Summary
Highlights
Dr. Lily Johnston, a vascular surgeon, explains that while heart attacks are not directly her specialty, the underlying systemic disease (plaque buildup) is preventable. This disease develops over decades, often starting in childhood, and current treatments often focus on individual issues rather than the holistic picture.
Not all saturated fats are equal; some, like those from whole-fat dairy, are not inherently harmful. The key is what you replace them with. Replacing saturated fats with refined carbohydrates or highly processed foods is detrimental. Different diets, even ketogenic, can be healthy depending on their composition and individual context. Fried foods, especially those from restaurants using re-circulated oils, are identified as single worst food for heart health.
Plaque in arteries is common, even in seemingly healthy individuals in their 40s. Its impact depends on its type and quantity. Plaque forming in one's 30s and 40s is a much higher risk than in later life. Soft, lipid-rich plaques are vulnerable and can rupture, leading to heart attacks. This soft plaque can be stabilized or even regress by managing risk factors, converting into a more stable, calcified form. Elevated insulin levels contribute to stiff arteries and plaque formation by down-regulating nitric oxide and affecting smooth muscle cells.
The impact of high LDL cholesterol in a low-carb, ketogenic lifestyle is nuanced. For individuals with existing plaque, cholesterol levels are relevant as they fuel plaque growth. However, for those without plaque, the decision to lower LDL is personal, considering trade-offs and individual health context. High HDL is not always beneficial, as its functionality, not just quantity, matters for reverse cholesterol transport. Lowering insulin and glucose levels is often more crucial for cardiovascular health.
Three key tests are recommended for early detection of heart disease. The CAC (Coronary Artery Calcium) score is widely accessible and inexpensive ($100-$150), identifying calcified plaque. A score over 300 indicates a high risk. CIMT (Carotid Intima-Media Thickness) is favored for its precision in detecting early-stage inflamed arteries and soft plaque, costing around $250-$400. CCTA (Coronary CT Angiography) provides detailed images of soft and hard plaque, assessing arterial narrowing, but its reliability in monitoring treatment effectiveness is still being evaluated.
Dr. Johnston identifies several foods as detrimental to heart health, including oatmeal (not always heart-healthy), sugar (bad), donuts, cookies, cakes (bad), pizza and processed carbs (bad), and most breads. Fruit juices, smoothies, and dried fruit are generally bad due to high sugar content. Flavored yogurts, low-fat dairy, margarine, fake coffee creamer, and most condiments with seed oils and barbecue sauce are also deemed harmful.
For heart health, a Mediterranean-style diet focusing on whole, diverse foods is often recommended if appropriate for the individual's overall health needs. Sleep is critical for cardiovascular health; both less than 6 hours and more than 9 hours per night increase heart attack and stroke risk, with 7-8 hours being optimal. Exercise, including aerobic and strength training, is a powerful tool for improving vascular health, promoting blood flow, and boosting metabolic health.
Critical lab tests for heart health include: Fasting insulin (optimal 3-4), platelet count (optimal <250,000 for inflammation), BUN, creatinine, and microalbumin for kidney function (microalbumin-to-creatinine ratio <7.5 for women, <3 for men), HDL (optimal >55 for women, >45 for men), triglycerides (optimal <100), Lp(a) checked once in a lifetime, hs-CRP (optimal <1), homocysteine (optimal <8 for B vitamin metabolism), and Vitamin D (optimal 60-100). Addressing these markers proactively can significantly reduce the risk of needing surgical interventions.