#21

I will agree that the specific claim of plaque reversal - hasn’t been adequately documented. I’m interested in outcomes and not giving non-evidence based interventions. I think his program does a good job in that arena.
I’d incidentally never rely simply on a diet and lifestyle interventions for a patient with vascular disease - nor would I be overly thrilled in de-escalating maximal medical therapy.
I suspect we agree on the issues here - but Ornish shouldn’t be discredited - but might the claims be ahead of the hard facts? Possibly. Does it matter? I think outcomes matter. On that, their program is doing well.

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#22

I can appreciate your perspective in saying that the treatment plan is usually pretty straight forward @DrFraser. In rereading my comments, I can see that may have overemphasized the importance of considering a wide array of options, especially in the more common cases.

With this in mind, however, when I look at this from the perspective of measurement science, I see a messy situation in which we have overemphasized statistical probabilities and underemphasized or outright ignored the unexplained areas under the curve which in many cases is large. When I look at lipids, for example, I see that apo(b) accounts for more variance in CV outcomes than LDL, HDL, and TG combined. Therefore, one would be wise to focus on managing to that single metric. But is that the case? How many adverse CV events do we see with low and normal apo(b) levels? Quite a few I think? How many do we see with overall normal lipid levels? Again, quite a few. The same is true for BP. And the converse is true for these metrics as well. I have relatives who lived well into their 90’s with high BP (few measured cholesterol then) an never experienced a CV event.

In sum, when I step far enough back to look at this simply as a case of data science, it looks like we have a seriously incomplete picture not necessarily of what caused a CV event (we can see the evidence) but of what allowed or set into motion or facilitated the chain of events that led up to the end state event. The dynamics are not quite as bad as blaming fire trucks for causing fires but it is not too far removed from that either. Your thoughts?

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#23

One other thought. We may not be following even the best trail currently available. When we see that 20% of CV events occur with normal levels of inflammation, we say, “Well, that’s not it” apparently not noticing that there is no other metric that accounts for that much variance in outcomes. Why aren’t we studying how many CV events occur with hsCRP levels at or below, say, 0.35? If the answer to that question is under 15%, that single metric should go to the top of our clinical management list until we find a better one. (Of course we need to refine our investigations as to whether CRP is a causal variable or a co-variant with the cause, and so on.) Even though we have a decent amount of evidence suggesting that is is tough for CV events to develop to a critical stage in a low inflammation environment, I have not seen a single post CV event treatment plan in which lowering CRP in a healthy way was the number one or often even a mentioned objective. LDL-C is generally at the top of these plans. This does not seem like good science. I make this case only as an example of a broader issue.

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#24

This was excellent, thank you! And a good take on EVOO! I find myself just adding it to add it because I’m supposed to. Perhaps now I will just add it when I feel a need to.

Also, you mentioned gut health and you are obviously knowledgeable, so here is a new one for you!!

My genes relating to my heart are not my friend. But I’ve been eating a great diet for many years (but of course I did a lot of damage during my ‘no fat but sugar is ok’ and lived on snackwells phase). I consume ridiculous amounts of fiber and have for several years… I’ll have a can of beans and head of kale for lunch kind of fiber!

So, in order for me to find something I excel in, I did the ZOE gut test. I was so excited to learn I have a rockin gut microbiome.

Imagine my surprise to discover it’s abysmal!!! My husband, who eats ruffles and Ben and Jerry’s and has little plant diversity blew mine away. ZOE gave me all the recommendations, but it was of no value because I was already doing it!

I messaged Dr B (the gut health guy) and he said based on my diet, he’d try to find out WHY my gut isn’t better than it is

But I have no clue!!!

Perhaps this is why my heart scan was as bad as it was… what came first…

Any thoughts/suggestions?

Yes, i could have more fermented foods, but i do consume them. I even did aprox 4 weeks of Methodology (once I saw Christopher Gardner used them for a study) last summer to see if I felt different and had more energy after having a ‘perfect’ diet, in the event I that what I thought was almost perfect was lacking. (I’ve used cronometer a few times to check, and i think I’m doing well, but you never know!)…

Any ideas on why my gut sucks… and is there anything to do when i already eat this way?

And this is why I’m starting rapa… I’m wanting to level the playing field a bit for my health because I’m behind the 8 ball.

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#25

The struggle is real. I’ve been vegetarian since I was 25 (vegan for many years now)… even that alone is weird to so many people, but lately it seems trendy, so you are good there even if your friends are slow to come around. Yesterday, I was just talking to someone at a hotel in NYC to see if their restaurant had anything I could eat. I said I’m vegan and expected the typical silent eye roll… without skipping a beat, she said that’s impressive!!! I was blown away… my how things have changed in the last few years. Since 2020 covid, I started mostly cooking at home and barely drinking (just because I was home) and I loved feeling better, so I never went back, but I will still have an occasional glass of wine. I just pick and choose.

