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Heart Attacks Heart Health Metabolic

Atherosclerosis and Inflammation

If you’re interested, you can read about how a coronary plaque ends up causing a blockage of the vessel and eventual ischemia. It’s often not what most people think. In this article, I will discuss the basics of how atherosclerosis and inflammation play a role in heart health.

Atherosclerosis

Plaque is the buildup inside an artery, leading to decreased blood flow and sometimes complete lack of blood flow – obstruction.

With obstruction comes ischemia – lack of oxygen to nearby tissue; not just muscle but the vessels themselves, the nerves, and connective tissue.

You need cholesterol to build up the plaque. With a total cholesterol value below 150, achieved naturally without medications, it’s rare to see someone develop much plaque in their arteries.

Another ingredient for plaque buildup is hardened vessels and increased pressures or turbulent flow of blood through those vessels. Hypertension can cause this; lack of exercise or inflammation can also contribute.

Unstable Plaque

Let’s lay the cards flat on the table – we don’t know much about inflammation. Astute clinicians can recognize inflammation when they see it. There are specific biomarkers that are helpful as well.

Inflammation adds to the problem of atherosclerotic and negatively affects heart health because it leads to unstable plaques.

A plaque is like a scab on a wound. If it’s the right time for it to come off, it’ll fall off without any bleeding. Rip it off prematurely, and you’ll get fresh blood.

That fresh blood will clot in the artery and create unstable plaque is prone to rupturing and exposing those raw surfaces. Suddenly you go from a tiny plaque to a massive clot that halts all blood flow in that artery.

Measuring Inflammation

There are several biomarkers that can tell us there is inflammation. But it’s not biomarkers alone I use in my practice.

Some people with inflammation in their bodies may never develop unstable plaque. And some with inflammation may not have much plaque, to begin with. But that might be the exception.

If someone has atherosclerosis, my goal is to increase their exercise capacity – both cardiovascular and anaerobic. Next, I want their systemic inflammation to be as low as possible.

Examples of inflammatory biomarkers:

  • CRP
  • ferritin
  • ESR
  • homocysteine
  • uric acid
  • triglycerides
  • HDL
  • platelets
  • neutrophils or leukocytes
  • insulin

Atherosclerosis and Inflammation

In regards to heart health, atherosclerosis isn’t a death sentence. Most of us will develop it, and less than half of us will suffer heart attacks or other complications because of it.

Preventing atherosclerosis is what I do in my program – that’s my main goal. But most of those who come to me already have atherosclerosis.

Plaque and inflammation have an essential relationship in heart health which I address with this second group. I want to decrease their total body inflammation to allow newly formed plaques or old plaques to stabilize.

Other Inflammatory Markers

No need to do these blood tests. Even without serology, we can tell if someone has inflammation.

The following are inflammatory markers I use based on signs and symptoms:

  • obesity
  • acne
  • rosacea
  • seborrheic dermatitis
  • joint pain
  • fatigue
  • sleep disturbance
  • agitation
  • sound sensitivity
  • GI changes
  • heavy menses
  • concentration issues

As you can imagine, these are rather subjective. Even if you have a little bit of all of this it doesn’t mean there is inflammation.

We use these data points as a guide. With them, we change our diet and lifestyle and reevaluate. If these markers decrease, then inflammation is likely.

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Heart Health Metabolic

Obesity and Cardiovascular Health

In my practice, I focus on obesity and cardiovascular health only when weight clinically affects heart health. Obesity, in isolation, if all else is optimized, offers only slight improvement if corrected.

Obesity has become a sociopolitical topic rather than a medical one. In my practice, I don’t focus too much on obesity unless it is a unique contributor to my client’s heart health.

Obesity in Healthcare

In western medicine, the patient is considered sick if their BMI is over 25. The patient will always have an ICD-10 code stuck somewhere in their medical chart.

It’s hard to know why conventional medicine manages patient health in such a way. Perhaps it expedites care and makes insurance billing simpler.

It is true that carrying extra weight puts most people at increased risk of insulin resistance, joint problems, sleep apnea, certain cancers, and other metabolic issues. But not everyone.

A person can be obese (BMI > 25) and relatively healthy. They manage their stress well, they are active, and their diet is optimized for their individual needs.

Vice versa, a person can have a normal BMI and not have an ideal metabolic profile. They can still have sleep apnea, hypertension, insulin resistance, and increased cancer risk.

Personal Perspective on Weight and Heart Health

I have clients who carry extra weight but live a good life. They have a diet that fits their individual needs, and they aren’t suffering in any significant way due to their weight.

For such individuals discussing obesity is clinically unnecessary. The minor percentage points of health advantages may not be worth the effort needed to change their weight.

If weight is an important topic, however, affecting their heart health, then we make that a priority. Think of sleep apnea or insulin resistance.

Obesity And Heart Health

I’ve worked with many heart health coaching clients and many of heart risk factors due to their lifestyles. Much more so than due to their body mass index.

We work together to improve their diet, stress, exercise, breathing, chemical exposures, and relationships that change their heart disease risk and improve their heart health.

If my client has the ideal diet, lifestyle, clean environment, sleep, and social support but remains overweight or obese, then we perform calculations to assess their ongoing risk.

This final risk score is how we determine if a weight reduction would add meaningful results; if it would improve this person’s heart health.

The Current Obesity Research

Look, all else equal, it’s potentially better to have a lower BMI – up to a point, of course.

However, we’re talking about an individual and not the population. The current research, just like most research, uses statistics to draw general conclusions. And it generally states a strong correlation between obesity and cardiovascular health.

General conclusions don’t define you and must be carefully applied to individuals. Otherwise, it’s easy to do a lot and not get results.

Most individuals who suffer from obesity also tend to have poor diets. They tend to be sedentary and, therefore, strongly correlate their weight and heart health.

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