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I focus on making our viewers and readers aware of the actual science. Unfortunately, research studies are often muddy and inconclusive. Still, I want to make sure that people who follow us get the conclusions. 

So, for this post, I’ll go through 15 truths about heart attack and stroke prevention that I have been advancing and teaching for years.

  1. You can reverse arterial plaque. 
  2. You can reverse most diabetes, prediabetes, and insulin resistance. 
  3. Carbs are not harmless. 
  4. Insulin resistance, prediabetes, and diabetes are not just about obesity or a high-carb diet. 
  5. You can’t supplement your way out of a bad lifestyle. 
  6. You can’t medicate your way out of a bad lifestyle. 
  7. Still, medications have a place.
  8. Moreover, meds that can help include statins. 
  9. Supplements also have a place.
  10. Periodontal disease is causally related to cardiovascular inflammation. 
  11. Cardiovascular inflammation is a far bigger cause of heart attack and stroke than high LDL cholesterol levels. 
  12. Over half of adults have insulin resistance, prediabetes, type 2 diabetes. 
  13. Insulin resistance, prediabetes, and type 2 diabetes are the major cause of cardiovascular inflammation. 
  14. Thus, insulin resistance, prediabetes, and type 2 diabetes also play a part in being the major cause of death and disability. 
  15. Fasting helps against type 2 diabetes, insulin resistance, and prediabetes.

 

(1) You can reverse arterial plaque.

Arterial plaque is very common. It increases with age. 

Some people could reverse plaque growth. John Lorscheider, one of our patients, has done it. Plenty of my other patients have done it as well. Even I myself was able to reverse 20 years’ worth of arterial plaque in just 18 months. 

 

However, most people may not make their arterial plaque disappear completely. But the inability to entirely reverse plaque should not be the end of the world. If you’re one of them, know that there are other possibilities. 

Stabilize arterial plaques.

First, you can shrink and stabilize your plaque. The type of plaque that’s stable is hard, calcified plaques. As demonstrated by the Honda study, calcified plaques don’t create risks for heart attack and stroke when compared to soft plaques.

Soft plaque vs. calcified plaque - Appearance

Soft plaque vs. calcified plaque – Appearance. The left shows “low IBS plaque,” which means soft or “hot” plaque, or in this study, “echolucent” plaque. The image on the right shows “high IBS plaque,” also referred to as calcified, hard, or “echogenic” plaque. (Echolucent plaques let ultrasonic waves pass through with no echo; thus, they appear to be transparent. Echogenic plaques reflect ultrasound waves; they appear as solid white mass.) Source: Honda O, Sugiyama S, Kugiyama K, Fukushima H, et al. Echolucent carotid plaques predict future coronary events in patients with coronary artery disease.

To measure calcified plaques, you may opt to do a coronary artery calcium scan. This test would provide you a calcium score. The higher the calcium score, the more calcified plaque there is. The more calcified plaque there is, the more stable plaque should be, right?

While that should be the ideal case, a high calcium score is a source of worry for lots of people. Why? 

This is the calcium score paradox. A high calcium score means previous cycles of plaque formation and inflammation have already happened inside the body. This is the reason people are worried whenever they get a high calcium score.

On the other hand, calcium score means plaque is calcified, not soft. Soft plaques are the ones we should be worried about. Soft plaques can cause blood clots. Blood clots can cause a heart attack and stroke. 

So having no soft plaques and only calcified plaques is as good as having no plaques at all. Now, if you want to measure both soft and calcified plaques, then go for a CIMT scan instead of a calcium scan.    

Reduce cardiovascular inflammation.

Aside from stabilizing plaques, you can also reduce cardiovascular inflammation. This is the process that produces harmful soft plaque. This soft plaque is more likely to be reversed than a calcified plaque.

(2) You can reverse most diabetes, prediabetes, and insulin resistance.