Now that so many credible people are saying alcohol is not good for us, I’ve noticed some people we dine with are no longer drinking either!!! And in the last couple of years, I’ve learned if I go to bed uber early, I sleep better because apparently that is my circadian rhythm… some friends are slowly starting to discuss sleep, too. I am in the general Bay Area, so this does explain why I know so many progressive people, so it’s definitely easier for me. None of this really helps you aside to give you some air cover for the great changes you’ve made.

And yeah, being grateful to be alive will do that!! I love that you’ve done all of this! If not for the wake up call from seeing my coronary artery calcium score, I’d be happily living on vegan cupcakes… wanting to live is an excellent motivator! I hear with profound weight loss, a lot of people eventually find new friends due to having less in common. I imagine the same thing happens with healthy lifestyle. ?

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#26

I can’t really give specific advice here - but Dr. B is great. I’m not overly convinced that Zoe is the end all be all in this space. If everyone involved was like Dr. B - would be much better.
There is the other component of things relating to gut inflammation, altered gut permeability. I’ve not been overly excited by the gut microbiome as there are multiple healthy patterns. I’m more interested in Zonulin, Occludin, LPS antibodies and then if positive, looking at food sensitivities of items that might contribute to inflammation and altered gut permeability. Not that I don’t go there sometimes on the microbiome - the usual first step is a KBMO Fit 176 test.
Anyway, this is a complicated area, and gut health naturally relates to autoimmunity and inflammation – and lots of other things. Great shout out for Gardner - love almost everything he does. Very smart fellow!
Sounds like you need a well trained physician who practices in this space who is used to figuring these types of things out.
Your gut may not be the main issue - and one would need a review by someone who sees you in a non-mass produced manner. I’m opposed to the attempts of mass produced treatments and analysis without personal contact, and without the physicians involved being both generalists and specialists. There is a whole body attached to both your gut and cardiovascular system - and to everything else. The whole system has to be considered in totality. I often see inappropriate diagnoses when there isn’t an understanding of the entire system and where to start digging in to evaluate an unusual presentation.
I’d suggest you take a look at A4M/Functional Medicine websites and find a physician who seems like a good match in your state who has expertise in vascular and gut … and whole body to take a look at everything.

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#27

Hi @RobTuck,

I can go based upon a remarkably unusual group of people on this forum, who aren’t very much like the patients I treat in the ER, or by a lot of years of seeing patients who present with symptomatic vascular disease.

I cannot recall cases when investigated having a lack of pretty obvious reasons for what has occurred. A lack of traditional risk factors (usually modifiable) and lab abnormalities +/- major lifestyle risks in my 27 years of practice has led to zero cases of symptomatic disease that I can recall. I’m sure such cases occur, but they are the outlier, not the rule.

I’m not saying there isn’t a lot more to learn in this space - but as of today … what to do - I think there are pretty clear pathways. Having a PCP tell you everything is good is totally different than having someone used to optimization micromanage all risk factors. People with symptomatic disease who have been told everything is fine based on current guidelines are commonplace - but long time optimized patients presenting with vascular disease is something I’ve not experienced.

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#28

Bempedoic Acid + Ezetemibe reduces LDL, ApoB, and hsCRP by 50%. At least according to my 77-year-old father’s bloodwork. It also agrees with the scientific literature available.

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#29

DeStrider sorry to hear about your mom. Here is what I can tell you. I bought a DASH Diet book, and did not read it, I researched using the Internet, and Chat GPT-4 on what to do…how to live to stay alive to the best of my ability. I cut and paste all of that info into a document and I add to it with Internet research and MS CoPilot.

I had my heart attack in late 2017 at the age of 57. I was diagnosed as having a heart attack and having 3 blocked arteries at one hospital, but left that hospital for a better hospital. I knew that I needed open heart surgery and had it done at Loyola University Hospital in Maywood, Illinois. They replaced my aortic valve with a tissue valve and gave me a 3 way bypass. They discovered that I have cardiomyopathy too.

For the heart daily I take 25mg Jardiance, 100mg Metoprolol Succ ER, and 80mg Atorvastatin.

I did not understand the importance of exercise and diet for staying alive, so it took me a while to get there mentally and physically. You have to change your lifestyle to stay alive, and the changes are easy.

95% of the time I am on the Mediterranean Diet and if I fall off, I am still on the DASH Diet. I may have 3 to 4 - 12oz cans of Pepsi or RC Cola a month, and some ice cream. The rest of the time I am on the Mediterranean Diet. I drink 4 to 6 cups of Lipton green tea with ginger, 3 cups of Lipton black tea, and 1 to 2 cups of coffee a day.

