My experiments with preventing heart disease

I wrote previously how learning that I had a family history of early heart disease prompted me to take a more proactive approach to managing my health. After getting tested for a number of markers associated with heart disease, and scoring in the high range for some of them, I began forming an action plan.

Of course I knew the basic plan would be to "eat well and exercise", as per the advice most doctors would offer. But I wanted more specifics. What's *my* optimal diet for preventing heart disease? Which has the greater effect, diet or exercise? Is focusing on one alone sufficient? How much should I be exercising?

Diet

I began by focusing on just diet. Generally I eat pretty well, avoiding sugar and refined carbs. This helps keep my weight under control (I have an endomorphic body type) but I do eat a fair amount of meat (minimum twice a day) and especially red meat (minimum twice a week). There seemed to be much literature advocating a plant-based diet as a means of not only preventing heart disease but reversing it. The physician behind much of this work, Dr Dean Ornish, worked with Bill Cinton to help him recover from his quadruple bypass in 2004.

I decided to try a modified version of the strict plant-based diet. I cut out all meat, fish, dairy and restricted eggs to a maximum of twice a week.  I found this change much tougher than I'd expected, I felt gassy and low-energy after the second week.  After one month I made a modification and switched to occasionally having lean, white meat or fish for dinner but still no red meat at all. I found this more workable and would still often go days without any meat at all.

After two months I ran another set of blood tests to see if my heart disease markers had changed:

Marker Change Target
Total Cholesterol 206 mg/dL (+/- 0%) < 200 mg/dL
LDL (bad cholesterol) 127 -> 119 mg/dL (- 6%) < 100 mg/dL
HDL (good cholesterol) 70 -> 77 mg/dL (+ 10%) > 40 mg/dL

I was happy to see improvement in the ratio of my LDL and HDL.  Even though it'd only been two months,  I was somewhat surprised that my total cholesterol hadn't changed at all though.  This made me curious about the exact link between diet and cholesterol.  I began looking into the research connecting them. I discovered something that stunned me. For 70% of people, diet supposedly has minimal effect on their cholesterol levels (more detailed explanation below).

More concerning to me was that my dietary change had negligible effect on two of the more advanced heart disease markers, in fact they showed a tiny increase:

Marker Change Target
Apo(B) 98 -> 102 mg/dL (+ 4%) < 80 mg/dL
Lp(a) 148 -> 151 nmol/L (+ 2%) < 75 mg/dL

I found there was considerable evidence that Apo(B) may actually be a more important predictor of heart disease risk than LDL cholesterol. The Canadian Cardiovascular Society has included Apo(B) in its heart disease management guideline since 2009.  A quick explanation of the theory is that the number of cholesterol particles you have, is more important than your total amount of cholesterol.  Apo(B) count is a proxy for the number of cholesterol particles because each particle has exactly one Apo(B) molecule. 

There were some more notable changes in two of my other makers:

Marker Change Target
Triglycerides (fat in your blood) 80 -> 49 mg/dL (- 39%) < 150 mg/dL
hs-CRP (Inflammation) 3.1 -> 0.8 mg/L (- 77%) <1 mg/L

I was happy to get my triglycerides down but they were already in the healthy range, unlike my other markers. It was also hard to know what to make of the inflammation decrease, since it's a notoriously variable reading (intense exercise or a recovering from a cold could both raise it). Frankly, it was a surprise to me that I'd scored so highly in the first place and I suspect it could have just been a funky reading (human involvement in the testing process means there's an inevitable margin for error on these tests).

Exercise

During these two months I'd not been exercising at all. Now I kept the same diet and signed up for a crossfit gym, working out there 3x a week. Two months later I ran the tests again. This time I found even fewer changes in my cholesterol levels:

Marker Change Target
Total Cholesterol 206 md/dL (+/- 0%) < 200 mg/dL
LDL (bad cholesterol) 119 mg/dL (+/- 0%) < 100 mg/dL
HDL (good cholesterol) 77 -> 73 md/dL (- 5%) > 40 mg/dL

However I saw some significant movement in my other markers:

Marker Change Target
Apo(B) 102 - 90 mg/dL (- 12%) < 80 mg/dL
Lp(a) 151 -> 88 nmol/L (- 42%) < 75 mg/dL

Given the importance of Apo(B) in particular, as I mentioned above, this was really encouraging. My remaining markers showed some mixed results:

Marker Change Target
Triglycerides 49 -> 61 mg/dL (+ 25%) < 150 mg/dL
hs-CRP (Inflammation) 0.8 -> 0.5 mg/L (- 37.5%) < 1 mg/L

I'm not concerned by the rise in my triglycerides though, as I'm still well within the healthy range. I plan to continue monitoring it and if it keeps continues moving upwards, I'll have plenty of time to figure out a strategy to course correct.  