Really. The CDC, ADA, and many professional bodies say that diabetes, prediabetes, insulin resistance may be chronic but reversible.  

If you read “The Obesity Code,” the book’s author Jason Fung talked about patients that were overweight and were able to reverse their diabetes. 

For those of us whose insulin resistance is caused by too much weight, the simplest thing to do is to shed some weight. In fact, even losing a few pounds can already go a long way. 

 

Indeed, it is possible to reverse diabetes, prediabetes, insulin resistance. I’ve reversed mine. Many of my patients were also successful. 

But I didn’t say things would be easy. It’s just going to take some work.

(3) Carbs are not harmless.

No matter what the ADA says, carbs are not harmless. Especially if you are insulin-resistant, prediabetic, or full-blown diabetic. 

To understand the impact of dietary carbs, we start the discussion with a classification of carbohydrates. 

Complex vs. simple carbs

Carbs can be complex or simple.

Starch and dietary fibers are examples of complex carbs. They are made up of many sugar molecules bound together in long, complex chains. (Thus, the name “complex.”)

Simple carbs (sometimes referred to as simple sugars) are easily broken down by the body to produce energy. For instance, glucose (a simple sugar) is carried by blood into the cells, where it is converted to energy.

Simple carbs are found usually in fruits, milk and milk products, candy, table sugar, and sugary drinks. They are of 2 types, depending on the number of sugar molecules they contain:

  • Monosaccharides – made up of a single sugar molecule. Examples are glucose, fructose (fruit sugar), and galactose;
  • Disaccharides – made up of 2 joined sugar molecules. Examples are sucrose (the other name for table sugar, made up of glucose and fructose), lactose (milk sugar made up of glucose and galactose), and maltose (malt sugar made up of 2 glucose molecules).

Complex vs simple carbs

So, which is better: complex or simple carbs?

There’s a prevailing notion that we should get more carbs from complex carb sources than simple ones. Complex carbs usually are high in fiber. They digest more slowly. They make the person feel full, which could be a good option if the person is on a weight loss program..

Still, making such a choice is not a straightforward answer. If a person has a problem metabolizing carbs, it wouldn’t matter whether the carb is complex or simple.

Glycemic Index (GI) & Glycemic Load (GL)

Aside from classifying carbs as simple or complex, we also rank carbs based on how slowly or quickly we digest them and how fast they increase our glucose levels over time (say, in 2 hours). This is what we refer to as the glycemic index (GI)

How does the GI ranking work?

We use glucose as a reference; it is given a GI of 100. 

Carb-containing foods are then compared to glucose and assigned their GIs. Here are the typical GI ranges:

  • Less than 55 – low GI. Examples: soy products, beans, fruit, milk, pasta, grainy bread, oats, lentils.
  • 55 to 70 GI – medium GI. Examples: orange juice, honey, wholemeal bread.
  • Over 70 – high GI. Example: potatoes, white bread, short-grain rice, pasta.

What’s the difference between higher GI foods vs lower GI foods?

A high-glycemic carb would break down and release glucose more quickly. They can instantly spike a person’s blood glucose levels. Such foods would help with energy recovery (especially after exercising) or offset hypoglycemia. 

On the other hand, low-glycemic foods prolong digestion and make people feel full. They release glucose slowly and steadily, which makes them better than high-glycemic foods when it comes to maintaining a good blood glucose level.

Does this mean that low-glycemic foods are safe for diabetics or prediabetics? 

Not necessarily. Just like in the simple vs. complex carb debate, the answer isn’t that simple. This time, we should also know that the amount of carbs we eat affects our blood glucose levels. 

For instance, pasta has a low GI. But a large serving of pasta can still cause blood glucose levels to rise faster than a smaller serving of a high-glycemic food. 

This explains glycemic load (GL). GL builds on the concept of GI. It considers both GI and the amount of carb in a portion. GL is based on the idea that a high-glycemic food consumed in small amounts would still give the same effect on blood glucose levels as larger amounts of a low-glycemic food.

