Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
18 Jan

How Might Inflammation Cause Heart Disease?

Despite its obsessive focus on cholesterol levels as the ultimate arbiter of cardiovascular disease, most of the medical field agrees that plenty of other factors also contribute: tobacco usage, psychosocial stress, activity level, and genetic predispositions. In short, a diverse set of lifestyle and genetic factors are consistently associated with cardiovascular disease. This is accepted in the ancestral health community, just as it’s accepted in the mainstream medical community, but the question remains – why? Why does stress contribute to heart disease? How does smoking tobacco increase the risk of heart disease? Why are both the sedentary and the overtrained at a higher risk for heart disease?

Well, as I’m (and others are) quite fond of saying, inflammation is most likely the ultimate cause of heart disease, and all those factors – even some of the genetic ones – are mediated by inflammation. When you get down to it, any explanation of the links between smoking and heart disease, stress and heart disease, exercise and heart disease, cholesterol and heart disease, and even genetics and heart disease must include inflammation to be accurate. As I’ll briefly discuss in the following post, each of these lifestyle and even genetic factors exert much (if not most) of their influence on heart disease via their effects on inflammation.

Let’s explore the evidence for the inflammatory roots of heart disease and continue our discussion of inflammation.

Tobacco

The most common form of tobacco ingestion is smoking – the inhalation of smoked emitted by the burning of dried tobacco. Now, some would argue that it’s the modern processing of tobacco that makes smoking it so bad for us, and that unprocessed tobacco is more benign and results in less heart disease. Or that it’s the modern diet that makes smoking so harmful (see the traditional Kitavans with their moderate smoking habit and apparent lack of heart disease). That’s probably true on some level, but it’s not really within the scope of today’s post. So when I refer to “smoking,” I mean the kind of mass market cigarettes that smokers in the industrialized world use: your Marlboros, your Camels, your Lucky Strikes. The kind that is linked to heart disease.

Plenty of studies show that inhaling incredibly hot, burnt tobacco plant material acutely increases inflammation, quitting immediately lowers inflammation, and recent review (PDF) of the literature specifically causally connects smoking-related inflammation and heart disease. One study even showed that smoking heaps acute inflammatory stress on atherosclerotic plaque, thus increasing the chance of a rupture. And when your atherosclerotic plaque ruptures, or breaks off, the resulting thrombus can lodge itself in the artery and block the blood flow. That, my friends, is a garden-variety heart attack caused by inflammation. Does it get much more cut and dry than that?

It’s also worth noting that smokeless tobacco ingestion, while far from benign, is associated with lower inflammatory markers and less heart disease than smoking.

Stress and Other Psychosocial Factors

Stress comes in many guises nowadays. While Grok had to deal with a few acute, undoubtedly intense psychological stressors, like facing down an opponent or a large animal bearing imposing claws and teeth, he probably didn’t experience the type of chronic, persistent psychological stress “enjoyed” by modern man. We know that psychosocial stress induces a physiological inflammatory response, and just like chronic exercise, chronic psychosocial stress can probably lead to chronic inflammation.

Studies consistently show that folks with higher amounts of psychosocial stress and depression display elevated C-reactive protein and IL-6 levels, both markers of inflammation. They’re also heavier and more likely to be diabetic, which are absolutely confounding factors, but the inflammation/stress association holds even when you account for the other variables. Teasing out cause and effect is probably impossible, but we know that stress, obesity, heart disease, and inflammation are all linked. A further clue may be found among people with anxiety disorders characterized by a heightened inflammatory response to psychosocial stress; commonly, this population experiences a “pro-inflammatory state” and hypertension, both of which are predictors of future cardiovascular disease. Another study found that certain psychosocial factors, like anger and cynicism, were linked to progression of cardiovascular disease.

For a further look at this, check out “The Great Cholesterol Con” by Malcolm Kendrick, who thinks stress is the primary cause of heart disease. I wouldn’t go that far, but it, along with the inflammatory response it engenders, plays a big role. This review paper attempts to explain how psychosocial stress-induced inflammation might lead to heart disease.

Cholesterol

In my recent post on blood lipids, I briefly summarized Chris Masterjohn’s ideas about heart disease. Namely, that heart disease is a problem of macrophages (cells that like to gobble up lipids and other things) in the endothelium (arterial wall) receiving oxidized (damaged) LDL and forming atherosclerotic plaque, which is then vulnerable to rupture. Regular LDL is not the issue; only oxidized LDL gets taken up and turned into plaque. Okay, sounds good (or bad), but how does inflammation figure into all this?