Conclusion

Given the importance of Apo(B) as a predictor of heart disease and its non-response to my diet-only modification, regular exercise is clearly an essential component of an effective heart disease prevention plan for me.

Looking at my LDL trend, the lack of change in the past two months is interesting. I can think of two explanations; 1) my body is sensitive to dietary cholesterol and I'd have to adopt a strict vegetarian/vegan diet over a longer period of time to bring it down into what's considered the healthy range, 2) my exercise regime increased my body's production of LDL and cancelled out any decrease from my diet modification (there is some precedent that increased muscle mass elevates LDL levels, and since starting crossfit I've gained just over 3lbs of muscle mass).

I plan to continue with my regime of limiting meat intake (I actually quite enjoy it now as it gives me a reason to explore new places and foods for lunch) and regular exercising. Hopefully in another couple of months my Apo(B) in particular will continue moving towards the healthy range.

I've always known that eating well and exercising are things I should be doing but tying them to specific data that affects how long I'm going to live for, gives me a level of motivation I've not felt before.

Thanks to Dr Mager for reading a draft of this.

HN discussion here.

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Notes

For the full explanation of how cholesterol works, I'd really recommend reading The Straight Dope on Cholesterol. It's an incredibly detailed set of articles though. This is a fairly good summary of the main points, though still a decent read itself. I'll attempt to give a super simple nutshell explanation here:

  • Cholesterol comes both from the food you eat (only animal food products) and is also produced by your liver (it's present in every cell in your body).
  • The type of cholesterol from food is typically too large in size for your cells to absorb it, so it just passes straight through.

