Updated: Sep 27, 2019
Heart disease is the combination of three ailments. They are damage in the arteries called atherosclerosis, sudden events that lead to tissue death in the heart called heart attacks, and an underperforming or dysfunctional heart called heart failure. These things combined make heart disease the leading killer in the United States. While categorizing all these situations under the name heart disease makes them seem like they are one disease with one cause, I believe that there are distinct mechanisms for each one. It is of particular interest to me to show how the disease process of atherosclerosis that supposedly leads to a blockage and causes a heart attack are not as linked as we may think.
There are many forward-thinking cardiologists who have come to the conclusion that saturated fat and cholesterol in the diet does not clog arteries and is not the cause of heart disease. I am glad that the number of cardiologists that think this seems to be growing these days. However, when I hear them talk about heart health, they are still very focused on the idea that atherosclerosis in an artery is what will lead you to a heart attack. All the discussion is about dissecting out different variations in blood lipid markers and theories about what does actually cause atherosclerosis. But what if, when it comes to heart attacks, a build-up of plaque in an artery or a clot formation was rarely the cause? What if a heart attack could happen without either of those two situations happening? I believe this to be the case.
In my post called “Are Heart Attacks Caused By Blocked Arteries?” I discussed the work of the pathologist Dr. Giorgio Baroldi and illustrated how his work overwhelmingly calls into question the idea that atherosclerotic build-up or a clot formation in an artery is the cause of most heart attacks. (1) To further this point, it is also worth it to note how divided, in many different directions, the pathologists in the field of coronary artery pathology are.
In his book, Natural History of Coronary Atherosclerosis, Dr. Constantin Velican, who is Head of the Department of Pathology and Histochemistry at the Institute of Internal Medicine at Colentina Hospital in Bucharest, Romania, lists the definitions of atherosclerosis given by prominent scientists in the field. Reading through them you get the sense that there are more differences than similarities, not only in what atherosclerosis is and its cause, but also whether it is involved in the process of a heart attack. (2) How can the western medical system be so sure of the standard of care for a disease when there is such a lack of consensus among the top researchers of the disease?
Based on this, and the findings of years of searching, I would like to suggest a theory that I believe causes the vast majority of heart attacks. I have discussed this theory before in my ebook, in other blog posts, and in my heart course, but this will be my most detailed explanation to date. I will warn you it does get a bit technical and it is a bit longer than my other posts.
First, we need to understand three imbalances in the body that drive many chronic diseases. Those are the inability to readily burn fat for fuel, an excess of free radicals that leads to oxidative stress, and an imbalance in the stress response of our Autonomic Nervous System. I have discussed these in more detail in other blog posts (here, here, and here) but I will review them briefly here.
The first is the inability for our body to readily burn fat for fuel. Our bodies have the ability to burn a few different nutrients to make energy. Those nutrients are protein, fat, and carbohydrates. However, just because we can burn all three doesn’t mean that we should. Since carbohydrates are easily to burn when they are present, like when we eat them, then our body will burn them first. All good right. Not exactly. Turns out burning primarily carbohydrates is not a fast track to good health as it will result in the excess production of free radicals when we rely on them for fuel. (3,63) Our bodies are much more efficient when we burn fat and to do this, we need to restrict our carbohydrates so that our bodies can learn to burn fat, and ketones, again. This imbalance explains why eating a large amount of refined carbohydrates has been correlated with heart attack risk. (4) The most important thing to remember at this point is that the heart prefers to burn predominantly fat and ketones (5,6,7) and, as we will see, bad things happen when it is forced to burn predominantly glucose.
Secondly, let’s briefly review oxidative stress. Every time our body makes energy from a protein, fat, or carbohydrate it has to make a waste product as well. This waste product is called a free radical. As we said, burning carbohydrates (glucose) for fuel actually produces more of these free radicals (3,63) than if we were to burn a fat or a protein. (8) Burning fat is the most efficient as we make the least amount of free radicals doing this. This is important because having too many free radicals can end up causing damage to our bodies, including the lining of our arteries. (9) Other things can contribute to excess free radicals in our bodies too. Elevated blood sugar (from eating carbohydrates) (10) and excess exposure to toxins in our environment will also result in elevated free radicals in our bodies. (11,12) This imbalance tells us why smoking has such a correlation to heart attack risk (13), as it is a major toxin exposure. For now, it is important to remember that free radicals will damage the lining of our arteries and can deplete what is called Nitric Oxide (14,15).
The third imbalance is a dysfunctional stress response in our Autonomic Nervous System. Our evolved stress response is supposed to work by being activated only when it needs to be, like when our life is in danger. However, because of the mismatch in how our stress response evolved and the current environment we modern humans live in, our stress response can become imbalanced. This means that instead of healthily going back and forth between a stress response and a non-stress state we can get stuck in a stress response that causes our bodies to be on constant high alert. This can alter the signaling of our Autonomic Nervous System to our body. (16) This imbalance explains why heart attacks are more prevalent on stressful days of the year (17) and why Mondays are the most common day for heart attacks to occur. (18) For now, remember that our ANS is always supposed to send a balanced signal to our heart cells and if this is interfered with it can trigger a series of events that can lead to a heart attack.
Now, how do these imbalances directly cause a heart attack? Let’s dig into it. As we said, the heart prefers to burn predominantly fat and ketones for fuel (5,6,7) and the body has mechanisms in place that ensure that this happens. One being that the fat we eat is packaged into chylomicrons and then delivered, more or less, directly to the heart by way of the lymphatic system before it can be used by other tissues giving the heart first dibs. Another being that the heart has a signaling pathway that allows it to communicate directly to fat cells. (21) The heart takes burning fat pretty seriously, and I believe that the majority of heart attacks happen when a series of events takes place that forces it to switch to burning predominantly glucose for fuel.
The Standard American Diet (SAD) that is full of refined carbohydrates is not a diet that is going to help our body run on fat for fuel. Like we said, our body does things to make sure the heart still gets to burn predominantly fat we do eat even if we are eating many refined carbohydrates as well. It is very interesting that most of the body will burn glucose first if it is present, which is why we have to restrict carbohydrates to get ourselves in ketosis,