Superior Index Go to the next: Chapter 4
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Hal felt great at 50. This was no accident. For his entire adult life he had worked hard to stay healthy: he exercised an hour a day, kept his cholesterol under control, didn't drink or smoke, maintained a healthy weight and blood pressure, managed his stress, rarely ate meat or dairy, avoided fast and processed foods, and got regular checkups.
One might then wonder why Hal had a heart attack while cutting grass in his backyard one sunny Saturday afternoon. He clutched at his chest, gasped, then collapsed. His wife, Muriel, delivering some lemonade and cookies, found him slumped unconscious on the ground next to his power mower.
Fortunately, Muriel was a nurse. She immediately began CPR, and after several minutes of chest-pounding and mouth-to-mouth resuscitation, managed to revive Hal just as the paramedics showed up.
Hal had been very close to death, but he was one of the lucky ones. For about a third of all heart attack victims, the first symptom is sudden death.
While hospitalized, Hal discovered my heart disease program. He got tested, and learned to his dismay that his C-reactive protein level had been "off the chart" at 8.3. We started him on the diet, nutritional supplements, and exercise program that would eventually reverse his atherosclerosis. Today Hal is happy and healthy again. His C-reactive protein is normal, his coronary arteries are plaque-free, and he's back to mowing his lawn.
Celeste, a 55-year-old Chicago real estate broker, was an avid reader of health magazines and knew a lot about how to stay healthy. Thanks to a statin drug, her cholesterol was normal. She had a tendency toward high blood pressure, but kept it under control by exercising every day and eating a vegetarian diet. She wouldn't dream of smoking.
One afternoon, on her way home from the office, Celeste passed out at the wheel and crashed into an elm tree. She had suffered a massive stroke. Celeste survived, however, and was referred to my clinic by a good friend. Biomarker testing told us that Celeste's unmeasured and untreated Fibrinogen level had been quite elevated at 384 (normal is less than 250).
Fibrinogen is a pro-inflammatory protein that causes clots to form in arteries. Celeste's left middle cerebral artery had become suddenly and completely blocked, cutting off the blood supply to a large segment of her brain. Had her fibrinogen remained elevated, she would have almost certainly suffered another stroke.
Celeste and I developed a reversal program of diet, exercise, and natural medicines; she has adhered to it and her brain has healed. She is back at work selling lots of great real estate. Every year for the past ten years she has sent me a bouquet of roses and a touching note that says, "Thank you Dr. Smith for saving my life."
At sixty-two, Art felt healthy and vital. A musician and avid skier, Art took great pride in the fact that his cholesterol was always under 200. He exercised every day, eschewed fatty foods, and didn't smoke. He kept his stress level and blood pressure low by playing piano and living a laid-back lifestyle. At a recent checkup, his internist told him he had no sign of heart or cardiovascular disease and that his general health was "perfect". A couple of weeks later, one wintry afternoon, Art slumped over his keyboard while practicing with his band. Fortunately, the bass player dialed 911, and with instructions over the phone kept Art alive until the paramedics got there.
Art's heart attack was not due to an elevated cholesterol level; it was caused by undiagnosed and untreated "metabolic syndrome" (also known as insulin resistance or Syndrome X), an extremely common condition in which elevated fasting blood sugar accelerates the atherosclerotic hardening of arteries. Art's fasting blood sugar was far above normal at 121. His triglycerides were also high at 350, and his protective HDL-cholesterol was depressed at 30 (should be above 45).
Jake was in the prime of his life. A forty-something businessman from San Francisco, he headed up his own advertising firm, where he played tough and called all the shots. At home, however, Millie, his wife and sweetheart of 25 years, was the real boss. She understood his soft side and exploited it by teasing him mercilessly. He loved to play with his kids and reveled in watching them grow up.
Jake took good care of his health - at least he thought he did. His father and grandmother had died of heart attacks, so Jake knew he needed to be extra careful. To his dismay, Jake's cholesterol had been creeping up in recent years. His internist, Dr. Bob Sweeney, had given him a statin drug to bring it down, and when Jake's cholesterol reached the normal range, Sweeney had pronounced him "healthy as a horse" and "free of heart attack risk".
About two weeks after his last visit to Dr. Sweeney, while roughhousing with Mikey, his seven-year-old son, Jake stopped suddenly and clutched his chest. He turned blue and collapsed on the Oriental rug. In less than five minutes, Jake was dead.