The inflammatory response and subsequent oxidative stress load is ultimately responsible for the oxidation of the LDL, while inflammatory cytokines produced at the atherosclerotic site can weaken and loosen the plaque, thus setting the stage for (and even causing) a rupture. In fact, inflammation is intimately involved in nearly every aspect of heart disease.

Exercise

That was covered fairly exhaustively yesterday, I think, but I’ll throw down the basics. The right type of exercise in the right quantities lowers systemic inflammation, while too much of the wrong kind (or even too much of the right kind) increases it. Both sedentary living and extreme overtraining (PDF) are linked to inflammation and heart disease, and I think poor management of exercise-related inflammation is the key in both situations.

One way exercise can protect against atherosclerosis (and therefore heart disease) is by increasing shear stress on the arterial walls, which causes the endothelium to become less permeable (less accepting of oxidized LDL particles) and produce more nitric oxide (a potent inhibitor of LDL oxidation). You can think of exercise, then, not just as training for your muscles, but also for your arterial walls. It’s enough of an inflammatory stressor to induce an adaptive response. Of course, too much shear stress can be too inflammatory and might actually cause atherosclerosis to progress.

Genetics

Familial hypercholesterolemia, a genetic variant that reduces the activity of LDL receptors and increases the susceptibility of LDL to oxidation, is famously linked to increased rates of heart disease. This doesn’t actually increase the inflammatory response, but it does mean that folks with FH are generally more vulnerable to oxidative damage from the inflammatory response, simply by virtue of their LDL particles spending more time in the blood.

There is another genetic predisposition that directly alters the inflammatory response and appears to increase the chance of developing heart disease (and other diseases): a single nucleotide polymorphism (SNP, remember those?) that changes the amount of IL-6 (interleukin-6, an inflammatory cytokine that I’ve mentioned before) secreted during the inflammatory response (PDF). People with this SNP secrete more inflammatory IL-6 than people without it, and they tend to have higher rates of cardiovascular disease.

I hope this was helpful, and that it drives home just how important – vital, really – the management of inflammation is to heart health. Hopefully now you have something to hand out when people raise eyebrows at your insistence that inflammation is the real cause of heart disease, rather than “cholesterol” or “all that bacon.” They may not all listen or read what you give them, but someone will. And who knows? You might just change a person’s life.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Great post, Mark. Chronic stress is an ugly, ugly beast.

    Abel James wrote on January 18th, 2012
    • It is – but what is the answer? as a ‘Type A’ personality I have tried everything to chill out, it doesn’t appear to be in my genetics

      Abigail wrote on January 19th, 2012
  2. I was at the dentist yesterday and they mentioned gum and mouth inflammation and the tie to heart disease. This certainly should also include inflammation caused by ingesting grain?

    Ed Crotty wrote on January 18th, 2012
    • I used to have trouble with bleeding and swollen gums years ago. Started taking CoQ10 everyday and gums completely healed in 1 week. I ran out on vacation a month ago and forgot to buy more. Gums started to bleed again.
      I am on a statin and they drain CoQ10 out of your body.

      Dick Conley wrote on January 18th, 2012
      • Just curious WHY you would continue on statins???

        Finnegans Wake wrote on January 18th, 2012
      • Weston A. Price figured this one out when his trips to figure out if other people worldwide had these problems. He found that primitive people showed they didn’t have the dental troubles that the Western world faced. It seems like it pretty much boils down to a vitamin K2 defiency. Vitamin A, D, and K2 all work synergistically together and magical things happen, and not just with your teeth and gums. Steven Guyenet, Richard Nikoley, and Dr. Jack Kruse (there are others too I’m sure, but I haven’t read their stuff) all have a lot of great information about this on their blogs. Very fascinating and important stuff.

        Todd wrote on January 18th, 2012
        • Thanks, Todd! From recent readings, this has been my conclusion as well. Apparently K2 deficiency leads to calcium deposits in the wrong places. Rather than in the bones and teeth, it’s deposited in the kidneys as stones or in the arteries as calcifications/plaque.

