wait till you have blocked arteries in all your veins and you can't walk up a flight of stairs and say, oh, you've got heart disease now. What is cholesterol?

What's it doing in our body? And how is it involved in heart disease? Well, cholesterol is not water soluble. So it can't move around our body freely. It needs to be carried around. So it's carried around by proteins. They're called lipoproteins. So when you go to the doctor, everybody by now gets their lipid profile done at least once a year, and they hear the terms total cholesterol. They get LDL, which is your bad cholesterol, or HDL is your good cholesterol. Those are lipoproteins. So there's low-density lipoprotein, which is LDL, which is considered

a bad protein, a bad lipoprotein. And then there's HDL, which is a high-density lipoprotein, which is considered good. LDL carries cholesterol from your liver to parts of your body where the cholesterol is needed to do its work. HDL, the good cholesterol, carries cholesterol from the periphery of your body and cells that have used it back to the liver for disposal. That's LDL's, that's HDL's job. That's why it's a good cholesterol. It carries cholesterol away once it's been used and gets rid of it. So where, where's the problem arise? And why is LDL the bad guy? And it's quite, and honestly, that's not, it's not the bad guy. And we're going to talk about that in a second. The problem with cholesterol is that it has an affinity for inflammation. And if the endothelial lining of the blood vessel wall in any part of

your body is inflamed, that creates an opening in that protective lining. The endothelial lining is the inner lining of a blood vessel. The blood vessel is like a pipe that's carrying water in your house. Well, your blood vessel carries blood throughout your body. The critical places those blood vessels have to be the healthiest are in your heart and in your brain. If you have inflammation in the inner lining, it's almost like rust in a pipe. If you have rust on that endothelial lining, that's inflammation. And cholesterol, particularly LDL,

has an affinity for that inflammation. And it will attach to the inflamed blood vessel wall. And it will actually enter in underneath that lining and begin to collect. And that's when it becomes a problem. When that happens, the immune system recognizes the cholesterol as a foreigner and creates an inflammatory response. And it sends these immune cells called macrophages to the site, and they begin to gobble up the cholesterol. And when they get big enough, they die, and they form these things called foam cells. And then these foam cells initiate an even more potent immune response. And that goes on day after day, month after month, year after year. First, it's on a

microscopic level, but then is that what we call plaque begins to grow underneath the endothelial lining. It pushes into the blood vessel wall, and that begins to occlude the blood flow. And when that happens to the blood vessels that feed the heart, then you start to experience what we call ischemic heart disease. Your first symptoms may be chest pain with exercise, chest pain when you're under stress. What we experience is the most devastating outcome of having that plaque forming is when it gets big enough that it cracks. And when it cracks, it causes a blood clot. And that blood clot will fill up the remaining space in the blood vessel. And that is a heart attack. And those can be lethal. And if they're not, they can create a

great deal of disability for patients. That's why cholesterol has gotten the bad rap, because it's the last bank robber running from the bank, and that's the one that got seen. But that's not the problem. The problem is what happened first, and that's the inflammation. So what causes inflammation? Lots of things. We're going to go back to lifestyle. And one of the most important things that causes inflammation are carbohydrates, particularly refined carbohydrates and sugars. And in the last 50 years, when we were living under the dogma of cholesterol is bad, our food industry started making low-fat foods. And to make low-fat foods tasty, you needed to add sugar, you needed to add salt, and you also needed to add fat. And the fat

that was being used, which was thought to be safe, were vegetable fats. But they were highly processed. And when you highly process vegetable fats, they become inflammatory. So now you have sugar, you have inflammatory oils that are now coursing through our bloodstream, creating inflammation. That's the critical piece. There are things that you can do to preempt heart disease. One of the big things that we're finding out is that the gut microbiome and leaky gut and also the oral microbiome are intimately tied in with cardiovascular disease. So if you have leaky mouth, leaky gut, you've got bacteria that are floating around your system. Your immune system then reacts to these organisms and then potentially can cause inflammation that's then being expressed itself in the vasculature. It's in the brain. You're

getting problems with memory, problems with brain fog, problems with shortness of breath. All of those things contribute to heart disease. The use of statins in primary prevention, meaning that if a person does not have any known heart disease, the number needed to treat, you have to treat about 500 people to prevent one heart attack. So statins for primary prevention really have no role, in my opinion. Unfortunately, because of standard of care and protocols, et cetera, and also how we sort of look at heart disease, a lot of people are unnecessarily being put on statin medications. And these medications do have their role. If you have a person who has had heart disease or has had heart surgery or stents,

there is good evidence that taking statins prevent secondary heart attacks and decrease risk for stroke and further heart attacks. But for primary prevention, which is what they're being used primarily for, they really are dangerous medications. There's lots of side effects. Patients can develop muscle disease. I think about 1 in 10 people will develop muscle injury. That's related to the fact that statins are actually poisonous to mitochondria. And then also they increase a person's risk for insulin resistance and diabetes.