Comments

Harj, Are you familiar with Peter Attia's blog? Very interesting stuff. Like you, he has been experimenting with diet (and exercise) and measuring the impact on his biomarkers. Brilliant guy. http://eatingacademy.com/
A variable left out here is meat/produce quality... Grassfed/pasteured meats and organic produce, prepared correctly could be the missing component needed to get those ratios looking sweet. Look forward to more of this.
@C Scott - absolutely agree. I tried to control for this as much as possible my only buying and cooking good quality meat at home. I do tend to eat out several times a week for dinner though, usually at decent places, so I'm hoping they invest in decent quality meat.
@Mark, I love his site - I linked to his series of articles about Cholesterol above
Have you heard of Arginine? It can really prevent heart diseases.
You should probably acquaint yourself wIth the work of Fred Kummerow at the U. of Illionois. Here's a starter: http://news.illinois.edu/news/13/0227heart_dise... But try to find his primary research online. He has shown that cholesterol remains completely misunderstood by most of the medical profession.
Very interesting post. My current **personal** understanding is that an optimal diet could be a plant based (not plant exclusive) moderate in proteins and fat. Cholesterol as a risk factor appears to be a proxy for something else, and may not be harmfull by itself. But oxidation and other problems occurs during digestion (see http://www.sciencedirect.com/science/article/pi...), mostly "catalysed" by red meat (heme iron probably causative), making potentially harmful compounds. This can be mitigated by having red wine or other antioxidants from plants with your meat, and generaly eating less red meat. The quality of meat matters for ethical and gustative reasons, maybe for having less added hormones or antibiotics, but for the other reasons the diference is marginal at best : it's still rich in heme iron acompanied by "ready to be oxydised" cholesterol, which seems (to me) to be the main problem. Lots of studies point to restricting proteins for longevity, unless you're young and still growing, or want to grow muscles. It seems to be the active part in caloric restriction, and a common denominator for the diets in Blue Zones. Longevity is certainly a good proxy for general cardiovascular health ;-) There are studies showing that diet can change cholesterol levels (i remember one on Tarahumara indians, who have very low cholesterol at baseline: seems to be necessary to observe an effect), but my understanding is that it does not really matters.
There is a continuing mythology surrounding cholesterol, primarily the assumption that eating it equates to it piling up in your arteries (as if your arteries were equivalent to household plumbing, which they certainly aren't). We model our living, biological systems as if they are inert mechanical or plumbing systems, when they are not at all inert. There is also a continuing mythology surrounding saturated fats, i.e. that they are bad for you -- they aren't in and of themselves (ignoring sources of the fats here, e.g. organic versus other, red meat versus white). Finally, there is the 'a calorie is a calorie' myth -- a calorie is a calorie when burning it to test energy content, but a calorie is most certainly NOT a calorie when that substance enters the complex biochemical system of your body. Sucrose and fructose, for example, are handled entirely differently; other substances are too, and you cannot equate 1 calorie entering your mouth as equivalent to 1 calorie of fat deposited if it's not utilized or burned in the body. The idea that because fat is 9 calories per gram whereas carbs are 4 calories per gram means you can eat more carbs than fats is entirely false -- your bodily systems behave non-linearly with respect to the substances you digest. Saturated fats are critical to brain function, cell wall health and other things. I recommend http://garytaubes.com writings, and in particular, this talk by Robert Lustig - http://www.youtube.com/watch?v=dBnniua6-oM Finally, understand that lowering your cholesterol levels naturally or with statins below 200 may (or may not) lower your risk of heart disease, but it will increase your risk of cancer and strokes.
Harj, do you use one of the new diagnostics testing services for your lab work, and/or do you have a recommendation for a good lab diagnostics vendor for self-monitoring? Thanks in advance. Great post.
Hello, My name is Dr. Dana Hansen and I am faculty at Kent State University, College of Nursing. You may view my faculty website page at http://www.kent.edu/nursing/facstaff/bio/~dhans... . We are contacting you because you are listed as the contact person of the blog. My research team and I are interested in learning about the family caregiver’s experience with reading their loved one’s illness blog. Therefore, we are conducting a research study and are inviting you to participate. Below are details of the study. You can also find out more by going to our study website: (will be added once website developed). If you are not the family caregiver of the person with a serious illness, please forward this information to someone who is. Family caregivers are eligible to participate in the study if: • Both you and your loved one are 18 years or older • The blogger/ill person must have a diagnosis of cancer, congestive heart failure (CHF), chronic obstructive lung disease (COPD), or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) • The blogs must be written in English with a minimum of 1 posting per month • The family caregiver must participate in the blog by responding to the blog or reading the blog Procedure and Time Commitment: The family caregiver should go to our website where they can click on an icon labeled “participate in study”. The family caregiver will be asked to read and agree to a consent form. If they choose not to participate after reading the consent form, they click on the icon labeled “I disagree”. If the family caregiver agrees to participate, they will complete a form asking their name and how to contact them. Then a member of our research team will contact them to schedule a time to conduct a 1-2 hour interview where we will ask questions about their experience as a caregiver interacting with their loved one on an illness blog. A nominal onetime payment of $50.00 will be sent to the participant once the interview is complete. Participation is voluntary, refusal to take part in the study involves no penalty or loss of benefits to which participants are otherwise entitled, and participants may withdraw from the study at any time without penalty or loss of benefits to which they are otherwise entitled. Thank you for your time and consideration, Dr. Dana Hansen Dana Hansen RN, PhD Assistant Professor Kent State University, College of Nursing 113 Henderson Hall, P. O. Box 5190, Kent, OH 44242
Hello, I am posting this on behalf of Dr. Hansen. Please note, we neglected to put the website in the original email. This email contains the website for the study where you will find important information. My name is Dr. Dana Hansen and I am faculty at Kent State University, College of Nursing. You may view my faculty website page at http://www.kent.edu/nursing/facstaff/bio/~dhans... . We are contacting you because you are listed as the contact person of the blog. My research team and I are interested in learning about the family caregiver’s experience with reading their loved one’s illness blog. Therefore, we are conducting a research study and are inviting you to participate. Below are details of the study. You can also find out more by going to our study website: https://nursing.kent.edu/caretaker If you are not the family caregiver of the person with a serious illness, please forward this information to someone who is. Family caregivers are eligible to participate in the study if: • Both you and your loved one are 18 years or older • The blogger/ill person must have a diagnosis of cancer, congestive heart failure (CHF), chronic obstructive lung disease (COPD), or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) • The blogs must be written in English with a minimum of 1 posting per month • The family caregiver must participate in the blog by responding to the blog or reading the blog Procedure and Time Commitment: The family caregiver should go to our website where they can click on an icon labeled “participate in study”. The family caregiver will be asked to read and agree to a consent form. If they choose not to participate after reading the consent form, they click on the icon labeled “I disagree”. If the family caregiver agrees to participate, they will complete a form asking their name and how to contact them. Then a member of our research team will contact them to schedule a time to conduct a 1-2 hour interview where we will ask questions about their experience as a caregiver interacting with their loved one on an illness blog. A nominal onetime payment of $50.00 will be sent to the participant once the interview is complete. Participation is voluntary, refusal to take part in the study involves no penalty or loss of benefits to which participants are otherwise entitled, and participants may withdraw from the study at any time without penalty or loss of benefits to which they are otherwise entitled. Thank you for your time and consideration, Dr. Dana Hansen Dana Hansen RN, PhD Assistant Professor Kent State University, College of Nursing 113 Henderson Hall, P. O. Box 5190, Kent, OH 44242

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