          Lexi wrote on January 19th, 2012
      • A heads up for you Dick Conley: Get off the statin. Look up on Google and you will learn that statin is carcinogenic. Search out marksdailyapple and ask them how your diet can change to get your cholesterol back normal. Dr Gerson has a famous diet of serious juicing for 30 days. I quit my statin and juiced and followed a no meat diet and got a blood test a month later and I was normal across the board. Ask any naturopath and they will tell you to eat better and quit the statin.

        ricardo wrote on January 18th, 2012
        • What about my Cardiologist who says that statins work by reducing inflamation?

          Dave wrote on January 19th, 2012
      • I noticed that my long-standing bleeding gums problem disappeared very quickly after going Primal, no drugs no nuthin’. And it only comes back when I stray off the Primal path too far and too long.

        Marianne wrote on January 19th, 2012
      • hi….gd morning….why are u on those nasty statin drugs? If u have a family hustory of heart desease,ok…maybe…but if its chosletrol related,please check ,and ask for a vap test to see if u have alot of small dense ldl particles..hope this helps!!!

        kim wrote on January 22nd, 2012
    • I have found http://www.tomlevymd.com to be a great source of information on just this subject…GROK ON!

      skeedaddy wrote on January 19th, 2012
  3. My wife’s father had by-pass surgery at the age of 48. Her mother has had strokes and artery-clearing surgeries since her early 60s. Naturally, my wife worried about her own arteries now that she’s in her mid 40s.

    She recently had sonogram tests done to see how much actual plaque her arteries had. A woman of her age typically has a 20% build up. Doctors don’t get worried until it hits 50%. My wife has 2%.

    She is now convinced the primal cooking I’ve doing for her may really be working. Pass the bacon!

    Stan the Man wrote on January 18th, 2012
  4. My mother was diagnosed with Familial hypercholesterolemia (after her father died of a heart attack), and she is therefore reluctant to come off statins and embrace the fat… but she is curious.

    What should I tell her? What are the best links out there on this??

    Thanks.

    Scott wrote on January 18th, 2012
    • Go to Dr. Michael Eades recent post on statins.

      Marylou Montgomery wrote on January 18th, 2012
    • Even scientists and doctors who understand the propaganda behind statins will generally state that people with inherited hypercholesterolemia should probably be on statins. I don’t think we know enough to make that call. My grandmother has been on statins for 30 years and too suffers from inherited hypercholesterolemia. She is now 93.

      I have seen some really bright scientists propose a basis for clogged arteries that makes a lot of sense to me. And, I have pieced together some of my own supporting views being a scientist myself. The human body is essentially a battery. The concept is very clear and very well understood by electrophysiologists. But it extends well beyond electrophysiology to encompass all nervous system activity that operates on an electrical potential.

      In order for this battery to operate normally, it requires a salt bath or electrolyte bath just like a car battery. That bath operates at a constant pH or it should. (Which by the way is just about the same pH as the ocean and is alkaline. No surprise.)

      Certain factors negatively impact the body’s ability to maintain that stable alkaline pH level. Those are stress, toxins and certain foods amongst other factors. When certain foods break down, they all break down into a specific pH product in the body. Corn-feed meat and butter high in Omega-6 fatty acids, farm-rasied salmon fed corn, grains, industrial food, artificial additives, sugar, sugar substitutes, etc all break down into a very acidic base product.

      When we eat foods that are acidic instead of alkaline (most fruits and veggies are alkaline and most meats high in Omega-3s are neutral to slightly alkaline (salmon, sardines, grass-fed beef, etc) they negatively impact the normal battery function of the body ie, electrolyte bath salts, and therefore, the pH of the body. The body’s battery is thrown out of kilter. This is why the number one cause of heart attacks is undiagnosed type 2 diabetes. The body’s electrolyte bath is thrown out of kilter and that impacts the heart’s ability to generate the needed electrical circuit or the body’s battery to function properly.

      Now, if the body is continuously impacted by this dynamic, the acidic pH of our body can literally eat the arterial walls. Cholesterol, used by the body to repair tissue, is marshaled to the scene and is deposed in the form of plaque. This theory would also explain the tie in to diabetes and heart disease, the brain plaque associated with Alzheimer’s and a few other dynamics that are seemingly without explanation but correlated to modern life.

      Now, is this actually what is happening? I dunno. But, for those who understand complex systems and how the body’s life force actually works, it makes a lot of sense from a macro level. Now, I am sure a biochemist could confirm or tweak the micro dynamics behind this and I think there are a few out there who have come reasonably close to this indictment.