So, again, statins really, in my opinion, should not be used for primary preventive heart disease. I have had patients who have come to me with a history of heart disease and never have they had their microbiome in the gut looked at, never had they had any type of testing done for increased intestinal permeability, which leads to metabolic endotoxemia, which is those gram-negative bacteria floating around in your blood. And then I also had some patients who've had heart disease that never had their oral microbiome looked at. The oral microbiome is really important. Lots of regular doctors don't even think about it. Even functional medicine doctors may not think about the oral microbiome

because they're not dentists. And a lot of dentists actually don't think that the mouth is connected to the heart. So there are tests that you can do that look at the oral microbiome. And interestingly, various specific organisms are more tied in with cardiovascular disease, also autoimmune conditions like rheumatoid arthritis and potentially even intestinal cancers. So CoQ10 is the body's natural antioxidant. Our body produces CoQ10. And statin medications are actually called HMG-CoA reductase inhibitors. That stands for hydroxymethyl-CoA reductase inhibitors. And when this enzyme is blocked in the synthesis of cholesterol, you also block the production of CoQ10.

CoQ10 is vital in the body for its antioxidant functions, and it's also vital because it also helps with mitochondrial function. So if a patient does need a statin medication, pretty much any patient should also concomitantly be onme Q10. You can also make an argument as people get older, their production or the natural production of CoQ10 can drop and you can actually measure CoQ10 levels, but optimizing CoQ10 in patients over 50 is a good idea, but especially if patients are already on statins. High cholesterol is not a statin deficiency. In fact, some studies

aggressively treating high blood sugar, high cholesterol, and high blood pressure with medication to prevent disease in pre-diabetics actually made them worse. Don't get me wrong, medication is often life-saving and critical when needed, but we're missing a big piece of the puzzle. Medications cover over the symptoms instead of addressing the underlying biology. And in the case of heart disease, that's inflammation, insulin resistance, oxidative stress, which is rusting and free radicals, hormonal imbalances, and toxins, and lots more. Bad diets, lack of exercise, stress, environmental toxins, nutritional deficiencies. Those are the things that lead to high cholesterol, high blood pressure, high blood sugar, and of course, heart

disease. In fact, over 90% of all heart disease can be prevented with a few simple habits. Staying your ideal body weight, exercising, not smoking, sleeping well, and eating a whole foods nutrient-dense plant-rich diet. Not a plant-based diet, a plant-rich diet, or what I like to call the pegan diet. But you may say, well, high blood pressure, diabetes, heart disease, they run in my family. Here's what the science tells us about genetic risk. Your genes load the gun, but the environment pulls the trigger. Your genes determine your predisposition, but not your destiny. In fact, 90% of chronic disease and unhealthy aging is caused by something called our exposome, not our genome. The exposome is the sum total of all our life inputs into our biology, our diet, first and foremost, that's most important, our activity, stress,

sleep, our relationships, our connections, meaning, purpose, toxins, microbes from outside and also in your gut, allergens, and lots more. The good news is we have control over almost all of it. Heart disease is the leading cause of death in the United States and also around the world. About 647,000 Americans die from heart disease every year. That's one in four deaths in America. Now, what most people and lots of doctors don't realize is that two-thirds of heart disease is caused not by fat or cholesterol, but by sugar and starch in our diet, causing a condition that's known as insulin resistance. In fact, the central feature of almost all age-related disease, whether it's heart disease or cancer or diabetes or dementia, even muscle loss and what we call sarcopenia, and even hormonal imbalances, is something called insulin resistance.

You just heard the first 15 minutes of episode two of Dr. Hyman's brand new longevity roadmap docuseries. To watch this full episode, visit longevityfilm.com and sign up for this free event. Between January 13th and January 24th, we'll be airing the longevity roadmap episodes for free. If you missed an episode, don't worry. We'll be playing all the episodes of this docuseries for free on the weekend of January 22nd. Again, to watch this docuseries, visit longevityfilm.com so you can take back your health today.

Thanks for tuning in.