The whole point of saying “Carbs are not harmless” is that, for most people, pasta, grainy bread, oat porridge, even though they are low in GI, they pose a bigger problem because people consume a lot of these foods.

(4) Insulin resistance, prediabetes, or diabetes is simply not just about obesity or a high-carb diet.

While we mentioned obesity and carbs as issues, age is probably still the biggest driver of a problematic blood glucose metabolism. 

By the time we get to age 60, the vast majority of us cannot metabolize carbs. Sugar just remains in our bloodstream, and many can’t get their blood sugar levels down. Often, it would take away too much insulin to control blood sugar, leading to insulin resistance. 

Worse, many have no clue that they have this problem. In fact, around 90% of people that have prediabetes don’t know they have such a condition.

 

(5) You can’t supplement your way out of a bad lifestyle.

Many people are grasping for the next big supplement.

People have heard about curcumin, garlic, some supplements with anti-inflammatory properties or the ability to control blood sugar. But relying on supplements ALONE won’t help at all. 

Lifestyle should still be everyone’s top focus. Lifestyle means changing habits from bad ones (like smoking and leaving a sedentary life) to good ones (eating and sleeping well).

 

Diet

There’s no question that diet remains the most important part of lifestyle when it comes to preventing a heart attack and stroke. But as an experienced prevention physician, I think there is “more heat than light” on the topic of diets. 

Diet debates are not a science thing. It is more of a belief thing. There are beliefs, perceptions, and habits that create a major problem for the majority of us to know how to develop a healthy diet. Therefore, we create major risks for ourselves almost every time we eat, yet we don’t know it.

 

Sleep & other lifestyle factors

Sleep is important too. It is associated with our metabolism. Sleep deprivation increases the production of the hormone cortisol, and cortisol can cause insulin resistance. And having decreasing sleep direction is correlated with increasing obesity.

Other lifestyle aspects are also important, like stress management and exercise.

 

So no one can’t supplement their way out of a bad lifestyle. This ain’t going to happen. 

And guess what…

(6) You can’t also medicate your way out of a bad lifestyle.

Like with supplements, you can’t simply rely on medications ALONE to replace your need to shed some pounds or change bad habits. You still got to do the work.

(7) Still, medications have a place.

Among the useful medicines that I take and recommend to my patients are metformin and ACE inhibitors. 

Metformin

Metformin is the #1 recommended first-level diabetes drug by the ACE (American College of Endocrinology) and ADA (American Diabetes Association). 

Metformin works not only on blood glucose metabolism. It also works against aging, polycystic ovary syndrome (PCOS), cancer, neurologic dysfunction, and weight loss.

 

ACE Inhibitor

As for blood pressure medications, I am taking an ACE inhibitor (Ramipril to be particular). Apart from decreasing blood pressure, ACE inhibitors can also reduce inflammation. And inflammation leads to those blood clots that can cause a heart attack or stroke.

(8) Moreover, meds that can help include statins.

Most of my patients avoid statins because of the side effects. Such side effects of statins include fatigue, muscle soreness, malaise, increasing blood glucose, dizziness, and brain fog.

Before you criticize me for my stand on statins, hear me out first. I myself used to be a statin-hater myself, but I “bit the bullet” and started taking a low-dose Crestor (rosuvastatin) years ago. 

I started with 5 mg. Once I got better control of my blood glucose with dietary carb control, I dropped my dosage to 2.5 mg Crestor two times per week. 

While statins’ purpose is to lower LDL cholesterol, that’s not the primary reason I take a statin and recommend it to my patients. Not known to many people, a low-dose statin can decrease inflammation.

 

Inflammation creates soft plaque. Soft plaques lead to a blood clot. And blood clots could cause a heart attack and stroke. 

So taking a low-dose statin for inflammation would help prevent heart attacks and stroke beyond a statin’s LDL cholesterol-lowering effect.