      If this is so, no one should be eating any animal meat fed corn and other tissue putrified foods. Because you are simply becoming as those animals have become – your body tissue is becoming permanently sick… the reason why 80% of antibiotics in this country are ingested by pigs, cattle and chickens raised to eat industrial food rather than eating food nature made them to eat. Ditto with sugar, sweeteners, highly processed foods, etc.

      Just thought I would add to the discussion and encourage people to think outside of the box about the topic as well as what they stick in their mouth.

      Namaste.

      Barry wrote on January 18th, 2012
      • Btw, ever wondered why the first thing they give you in the emergency room after suffering a heart attack is a magnesium drip? Magnesium is one of the primary salts needed by the body to maintain proper electrolyte action so the heart’s electrical system will operate normally. And, what robs our body of magnesium? Industrial vomit we call food in these here United States. Just sayin. lol.

        Barry wrote on January 18th, 2012
        • Athletic activity (heavy sweating) can cause electrolyte imbalances, which in turn are sometimes associated with sudden heart attacks in someone who is generally physically fit. Sports drinks (like Gatorade) can help restore electrolyte balance.

          Extreme diarrhea (such as encountered in third world countries) causes extreme dehydration which in turn also causes potentially fatal electrolyte imbalance. An emergency treatment for these cases involves a specifically formulated IV solution including sugar and salt.

          OK, that said – for those of us who don’t want to include processed foods, sugars, salt, etc. in our diet, there are other ways to maintain/restore electrolyte balance.

          For one, there is a product called Body Rescue that is an alkaline booster in the form of drops that are added to a glass of water. Maintains the alkaline body condition which in turn maintains electrolyte balance – among other benefits.

          Also, there is no reason that I know of not to include magnesium supplements for daily nutrition. I always balance my calcium intake with magnesium. I prefer to get my potassium from food as supplements are very rough on the stomach. Many vegetables and fruits are naturally high in potassium.

          At age 59, I have excellent blood pressure, heart rate, and above average bone density – due in part to utilizing the supplementation above.

          rrustad wrote on January 19th, 2012
        • Barry,

          FInal comment here as well….I agree with your response to my post, other than to clarify that what I meant was that there are other ways to restore or to maintain electrolyte balance than to consume sports drinks or an IV containing some form of salt or sugar. I know that these interventions have saved lives but that’s not something I would want by way of lifestyle choices. So, again, we are in agreement.

          About calcium/magnesium supplements, again we are in agreement – and I wish to clarify what I said. When I said “balanced” supplementation, it was short hand for your later explanation about the need to establish proper ratios. That is what I do and I monitor it via metabolic blood tests as well. And, again, that is only “in part” what has contributed to my good bone density, etc.

          Like you, I am ( or technically, was ) a scientist by trade. However, I am a “she” not a “he” :-). Nice “chatting” with you on this topic.

          rrustad wrote on January 20th, 2012
        • Mustad,
          I am always on the lookout for a future Mrs…. Care to discuss this over a metabolic blood test? HAHA!

          Barry wrote on January 23rd, 2012
        • “Industrial vomit”

          +1

          BillP wrote on August 23rd, 2012
      • Wow, I had never thought of the body as an electrical device, even though the evidence was there. Your epistle (not intended to be a pejorative!) widens the discussion, giving us all more to think about.
        It’s sort of ironic that this discussion centres around stress and its implications, yet the difficulty of avoiding the “industrial vomit” (great metaphor, BTW) is almost guaranteed to induce stress.

        Barrie wrote on January 18th, 2012
        • Some good points by Mustad. Science is now starting to understand that distance-type exercise or exercise that stresses the body for long periods of time has a profoundly negative effect on the body. ie, There could come a day when science tells us we shouldn’t be running marathons or riding in the Tour de France. Obviously, he states one negative impact of electrolyte imbalances. There are many more including degenerative diseases.

          I think Mustad may have meant to say that for those who don’t wish to exclude sugars… that there are other ways of maintaining electrolyte imbalances. It’s a false truth to believe one can eat sugar or industrial food and simply eat sea vegetables or pop an electrolyte supplement and everything is a-okay. The issue is much more complex than simply an electrolyte issue. Any type of fructose causes cirrhosis of the liver, excess cholesterol production (that may also cause brain damage), kidney damage, destroys the natural fauna of the gut and therefore, impact serotonin production and subvert other necessary body processes. I was simply commenting on the electrical properties of the body but inflammation comes from many factors as Mustad states. The most controllable factor is to quit eating fructose, corn-fed meat, corn-fed butter and corn-fed fish, highly processed foods, sugars, foods with man-made additives and foods treated with pesticides/herbicides.

