Food and MedicinePreventing Heart DiseaseJohn E Whitcomb, MDBrookfield Longevity and Healthy LivingBrookfield, WI

Sponsored by the Wisconsin Integrative Medicine SocietyFirst Annual Conf. in Wisconsin on Integrative Medicine

Country Springs Hotel, WaukeshaDec 1, 2012

Objective1. New understanding of how

heart disease develops2. How to measure the trouble

you are in3. Use food to fix it

Take Home Messages1. Heart diseases starts as

inflammation caused by bad food choices

2. It develops slowly over 30-40 years3. Insulin is the junction where

metabolism and inflammation intersect4. We learn in stages and adapt when

given successful options5. Viscosity, wheat, alkalinity may all

play heretofore unexplored roles6. Vascular disease can be reversed

Old Theory1. Heart disease is a plumbing

problem2. Blood vessel gets plugged up3. Solution?4. Rush to the hospital5. Rush to the cath lab6. Rush to surgery

Plumbing Problem

We try to fix it when it shows up

Our current model lets you jump off the cliff, then tries to pull you back

Dirty Little Secret…..Routine Angioplasty Does NOT

prolong lifeEmergency angioplasty stops a

heart attack“THE PROBLEM”…….?Insurance pays for it, richlyIn medicine we do what we are

paid for

As many as 85% aren’t visible

Like all good science…1. We always want to dig deeper2. Go to the real sourceWhat are the risks for Heart Disease?1. High blood pressure (>130/85)2. Diabetes (> 100 FBS)3. Disordered lipid metabolism (>150

triglycerides and or < 40 HDL, <50 HDL)4. Inflamed belly fat with big tummies

(WHO Waist to Hip > .9 or .85)5. Micro-albuminuriaAKA: Metabolic Syndrome

Pop Quiz1. 65 % of heart attacks occur where

there is no obvious visible plaque? T or F

Answer: False, 85%2. Dirty little secret of angioplasty is?It doesn’t prolong life (unless with an

acute MI) because that’s not where the next one will happen

3. Name the size your waist/hip ratio should be.

< .9 for men, < .85 for women

The Solution?

Data for Women and Lifestyle“Adherence to a Low-Risk, Healthy

Lifestyle and Risk of Sudden Cardiac Death Among Women” JAMA: July 6th, 2011 page 62-69

Nurses Study from 1984 to 2010: 81,722 women

Results: 92% less risk of sudden death for women lacking the four risk factors compared to women with all four risks

First reduction is 45% better for having one low risk feature

Risks are?1. Not currently smoking, 2. Exercise at moderate to

vigorous intensity ≥30 min/day, 3. Diet in the top 40% of the

Alternate Mediterranean Diet Score (aMed) distribution

4. And BMI <25 kg/m2

Mediterranean Diet Is?A diet in the Mediterranean?Abundant vegetables, legumes,

fruitSmall amounts of

fish/meat/cheeseCheese and yogurtOlive oil in moderationWine in moderationVariety of antioxidantsLittle sugar/refined white flour

Life Style Trumps Drugs 3:1

Pop Quiz1. Name two features of the

Mediterranean Diet?Lots of veges, olive oil, less fish and

meat, some wine, some sunshine2. Name two strategies to help you

survive a heart attack and sudden death.

BMI < 25, Exercise, No smoking, Diet3. Adding one less risk factor increases

your odds of survival by_____%?40

ConclusionLife Style beats taking pillsPills might not do that muchAngioplasty doesn’t do that muchOur four strategies are the current

state of the art. (Lunch today will be…)

Our first step, on our change journey, should be to adopt those four.

But what happens if you are ambitious and want to do better than 92%?

Good ScienceGoes to the rootIs high blood pressure the root or

is it a symptom?Is Diabetes the root, or a

symptom?Do you want to do better than

92%What’s the next generation of

improvement?

New ConsensusDiabetes and high blood pressure

are part of a confluence of forces“Endothelial dysfunction”Common Soil HypothesisInsulin, sugar metabolism and

diabetes are all comingled. With insulin and sugar, you get inflammation.

Bottom Line?The beginning of vascular

disease is likely an autoimmune reaction of disordered inflammatory messages in the vessel wall

Toll receptor proteins lining the vascular wall set of inflammatory messages that starts the cascade

When do you want to intervene?

Glycocalyx May be Key!

The simple view

Read it in Wikipedia

What may be setting this off?