That’s not all. Some newer statins have an extra desirable effect. 

For instance, Pivasta (pitavastatin) helps against insulin resistance. I take Pivasta now to enjoy the double purposes of controlling my insulin resistance and inflammation.  

(9) Supplements also have a place.

I mentioned a while ago that you can’t supplement your way of a bad lifestyle. However, that doesn’t mean supplements won’t provide any benefits at all. 

If you’re looking for a supplement that would aid you to pursue better cardiovascular health, these 5 supplements should be a good start.

Vitamin D

Vitamin D is popularly known for maintaining healthy bones. But it also promotes good cardiovascular health. It does that by preventing insulin resistance. 

Persons with blood levels of less than 30 ng/ml of vitamin D were up to 5x at greater risk for developing diabetes than people with over 50 ng/ml (Park, 2018). 

 

We get vitamin D from the sunlight. Is it necessary to supplement? 

Sunshine alone won’t be enough to meet our body’s vitamin D requirement. But if you’re considering supplementing, know that less than 1,000 IU dosage is not significant to have an impact on preventing prediabetes or type 2 diabetes. 

I myself take 5,000 IU daily, and I feel no terrible effects. What I usually recommend is to take the same dosage as mine, then get tested for the amount of vitamin D in the bloodstream. 

The result should be between 60 and 80 ng/mL. Based on the result, increase, decrease, or maintain the dosage of vitamin D supplement to meet this target vitamin D level in the blood. 

Never take too much vitamin D as this can produce harmful effects.

Vitamin K2

There’s an assumption that vitamin K2 moves calcium from arteries into bones, a process that may stabilize calcified plaques (which are already stable).

 

However, it seems there are different mechanisms at play here. Mechanisms that are connected with proteins called osteocalcin and MGP

  • Osteocalcin has important roles in bone mineralization and calcium homeostasis. It is activated by carboxylation, a reaction in which vitamin K2 is the essential cofactor. 
  • Vitamin K2 also activates MGP (matrix Gla protein) through carboxylation. MGP ensures that calcium is used in bones and not deposited in arteries and other tissues.

Affecting the calcification-decalcification process appears to be not the only way how vitamin K2 impacts cardiovascular health

Niacin

Niacin (vitamin B3) is known as a treatment for pellagra, but it has been shown to have desirable effects concerning cardiovascular health. 

One, it is the only thing that can increase HDL cholesterol and decrease LDL cholesterol.

 

Two, it is one of the few things that could improve lipoprotein(a) or Lp(a). 

Bergamot

Bergamot is an oil extracted from Citrus bergamia, a fruit grown in southern France and southern Italy. 

There is medical evidence that bergamot extract positively impacts blood glucose and cholesterol levels. It has been also shown to have anti-inflammatory and antioxidant effects. It may improve LDL, HDL, and several other things.

 

Berberine

Berberine is a traditional Chinese herb extract used as an OTC drug for bacterial diarrhea. Now, it is also found to cause a drop in blood glucose levels, prompting the berberine vs. metformin comparison.   

Is berberine good? 

Considering its relatively low cost compared to other first-line medicines and treatment, berberine might be a suitable alternative for low socioeconomic status patients for treating type 2 diabetes, hyperlipidemia, and hypertension over a long time. 

However, berberine’s half-life is only 4.8 hrs. So if you prefer to take berberine, take it twice a day. 

Moreover, metformin is not that expensive anymore. Thus, I would first recommend metformin to my patients over berberine.

 

There are other supplements purported to have cardiovascular benefits, like magnesium, cinnamon, fiber, curcumin, and fish oils. 

But the big problem with supplements is that they are not yet fully tested and the proofs of their effectiveness are mostly anecdotal. So in the end, be cautious if you plan to go the supplements route. 

(10) Periodontal disease is causally related to cardiovascular inflammation. 