          The body is a highly complex state machine. And, when it is knocked out of that stasis for any reason, there are consequences. You can’t have your cake and eat it too. You can’t eat industrial goo and pop a pill to ameliorate their consequences.

          By the way, one final comment in this thread of remarks. Every substance ingested by the the body, either through the skin, the lungs or the stomach, that isn’t supposed to be there, is viewed by the body’s complex state machine as a poison. Every drug ever made is viewed by the body as a poison. That is a medical fact. Now, we sometimes have to deal with the effects of that poison by dealing with side effects in order to stay alive. ie, Terminal or other life-threatening illnesses. There is NO medical evidence that statins have any positive impact on normal heart function. There are MANY known negative effects or unintended consequences of putting statins in our body and the list is growing as people eat these things like candy. People need to do their own diligence.

          By the way, you may want to do some diligence on your calcium supplements. Excess calcium CAUSES bone density issues it doesn’t ameliorate it. Another medical myth. Excess calcium interferes with the absorption of magnesium. You need more magnesium and less calcium to ensure proper bone density. And, don’t expect to get it from your food. Because our soils are mineral-depleted and much of what we consume is void of necessary nutrients. Magnesium supplements don’t work unless it is magnesium chloride. NIH has done a study on magnesium absorption. Just sayin. lol.

          Barry wrote on January 20th, 2012
      • Well said. Those with familial hypercholesterolemia might gain more benefit on statins than off. Would those with this unfortunate genetic variant do fine if they followed a primal diet and exercise program? Maybe, but who wants to conduct or participate in a large randomized control trial to find out?

        Rachel Fischer, MD wrote on January 19th, 2012
        • All the recent research on statins points toward their anti-inflamatory effects as the likely mechanism for any protection they provide – which begs the question re using less toxic forms of anti-inflammatory treatments/routines.

          Sometimes a drug’s incidental effects are medically valuable. For example, in veterinary medicine, doxycycline (a common antibiotic) has been used to treat specific auto immune disorders as effectively as chemotherapy. Also, doxycycline has comparatively low toxicity.

          But, in the case of statins the level of toxicity is a genuine cause for concern.

          rrustad wrote on January 19th, 2012
      • “Because, not to decay is the quality of alkaline body. And as long as the individual mind gets to that universal consciousness, the body has to be intact.. In order that it remains intact, it becomes alkaline.

        If the body is acidic, more of acid in the system, then the oxygen going in becomes carbon dioxide. If the body is acidic, more carbon dioxide is produced. To throw it out, the exhalations become deeper, heavier. When the exhalations become heavier, inhalations become correspondingly heavier also. So the breath grows heavy when the system is acidic.

        Opposite to this, when the acidity becomes less then the breath becomes slow. That is why during meditation the breath becomes slow, the body becomes less acidic, more alkaline.

        This is the reason why the body lasts longer for those who meditate, long life. With meditation the blood chemistry changes, becomes less acidic, more alkaline…”

        – Maharishi Mahesh Yogi, Hochgurgl, Austria, 1962, tape number 2.

        rrustad wrote on January 19th, 2012
      • I took a statin. I have genetic cholesterol FH. However, the statin CAUSED neuropathy inflammation- the very thing you want to avoid to prevent heart disease. I am now off the statin and will never take it again. Statins can cause nerve damage and nerve inflammation- with symptoms such as red colored skin and red hands and feet and red facial skin, with burning pain. They are very dangerous.

        Pat wrote on April 13th, 2012
      • When triglycerides are above 70 the LDL become flat and sharp like knives, cutting into the arteries like razors and get stuck. It causes an injury that promotes the production of even more LDL (again the flat, sharp kind) in order to repair the site. After awhile, when enough have piled up, it becomes visible as plague.

        LDL isn’t bad. It’s only bad when triglycerides are above 70 and they change from fluffy, big into flat and razor-like.

        Triglycerides only go up when high amounts of insulin is produced to get rid of blood sugar.

        This is why diabetics have more problems than just a tired and worn out pancreas.

        LDL isn’t bad cholesterol, they serve as a shuttle bus for the workmen (nutrients) to be delivered to the injury site and do repairs. So keep your triglycerides down in order to heal more efficiently, too, not just to prevent or beat diabetes or heart/artery disease.

