Reversing heart disease through diet and other interventions

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You can reverse or help heart disease through diet and exercise, but the efficacy of reversal really depends on how advanced your heart disease is, and genetic factors. We'll break it down below.

Heart disease isn't quantitatively defined, but rather a qualitative assessment that someone has a non-trivial chance of having a heart attack, stroke, or other harmful cardiac event caused by atherosclerosis.

Diagnosing heart disease

Atherosclerosis refers to a buildup of fats, cholesterol and inflammation on on inner lining of artery walls. The mechanism of atherosclerosis is not fully understood, but we have rough hints of how it works. There are several ways to screen for it including cardiac catheterization, doppler sonography, blood pressure readings and more. These all essentially measure if certain areas of the body aren't getting enough blood flow.

Lab tests can help you figure out if you're on the road to heart disease before any tests pick it up. Namely, through seeing nascent signs of elevated blood sugar or insulin resistance. This is why Galen recommends periodic blood lab tests for the majority of adults.

A more preventative test that is gaining popularity is a calcium CT scan. This scan provides a viewing of your arteries and their calcium deposits. This is called "calcification" and can be present with no other signs of heart disease! If you've already been diagnosed with heart disease, odds are this test won't be helpful. But it can be a game changer for those that don't have significant atherosclerosis yet.

Understanding the causes of heart disease

Reversing late-stage atherosclerosis

If you have late stage atherosclerosis, with a high risk of heart attack, you will be prescribed various drugs to thin your blood, lower your lipids, and lower your blood pressure. At this point, you have to throw the kitchen sink into the problem. An advanced level of atherosclerosis must be taken very seriously and strong interventions must be put in place to save your life. However, efforts cannot stop here because fixing those cardiovascular risk factors has not fully been shown to help those that are insulin resistant.

There's a few ways you've ended up here. Odds are you're insulin-resistant, and insulin resistant folks must pursue more heavy-handed therapies because in an insulin-resistant state, your body builds plaque at a much faster rate than metabolically healthy people through various mechanisms including directly by inhibiting nitric oxide production (endothelial disruption) and stimulating the MAPK pathway (reference, PUBMED ID: 31050706). Genetics and lifestyle do play a role in insulin-resistance, namely establishing thresholds. Certain people are able to metabolize glucose more effectively. A high level of muscle mass can introduce a glucose buffer, blunting your blood sugar spikes. Lastly, some people have more distributed fat stores.

Genetic factors like the presence APOE e4 or APOE e2 alleles has been shown to increase your odds of developing atherosclerosis but it is unclear whether the presence of insulin resistance is a pre-requisite to to the mechanism that causes these genes to become harmful.

Insulin Resistance, perhaps the largest contributor to heart disease

A massive risk factor in all stages of atherosclerosis is stomach fat, referred to as visceral fat. When your body accumulates visceral fat, its essentially a signal that all other fat stores are totally utilized, and fats must be now stored in the least desirable place - your stomach. This is a bit of a simplification but gets the point across. When stomach fat is being generated and/or present, it means your body can't cope with the amount of fats you're generating. Adipose tissue is indicative of chronically over-taxing your body with insulin spikes and excess calories. It is a sign of insulin resistance, caused by prolonged levels of high blood sugar.

A revisionist theory of atherosclerosis places far more weight on insulin resistance in causing atherosclerosis. The mechanism by which this happens is that it reduces the ability of fat tissue to clear and store circulating lipids, in part by reduced lipoprotein lipase activity among other things. More weight has been thrown behind this theory by type 2 diabetes patients not having lowered cardiovascular risk factors despite controlling things like dyslipidemia (high amount of lipids in blood), hypertension (very high blood pressure), and procoagulant state (propensity of blood clots to form) with medication.

One of the best pieces of literature on understanding the role of insulin resistance and heart disease is an article in Cardiovascular Diabetology, Association between insulin resistance and the development of cardiovascular disease.

Reversing heart disease

You cannot reverse advanced atherosclerosis in conventional medicine. Once you've gotten a non-trivial amount of atherosclerosis, you must adopt draconian measures to survive. There are experimental therapies that are great candidates for reversing atherosclerosis though, such as focused ultrasound, which breaks apart plaque.

If you don't have advanced atherosclerosis, you can absolutely use dietary and lifestyle interventions to reduce your odds of developing it though.

What do respected public experts say about factors that cause heart disease?

Research has shown a strong link between elevated LDL cholesterol levels and a higher risk of cardiovascular disease. In a Huberman Lab episode, Layne Norton highlighted Mendelian Randomization studies that reveal a direct correlation between lifelong LDL cholesterol exposure and heart disease risk. Scientists believe that LDL cholesterol can infiltrate the endothelium, a process facilitated by apolipoprotein B (apoB), which is associated with LDL. These studies confirm LDL's role as an independent risk factor for heart disease, demonstrating a clear dose-response relationship.

However, in this same episode Peter Attia, another respected figure in longevity medicine added maintaining lower apoB is crucial for managing atherosclerosis risk. ApoB is the primary agent in causing atherosclerosis. Notably, in our own research and literature review, we saw that ApoB is secreted more and cleared out less with high insulin resistance (reference, PUBMED ID: 23721961).

A diet and lifestyle to prevent heart disease

There's a good deal of evolution and change happening in how scientists identify the ideal diet for preventing heart disease. Previously people thought vegan diets, or removing animal-based products from their diet would help prevent heart disease. This trend sparked artificial butters and alternatives to animal fats that ended up being far worse than the products they replaced (via trans fats).

We can unequivocally say a few things though.

1. A diet that minimizes blood sugar spikes is good. This generally means higher protein intake and avoiding combining heavy amounts of fats and carbohydrates in the same meal. A higher level of carbohydrates may be tolerated if the individual is regularly exercising and consuming the stores carbohydrates.
2. More muscle mass blunts blood sugar spikes, so doing an exercise routine that promotes muscle mass is unequivocally helpful.
3. Not over-consuming calories. Having too many calories, even if they are nutritious will cause insulin-resistance.
4. Increasing your cardiovascular fitness through intense exercise (interval and high intensity cardiovascular-based exercise sessions).
5. A high volume of low-intensity cardiovascular exercise has been shown to increase mitochondrial flexibility, keeping your cells youthful.

All of these recommendations must be done consistently in order to realize their benefits.

Are there any dietary silver bullets?

Many will point to purported superfoods such as olive oil, cacao, etc. that promise protective cardiovascular attributes. The truth is, there's a degree of legitimacy to their claims but it is dwarfed by diet and exercise. If we had to assign numbers, 95% of the benefit you can accrue to preventing and reversing heart disease will be diet and exercise, and maybe 5% on esoteric supplementation. So we found it not useful to cover this in our summary of preventing and reversing heart disease.