Three decades ago, the CDC already knew that there’s a link between gum and heart diseases. But the CDC had not established the exact connection, like which one causes the other, or is there another factor bridging the two.

 

According to the University of California, Los Angeles, 55% of American adults have insulin resistance. 

According to the American Academy of Periodontology, half of the American adults suffer from gum disease, almost the same as the number of people with insulin resistance. 

Are these facts a coincidence? Probably not.

Plaque forms inside the arterial walls. If inflamed, arterial plaque may leak into the bloodstream, form a clot, and cause a heart attack or stroke. 

What is the leading cause of cardiovascular inflammation? 

Again, it’s insulin resistance. 

Moreover, gum disease starts with bacteria and other pathogens. While these pathogens lead to oral plaque and inflamed gums, they also secrete an inflammatory enzyme that affects the permeability of arterial walls. 

That change makes the arteries more prone to plaque build-up. If arterial plaque gets inflamed, it could cause a heart attack or stroke. 

So the connection between cardiovascular health and gum disease somewhat lies with inflammation.

(11) Cardiovascular inflammation is a far bigger cause of heart attack and stroke than high LDL cholesterol levels.

Our medical standards are wrong about that. 

They continue to ignore cardiovascular inflammation being the bigger cause of heart attack and stroke. And heart attack and stroke continue to be the leading causes of death and disability. 

Now, I will say this. LDL cholesterol is totally not off the plate. It is still an actor. But we continue to ignore the bigger actor, which is inflammation

(12) Over half of adults have insulin resistance, prediabetes, type 2 diabetes.

That’s not my belief. That fact is from UCLA.

UCLA 2016 Estimate of Californians with Prediabetes

Guess what? 

We’re not talking about adults 60 years old or older. We’re talking about adults 30 years of age or over.

(13) Insulin resistance, prediabetes, and type 2 diabetes are the major cause of cardiovascular inflammation.

It’s unfortunate that we don’t understand the severity of the prediabetes and diabetes epidemic.

 

It’s tragic that doctors and patients are ignoring the fact that what causes heart attack and stroke (the leading causes of death and disability) are right in front of us. We don’t feel it, but it’s sneaking upon us.

(14) Thus, insulin resistance, prediabetes, and type 2 diabetes also play a part in being the major cause of death and disability.

People could have lived two decades longer. Deaths due to heart disease could happen two decades later. 

Such a fact does count. And again, that is an absolute truth. If you haven’t heard these on our YouTube channel, shame on us. But it’s there. 

(15) Fasting helps against type 2 diabetes, insulin resistance, and prediabetes.

Fasting—whether it’s mimicked, intermittent, or prolonged—decreases high blood sugar and insulin levels. I’ve got plenty of patients who don’t fast. Our culture has gotten away from fasting, and we’re so used to eating 3 to 4 meals a day (not to mention the snacks).

I understand. I’ve been there until a few years ago. I’ve done fasting on and off for many years. I just didn’t know that it was so important and had given it up until a few years ago. Then I restarted it.

 

My name is Ford Brewer. My team and I work to prevent heart attack, stroke, cancer, and dementia. Our goal is to help you understand how to prevent major killers and disablers. Most of them are driven by the process of cardiovascular inflammation

If you want to know more about the science of preventive medicine or you have questions about certain aspects of your health, check out our webinars, membership programs, and online courses.

If you’d like to learn about the basics of heart attack & stroke prevention for free, complete this form, and get access to our CV inflammation course. If you’re interested in how we can help you, check out our services page.

References

Better Health Channel. Carbohydrates and the glycaemic index. Better Health Channel website. https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index. Update March 2020. Accessed February 20, 2021. 

Beulens JW, van der A DL, Grobbee DE, Sluijs I, et al. Dietary phylloquinone and menaquinones intakes and risk of type 2 diabetes. Diabetes Care. 2010 Aug;33(8):1699-705. doi: 10.2337/dc09-2302. 

