I recently went for a jog and listened to Peter Attia, M.D. interview Erin Michols, M.D. on the topic of cardiovascular disease in women. Though the podcast was mostly about women’s health and the nuances of the various lipids, hormones, and other chemicals during different stages of their lives, there was an off-the-cuff statement by Peter that makes me ponder.
He stated that given the 5 pillars through which we can impact a person’s health - nutrition, exercise, sleep, emotional/mental health, and pharmacotherapy, he believes…
“The lowest impact in my view on cardiovascular disease is through nutrition.”
At first, I want to argue this point. We are typically taught that diet alone can change our body, our mind, and can reverse diseases like diabetes. But that all may be true to a certain extent while not affecting our risk for cardiovascular disease.
For example, when I got my latest bloodwork while being a strict vegan for over two years, my LDL-C was calculated at 90 mg/dL. In prior years, it has ranged from 81 to 95 mg/dL. Assuming LDL-C is the closest measure we have on these old bloodwork records, it doesn’t seem like cutting out all meat and dairy had much of an effect. Dr. Erin Michols also stated that she has vegan patients that do everything right and still have high cholesterol which frustrates them. She acknowledges that a poor diet would make their numbers even higher and believes the diet may influence about 20% of the LDL while genetics and the liver make up the other 80%.
This anecdotal information is ancillary to my main thought experiment. Accepting Peter’s premise, what would we change in our lives or society to reduce the incidence of Arteriosclerotic Heart Disease (ASHD)? Dr. Michols was co-author on an American Heart Association statement that suggest the many methods to affect ASHD both positively and negatively.
Psychological factors that influence cardiovascular health. Image credit: Circulation 2021
Another thing Peter mentioned is that atherosclerosis is caused by the duration and level of apoB (which includes LDL) in the blood vessels over time and over a certain pressure. It is like adding up the area under a curve. The longer the apoB is high, the longer the pressure is elevated, the more time you have on this planet, then the higher the buildup of calcium and risk for atherosclerotic cardiovascular disease.
My take away is to put more emphasis on the other factors. I am putting my bet on exercise, sleep, and stress reduction. Exercise is away to reduce stress, increase blood flow, and increase metabolic activity. Getting good quality sleep gives the body time to repair and rejuvenate. Finally, finding ways to purposefully reduce stress can go a long way (easier said than done as we meet up with family and fall back into hold habit snow track grooves). I look forward to learning more in the future if nutrition is the smallest of the 5 pillars for affecting cardiovascular disease. Let me know which pillar you think you can change for positive heart health benefits.