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Optimizing Heart Health
Measurement, actions, and supplements for cardiovascular health
Heart disease is the leading cause of death globally and has been for multiple generations. Each of us probably knows at least one person who passed away from a cardiac event, and many of us are attempting to prevent our own cardiovascular issues. While the issue of heart disease is long-standing, there is a wealth of research and findings not typically incorporated into standard tests and treatment that may allow us to more accurately measure and manage our cardiovascular health.
Markers of Cardiovascular Health
When it comes to understanding heart health, one term you'll frequently encounter is 'lipids’, but what exactly are these microscopic substances, and how do they contribute to cardiovascular health?
Lipids are fat-like substances that play essential roles in our bodies, serving as building blocks of cells and storing energy. The three primary lipids relevant to heart health are triglycerides, low-density lipoprotein cholesterol (LDL), and high-density lipoprotein cholesterol (HDL). Triglycerides, the most abundant fat in the body, provide a significant energy source. LDL and HDL, on the other hand, are involved in transporting cholesterol within the body.
If you’re interested in how this all works, Peter Attia has an incredible series of posts explaining it all. Special proteins, apoproteins, are essential in moving cholesterol around the body and facilitating their interactions with other cells. The most important of these is the apoB class. The critical takeaway: the number of LDL particles (LDL-P) and/or apoB are the absolute best predictors of adverse cardiac events. Pretty much everything else is just noise.
Unfortunately, most people only do a standard lipid panel, which does not measure either of these markers. If you or your doctor are basing your “cholesterol levels” assessment based on just LDL, HDL, and triglycerides from a standard lipid panel, that’s just not good enough.
Increasingly, it is believed that it’s the combination of the amount of cholesterol particles and insulin resistance over time that may cause cardiovascular problems. To reduce risk, you need to improve both your cholesterol numbers as well as focus on metabolic health, specifically your blood sugar levels.
This is why we incorporate apoB, HbA1c (which reflects your average blood sugar levels over the past 2-3 months), and hs-CRP (a measure of systemic inflammation) testing in our Cardio Care package and offer our members Quest’s Cardio IQ Panel (which has both LDL-P and apoB).
Diet and Lifestyle
Any approach to improving cardiovascular risk should account for improving metabolic health and lipids, which is why we focus on a few essential diet and lifestyle principles:
Emphasize a Low Carbohydrate Diet: A diet low in carbohydrates can help manage insulin levels, potentially preventing metabolic diseases that can lead to heart disease.
Prioritize Quality Over Quantity: Focus more on the food quality rather than just its caloric content. We encourage the consumption of nutrient-dense whole foods, such as vegetables, lean proteins, and healthy fats.
Include Healthy Fats in Your Diet: Incorporate healthy fats into your diet, particularly monounsaturated fats (as found in avocados and olive oil) and those high in omega-3 fatty acids (as found in fish).
Limit Processed Foods: Generally avoid heavily processed foods, which often contain high levels of sugars, unhealthy fats, chemicals, and sodium.
Engage in Regular Cardiovascular Exercise: Cardiovascular exercise can make your heart stronger and more efficient at pumping blood throughout the body, reducing insulin resistance and systemic inflammation.
In addition to following a heart-healthy diet, a number of supplements have also been shown to improve lipid profiles. A relative newcomer to this group of supplements is berberine.
Berberine is a well-researched botanical that has been tested in numerous clinical studies. It has a long history of use in traditional Ayurvedic and Chinese herbal practices, where it is used for a broad number of applications.
Berberine is thought to reduce LDL cholesterol through a number of physiological mechanisms. In a meta-analysis of six trials, 229 patients with high cholesterol who took between 900-1,500 mg of berberine supplements per day saw improved LDL cholesterol levels with reductions of 20-50 mg/dL (about 25% reduction from baseline).
Kong et al. reported that compared with placebo, oral berberine reduced the serum total cholesterol by 29%, triglycerides by 35%, and LDL cholesterol by 25%.
Additionally, Berberine has been shown to support healthy blood sugar metabolism and insulin sensitivity.
For the geeks here, this paper talks about “Lipid lowering nutraceuticals in clinical practice,” in which they explain the various mechanisms that these different supplements work to help lower cholesterol. One of the benefits of berberine specifically is that it may have an effect on the inhibition of PCSK9 which can result in the lowering of apoB specifically.
Berberine may lower blood sugar or blood pressure, so if you take medication for diabetes or hypertension, be sure to monitor your blood sugar and blood pressure while taking this supplement. Other potential side effects of berberine include constipation, diarrhea, abdominal distention, and bitter taste. Berberine is unsafe to take if you are pregnant or breastfeeding.
While berberine has been shown to reduce LDL cholesterol, it is important to talk to your healthcare provider about any supplements you plan to take. This is especially important if you are taking any prescription medications - please see WebMD’s list of possible medication interactions.
Advanced lipid tests focusing on LDL-P and apoB are more predictive of heart health than conventional lipid panels.
There is a synergistic risk posed by high cholesterol levels and poor blood sugar control, which is why we emphasize regular checks for HbA1c and hs-CRP levels.
Start with a focus on diet—low in carbs, high in whole foods and healthy fats—alongside regular exercise.
Additionally, we introduced berberine, a supplement that has been shown to improve lipid profiles and support healthy blood sugar metabolism.
Realize Me provides advanced software for health optimization. Our members receive significant discounts on high-quality supplements and lab testing. Check out our new Cardio Care package here.
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