In the morning I take my supplements, wait 30+ min and then take 2 tablespoons of extra virgin olive oil(EVOO), sometimes 3. For breakfast I have a small bit of cereal with 2% organic milk, and 1 cup of blueberries. For lunch I might eat a small salad or packet of fish (wild caught salmon or yellowfin tuna) at least 2 to 4 times a week. For snacks I eat pumpkin seeds, almonds and chew gum. We eat pizza 3 to 4 times per month, and it is a small thin crust cheese pizza, split between my mother and I. If we have spaghetti I cook and drain 1/2 box of noodles and add 3 tablespoons of EVOO…mix it up, and then add the spag sauce. I try to eat 2 meals per day. I try to add EVOO to everything that we eat and I do not eat things like butter. I need to stop adding cheese to my spaghetti!!! It is on mt ToDo List.

Now that it is warm out I will be getting back to walking 3 days per week. I try to walk 3 to 5 miles when I walk and I maintain a good pace.

I go to the Drs on the 22nd and I am going to talk to him about Ozempic to drop 40lbs.

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#30

IKARIA, GREECE

Engineer more mindless movement into our lives.
Eat a Mediterranean-style diet
Stock up on herbal teas
Nap
Fast occasionally
Make family a priority
Choose goat’s milk over cow’s milk

In 2009, Greek physicians and researchers found that 13% of Ikarians in their study were over 80, compared to about 1.5% of the global population and about 4% in North America and Europe. People on the island were 10 times more likely to live to 100 than Americans.

Ikaria, a small island in Greece’s Aegean Sea, is known as a “blue zone” because it has a higher life expectancy than the rest of the world. On average, people on Ikaria live 10 years longer than those in the United States and Europe, and one in three residents live past 90. The island is known for its healthy lifestyle, which includes a Mediterranean diet that emphasizes fruits, vegetables, whole grains, and olive oil. This plant-based diet has been linked to health benefits such as reduced risk of heart disease and improved cognitive function

Ikarians eat lots of potatoes, beans, olive oil, and fish. They also drink goat’s milk, which contains potassium and the stress-relieving hormone tryptophan. The diet also includes around 80 different kinds of wild greens and herbs, some with 10 times the antioxidant levels of red wine. Ikarians drink oregano, mint, rosemary, and sage tea, and natural, sulphite-free red wine in moderation

Ikarians have traditionally been fierce Greek Orthodox Christians. Their religious calendar called for fasting almost half the year. Caloric restriction – a type of fasting that cuts about 30 percent of calories out of the normal diet – is the only proven way to slow the aging process in mammals.

Here’s what’s in an Ikaria-inspired diet:

  • 20% is vegetables

  • 17% Greens

  • 16% Fruits
    Figs, raisins and dried fruits

  • 11% Beans and legumes
    Broad beans (aka, fava beans)
    Chickpeas
    Gigantes (giant beans)
    Lentils
    Split peas

  • 6% Extra Virgin Olive oil and Olives

  • 6% Fish

  • 5% Pasta, especially whole wheat pasta and gluten-free, high-protein, bean-based pastas, such as chickpea and lentil pastas

  • 5% Meat

  • 4% Sweets

  • 1% Grains
    Bulgur
    Farro

Garlic

Herbs

  • Bay leaves
  • Oregano
  • Savory
  • Thyme
  • Mint

Nuts

  • Almonds
  • Pistachios
  • Sesame seeds and tahini
  • Walnuts

Sea salt

Honey

Yogurt

Feta Cheese - Choose goat’s milk over cow’s milk

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#31

@TBI-CHI Thank you for the inspirational advice. I think that there are some good practices in there. Thank you.

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#32

I gave you the information about IKARIA, GREECE because that is basically what I am doing. When I say that I am doing this to stay alive I am not kidding.

My Drs were talking about how well my numbers looked, but I am still overweight. 210 to 220lbs at 5ft-8in, but for 1/2 of my life I was in construction, a weight lifter, martial artist and it is hard to drop weight. I’d like to drop down to 170lbs or less i 2024, and will be talking to them about that on the 22nd.

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#33

Exercise as a therapeutic tool in age-related frailty and cardiovascular disease: challenges and strategies

#34

Love this. I’ve been tuning out the “EVOO is superfood” for years. Too many calories for the benefits. And I really only love it with bread, which is another devil.

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#35

I have been reading (and ignoring for too long) the idea that underlying the creation of arterial plaques is damage to the glycocalyx protecting the artery wall. Higher apoB is worse in any case but the big problems occur when the “shielding” is damaged, and the apoB particles can more easily get through. If true, lowering apoB is helpful but not solving the problem (inflammation, high insulin, high blood glucose, Uric acid). Improved metabolic health is the key, is what is said by many including Dr Twyman (I just interviewed him).

One of the benefits of statins is lower inflammation. If only statins didn’t mess with my mitochondria.

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#36

Go with Bempedoic Acid. 50% lower ApoB and inflammation. I don’t think it messes with your mitochondria either. Win win.

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#37

I agree. It’s already paid for and on the way. Statins are a part of my past, not my future.

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#38

Which is an euphemism for apoB/LDL doesn’t matter and the sleight of hand which leads to the misinformation and confused people.

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