Brewer F. Berberine vs. Metformin. PrevMed website. https://prevmedhealth.com/berberine-vs-metformin. Accessed February 20, 2021.

Brewer F. Can Metformin Help You Lose Weight? PrevMed website. https://prevmedhealth.com/can-metformin-help-you-lose-weight. Accessed February 20, 2021.

Brewer F. Coronary Calcium Score: Under-Utilized But Still A Great Test. PrevMed website. https://prevmedhealth.com/coronary-calcium-score-under-utilized-but-still-a-great-test. Accessed February 20, 2021.

Brewer F. Does Niacin Work? The Great Niacin Debate. PrevMed website. https://prevmedhealth.com/does-niacin-work-the-great-niacin-debate. Accessed February 20, 2021.

Brewer F. How Does Inflammation Cause Cardiovascular Disease? PrevMed website. https://prevmedhealth.com/cardiovascular-inflammation-and-plaque-formation. Accessed February 20, 2021. 

Brewer F. How to Reverse 20 Years of Arterial Plaque. PrevMed website. https://prevmedhealth.com/how-to-reverse-arterial-plaque. Accessed February 20, 2021.

Brewer F. Magnesium Deficiency is Common – Should You Supplement? PrevMed website. https://prevmedhealth.com/magnesium-deficiency-is-common-should-you-supplement. Accessed February 20, 2021

Brewer F. Prediabetes: A Risk for Heart Attack & Stroke? PrevMed website. https://prevmedhealth.com/prediabetes-a-risk-for-heart-attack-stroke. Accessed February 20, 2021.

Brewer F. Reducing Arterial Plaque – Is It Possible? PrevMed website. https://prevmedhealth.com/reducing-arterial-plaque-is-it-possible. Accessed February 20, 2021.

Brewer F. Sleep: Why It’s Important. PrevMed website. https://prevmedhealth.com/sleep-why-its-important. Accessed February 20, 2021. 

Brewer F. Stopping Statins: Is It Safe? PrevMed website. https://prevmedhealth.com/stopping-statins-is-it-safe. Accessed February 20, 2021.

Brewer F. Vitamin K2 & Cardiovascular Health – What’s the Real Score? PrevMed website. https://prevmedhealth.com/vitamin-k2-cardiovascular-health-whats-the-real-score. Accessed February 20, 2021.

Brewer F. What is Carotid Intima-Media Thickness Test (CIMT)? PrevMed website. https://prevmedhealth.com/what-is-carotid-intima-media-thickness-test-cimt. Accessed February 20, 2021.

Brewer F. What is Vitamin K2? Can It Remove Arterial Plaque? PrevMed website. https://prevmedhealth.com/vitamin-k2-can-it-remove-plaque. Accessed February 20, 2021.

Brewer F. What Vitamin D Can Do to Your Immune System & CV Health. PrevMed website. https://prevmedhealth.com/what-vitamin-d-can-do-to-your-immune-system-cv-health. Accessed February 20, 2021. 

Honda O, Sugiyama S, Kugiyama K, Fukushima H, et al. Echolucent carotid plaques predict future coronary events in patients with coronary artery disease. J Am Coll Cardiol. 2004 Apr 7;43(7):1177-84. doi: 10.1016/j.jacc.2003.09.063. 

Li Y, Chen JP, Duan L, Li S. Effect of vitamin K2 on type 2 diabetes mellitus: A review. Diabetes Res Clin Pract. 2018 Feb;136:39-51. doi: 10.1016/j.diabres.2017.11.020. 

Park SK, Garland CF, Gorham ED, BuDoff L, Barrett-Connor E. Plasma 25-hydroxyvitamin D concentration and risk of type 2 diabetes and pre-diabetes: 12-year cohort study. PLoS One. 2018 Apr 19;13(4):e0193070. doi: 10.1371/journal.pone.0193070.

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