A routine homocysteine level check could have saved his life. Homocysteine is an irritating amino acid our bodies generate in the normal course of metabolism. Certain B-complex vitamin deficiencies can block the proper removal of excess homocysteine, causing a buildup that escalates risk for heart attack, stroke, and a raft of other diseases. My staff located the sample of blood that had been used to test Jake's cholesterol, and we ran a homocysteine test on it. Jake's homocysteine had been extremely high at 14.7 (ideal is 6.2 or less).
The point I am making here is that paying attention to the new heart markers could save your life. Conversely, it could be costly to stay stuck in the fantasy land of "Fix your cholesterol with a statin and you're home free."
Now let's take a look at a more hopeful case, that of Chip, a 48-year-old dentist who came to see me five years ago because he had read my book, Renewal: The Anti-Aging Revolution, and wanted to work with me on an anti-aging program.
Before starting him on a program I examined his "biochemical landscape" to spot any life-shortening abnormalities. In other words, I ordered my usual battery of blood tests. Chip's lipid panel and cholesterol were normal, but all five remaining heart disease markers (homocysteine, C-reactive protein, fasting blood sugar, fibrinogen, LDL particle size) were elevated, effectively putting him on a collision course with a heart attack. We discussed this in his follow-up visit:
- "Chip, your test results here tell me there are major problems in your cardiovascular system. You are at very high risk of a heart attack or stroke."
- "I don't understand, doc. My internist told me my heart was fine. My blood pressure, cholesterol, and LDL have never been elevated, I don't smoke, I eat almost no animal fat, I'm not overweight, and I have never had any symptoms that would suggest a problem with my heart."
- "Chip, nowadays, we have far better tools than cholesterol and LDL for predicting atherosclerotic heart and cardiovascular disease. Your `independent markers' for heart disease are telling me your risk is high."
- "What are these `independent markers'?"
- "As a medical professional you may have heard of some of them. They are fasting blood sugar, C-reactive protein, homocysteine, fibrinogen, and LDL particle size."
- "And mine are all elevated?"
- "Yes, some more than others, but all are high."
- "What do these `new markers' actually tell you, doc?"
- "Good question. They are the molecular `bad guys' that cause atherosclerosis. We have a thorough understanding of the mechanisms that lead up to heart attacks and strokes, far superior to what we had 50 years ago when the cholesterol connection was discovered. The molecular biology of the arterial hardening and heart attack processes is very well understood by researchers in the field. These new markers are literally the molecular bad guys that cause atherosclerosis. We can measure them, and when any of them is present, your risk is high."
- "Does this mean I am doomed to have a heart attack?"
- "No, but it does mean that, based on the research behind these markers, unless we get them back to normal, your risk is very high."
- "I am going to put you on a program of diet, exercise, and nutritional supplements. This will gradually bring all your markers back to normal, and with them, your risk will go from very high to very low."
- "Doc, not to question your insight into these things, but you are asking me to trust some numbers on a piece of paper. How do I know I am preventing anything if I don't already have symptoms or signs of heart disease?"
- "Well, Chip, you put your finger on the problem. Let me try to explain. You do have choices. You can wait until you have a heart attack, and then - assuming you survive - address the problem. Or you can familiarize yourself, as I have done, with the huge body of research evidence that tells us these markers provide an extremely accurate assessment of risk. And it's reassuring - to those of us who consider ourselves good scientists - that these markers are not just innocent bystanders to the atherosclerotic process. They are the key players, the molecular villains that cause the problem. So when we see them, there is no question that trouble is ahead, and when we make them go away, we can be sure that we have averted a disaster. This molecular biological approach epitomizes our new direction in modern medicine. Now we can use nutritional medicine to head off disorders that accelerate aging and shorten lifespan."
- "That is why I am here, Dr. Smith."
Chip diligently followed the program I laid out for him. Gradually (it took over a year), he got all his markers back into the normal range. Though he never had a symptom (there's a reason we call atherosclerosis the "silent killer"), Chip appreciates the fact that we averted a heart attack, and may just have saved his life.
Though millions die every year of preventable heart attacks and strokes, you do have a choice. Like Chip, I want to show you how to outsmart the "Number One Killer".