What Markers Should You Track to Calculate Your Risk of a Heart Attack?
Updated: Mar 15, 2022
If you follow my blog you are familiar with the theory that the majority of heart attacks are caused by three imbalances in the body. Those imbalances are not being fat adapted, or not being in a state of ketosis, having a high amount of free radicals in the body resulting in oxidative stress, and having an imbalance in our Autonomic Nervous System signaling to the heart. I have discussed these and how they cause heart attacks in many previous posts, especially the one titled, “It’s Not Blockages, So What Really Causes Heart Attacks?”. In this post we are going to discuss the best things you can be tracking to make sure your body is not at risk for complications from these imbalances.
First up is being fat adapted. People refer to this as being in a state of ketosis where you make it so that the primary fuel source for your body is fatty acids and ketones. To do this you must restrict carbohydrates to less than 20-30 grams/day for about 4-6 weeks. This will allow your body to become adapted to burning fat and ketones. This fuel source is much more efficient for our body and the heart has been shown to prefer ketones for fuel even in the presence of glucose (1,2). Providing your heart with plenty of ketones so that it can thrive is essential for preventing heart attacks.
As we said, to do this you have to restrict your consumption of carbohydrates and over time your body will become a fat burning machine. A pretty cool thing happens when we start making and burning ketones. Since we are relying on fat and protein and not carbohydrates, we have a much lower spike in insulin. This is important because insulin is a hormone that tells our body to store energy, this is why carbohydrates make us gain weight. When we have much less insulin around, we don’t store energy and we end up wasting it. We can waste it in the form of heat, or we can waste it in the form of ketones. This video of a talk by Dr. Ben Bikman discusses this concept. Measuring the wasting of ketones is how we can tell if we are in a fat burning, ketogenic state.
So how do we measure ketones? Well, we waste ketones through our urine and through our breath. You can get urine testing strips to measure ketones in urine or you can buy a device that you breathe into and measure ketones that way, but these are not the most accurate ways. The most accurate way to measure ketones in in the blood. You can buy a relatively inexpensive ketone blood test kit that will do the trick, although the test strips can become costly. A blood ketone level of 0.5-1.5 mmol would indicate mild ketosis and a level of 1.5-3.0 mmol would be in the optimal ketosis range. It is worth noting that being in ketosis is very different than ketoacidosis that can sometimes be seen in people with uncontrolled Type 1 Diabetes. This happens when blood ketone levels get above 10 mmol.
There are also ways that you can get a sense if you are in ketosis other than testing. Ketosis can cause what is called keto breath. It is often described as a “fruity”, acidic, or metallic taste in your mouth. You may also have smelly urine or smelly sweat. These things are more common when you first become fat adapted.
Next up is measuring your oxidative stress. This one is not as straight forward or as easy to measure on your own as ketones are. Remember that the relevance to heart attacks, as far as oxidative stress goes, is that high oxidative stress will deplete Nitric Oxide (NO). So, we could measure NO levels to get some sense of oxidative stress. The best way to do this is probably a blood test for serum NO. You could also get blood tests measuring symmetric dimethylarginine (SMDA) and asymmetric dimethylarginine (ADMA) to get an indication of the health of your arteries, which is where NO is made. You could also use NO saliva test strips, though that is probably not as accurate of a measure.
Outside of measuring NO there are many other markers we can look at when it comes to oxidative stress and they are all done by blood test. Gamma glutamyl transferase (GGT) is a liver enzyme that can be elevated in a state of oxidative stress. You can also look for f2-isoprostanes, which measures arachidonic acid damage from oxidative stress, lipid peroxides, which measure damage to unsaturated fatty acids from oxidative stress, and 8-hydroxy-2’-deoxyguanosine, which measures DNA damage from oxidative stress. I think it would also be wise to look at markers of inflammation like hs-CRP, serum ferritin, and various interleukins. Markers of inflammation will be elevated when there is high oxidative stress, though that is not the only reason they can be elevated.
Next, we need to discuss how we can measure balance in our autonomic nervous system. The best way to do this is through Heart Rate Variability (HRV). If you find your pulse on your wrist and then calmly take slow deep breaths, you will find that when you breathe in your heart rate quickens and when you breathe out your heart rate slows. The difference between the fastest your heart rate gets on the breath in and the slowest it gets on the breath out is your heart rate variability. When you breathe in, your sympathetic nervous system is stimulated. When you breathe out, your parasympathetic nervous system is stimulated. A high heart rate variability will tell you how able you are to go from one state to the other and the balance you have between the two.
To most common question I get when it comes to HRV is what the normal range is supposed to be. There is actually no real normal range. When you start tracking your HRV you should get a good idea of your baseline after a few weeks and then work to improve your score from there. To give you some sort of reference refer to the charts below.
As far as devices to measure HRV, there are many. My two favorites are Elite HRV finger sensor and the Oura Ring. The Elite HRV sensor is a device you do not wear but rather just test your HRV at certain times during the day. The Oura ring is a ring that you wear that will track your HRV and other biomarkers throughout the day. There many other devices, most of them being one’s with wrist bands that you can wear. Most of the devices will have an app for your phone where you can download and track your markers.
Lastly, I will list the general baseline bloodwork that I think will give you a good idea of where you stand on your health. While many of these markers can be ordered on your own through independent labs it is important to discuss them with a knowledgeable provider before taking any action, preferably a provider trained in functional medicine.
NMR Lipid Profile
Basic Lipid Profile
Glucose control - Fasting Insulin, HbA1c, Fasting Glucose
Comprehensive Metabolic Panel + GGT