Viscosity?Viscosity is so far the only diagnostic

marker that has been correlated with every presently proven cardiovascular risk factor,

Including cigarette smoking,Type 2 diabetes, Metabolic syndrome,High blood pressure, Elevated LDL cholesterol, Low HDL cholesterol, Age, and Simply being male

ConclusionTo fix vascular disease….We have to fix Diabetes and hypertension…..?ViscosityWhat makes viscosity?Inflammation (makes for thicker blood)Toll receptor proteinsAnd the data shows, it will work better

if we do it ourselves rather than depend on a pill

Post-Prandial Stress

Look what happens with a beverage containing 75 grams glucose with 700 cal cream

Within 2 hours, glucose and triglycerides double

Nitrotyrosine and C-reactive protein

Flow mediated dilation deteriorates

Makes you feel better about a milkshake?

How is food going to fix this?Turn off inflammationCool off Toll Receptor ProteinsCalm your blood thickeningAlkalize your bodyMellow out endothelial

dysfunctionWatch high blood pressure go

awayObserve diabetes melt

Big Boast?Can you turn off insulin?And lose weightControl your “endothelium”Answer: YES. It takes about 6

weeks to measure, control and heal your endothelium. Once controlled, your risk drops even further.

How to turn off insulinNO free CARBS – major shift to proteinWheat may be a topic all of its own with

its clear autoimmune triggersChoiceGreen vegetables – (vegetable protein)

◦Spinach is 50% protein◦Broccoli has more protein than steak (2:1)

Animal protein – what we eat during winter/dry season for 5 million years

What is insulin?Our STORAGE hormoneNOT, emphatically NOT, our glucose

hormoneReleased when we have too many carbs

released too quicklyIndicates foods rich in carbs which are

usually secreted at the end of summerSummer is followed by 6 months of….?Today: our bodies get the message that

we are always at the end of summer – store fat

Esselstyn has proven you can reverse CAD with LOW fat - plant

Nutrient Plant Based Food Animal BasedCholesterol (mg) 0 137

Fat (mg) 4 36

Protein (grams) 33 34

Beta-carotene (mcg) 29,919 17

Fiber (grams) 31 0

Vitamin C 291 4

Folate (mcg) 1168 19

Vitamin E (mg_ATE) 11 0.5

Iron (mg) 20 2

Magnesium (mg) 548 51

Calcium (mg) 545 252

500 calories from plants: equal part mix of spinach, potatoes, limas, peas, tomatoes500 calories from animals: equal part mix of beef, pork, chicken, whole milk

Pop Quiz: Plant vs Animal Source of Nutrients

WHICH has more Protein?

Pop Quiz1. Which food group has more

protein? Plants or animalsEqual – essentially2. Which food group, cal for cal,

has more iron?Plants3. Which food group has more

beta-carotene?Plants

Common Soil HypothesisInflammation and metabolism are oneCalm insulin And you calm inflammationConclusionThe trigger for insulin are foods rich in

freely available carbohydratesYou have to stop eating white carbs in

such abundanceWheat is a particular problem: leaky gut,

acid content, autoimmune stimulant, etc etc

Hence: Non Carb Diets -Atkins: If you choose the meat

approachOr pure vegetables, very low fat

if you choose the Esselstyn approach

But neither has carbsNeither gives the winter signalWith the loss of insulin, you open

up fat cells, lose weight, drop your LDLs, raise your HDLs

WWW: What will work for meYou have to turn off insulin < 5You have to lose weightYou have to exerciseYou can’t smokeYou need to replace missing

nutrients like Vitamin D, omega fats,

This gets you to 92% reduction in risk

Are you Ambitious?Reverse and prevent completely?Get off wheat and all high glycemic foods/sugarsChoose a diet high in natural protein, fiber,

antioxidants, omega fats, (Paleolithic)Optimize hormones, remove toxins (Lead etc)Alkalize? (High green vegetable)It takes about 6 weeks to control the

endothelium completely“As goes the endothelium, so goes the patient”Measure and supplement endothelial

dysfunction (arginine, folate, Vit C, taurine, Mg, NAC etc)

Supplement proper inflammatory inhibition

PreDx Test is FREE! So you can repeat it and see how you are doing

Questions?My practice is at 17585 W North AveSheila or Sharon: 262-784-5300We specialize in sustained and

permanent weight loss, hormone balancing for men and women, reversing high blood pressure and diabetes, sorting out fatigue, Lyme

Functional Medicine at its best….Teaching how your body functions at

optimal levels