        Al wrote on February 26th, 2014
  5. Question: Just how important is the consumption of oxidized fat as a contributing factor in heart disease? I eat a lot of bacon and sausage. High-temperature cooking could be a mistake, but it’s hard to know whether this is truly a big deal. Hmmm…

    JoelG wrote on January 18th, 2012
  6. My paternal grandfather has had a couple of strokes, my maternal grandfather died of a heart aneurysm, and virtually all of my older relatives have arthritis. My mother has Raynaud’s and slightly high cholesterol, which she manages by reducing her sugar intake! I’m so grateful my Hubby found MDA, so I now know what to do to reduce the inflammation in not only my body, but others I care about too!

    Since going primal, I no longer have the aches and pains in my joints that I’ve suffered with for years, and I’m only 28! Thank you Mark Sisson! Grok on!

    Steffy wrote on January 18th, 2012
    • Be encouraged that I, at 68, have found some relief from aches and pains, including osteoarthritis, at least in part because of attempting to go primal. I have Arthrotec prescribed for pain, but I have reduced my dosage in half, with no perceivable increase in discomfort, since reducing grain and sugar intake. My doctor, sympathetic as he is to my efforts – he approved letting me discontinue meds for high blood pressure after I demonstrated consistently lowered levels – does not want to discontinue the painkiller entirely. He is falling back on the medical school mantra of making the patient comfortable, even though the analgesic does nothing positive for overall well-being. I will continue to work on him.
      As for MDA, I find it inspiring and encouraging. Mark is not a drill sergeant; he realises we are human and will backslide from time to time. The articles are interesting, even with some fairly technical descriptions of physiological processes. A challenging read never hurt anyone! I continue to try to limit grains and sugar intake, which has helped me and my wife to reduce, at least somewhat, our weight; we feel better without those things, even though she likes her rolled oats for breakfast.

      Barrie wrote on January 18th, 2012
  7. High temperature cooking of PUFA or MUFA is a factory of trans or oxydised fatty acids you are right! Either with bacon or with olive oil …
    If you eat mostly this type of cooked oils it is not a tiny amount year after year.
    So it’s simple mostly raw food and slow cooking is by far more paleo.
    And I don’t speak there of cooked food borne carcinogens!
    My opinion is that a lot of paleo addicts are wrong about cooking their meat like they do.

    guy-andré pelouze wrote on January 18th, 2012
    • I imagine it’s not the technique that’s to blame so much as the environment. Ten thousand years ago humankind couldn’t go the to the store and buy a week’s worth of bacon, eat it, and then do so again every week, week after week. The natural environment gave us what it had available. Goat one day, birds the next, fish after that, berries when there were berries, etc. If you naturally have a taste for variety (like I do) and eschew a daily regimen of bacon and eggs or sausage and eggs for more varied fare (such as sardines and/or anchovies and olives, I love that occasionally) then it’s not an issue but for a lot of people a daily eating regimen is normal/comforting to do and they do so… because they can.

      Tim wrote on January 18th, 2012
      • Also true. Variety is the key.
        I’ve consumed over 220 different foods in 2011…and my list is still growing.

        I rotate elk, bison, rabbit, beef, chicken, seafood, lamb, goat, pork and most of their organ meats. When I make beef tongue stew I probably don’t see the same food again for 8 weeks.
        Thymus, pancreas, thyroid, brain, liver, spleen, kidney, salivary glands, tongue and lip, heart, tail, ear-nose-throat cartilage, cartilage of the heart, heart fat, kidney fat, feet (bone broth) and fresh blood.
        This is just the list of Beef Organ Meats without ever touching the actual muscle.

        Same list goes for elk or deer with slightly diff. nutrient content. Add the 150 diff. veggies or fruits and nuts (e.g. boiled chestnuts) and how many diff. combinations of meals you can make…I don’t think I’ve eaten the same meal twice since fall last year.

        Arty wrote on January 18th, 2012
    • I totally agree.
      I do believe consuming animal flesh in its raw state is the healthiest way to consume it.
      But…who wants to gnaw on a cold slap of fat?

      I cook everything minimally, often leaving everything semi-raw and bloody, like a juicey buffalo steak.

      Arty wrote on January 18th, 2012
      • You should always cook meat to kill bacteria…Broil for at least 1 minute per side.

        Mary wrote on January 19th, 2012
    • I don’t disagree.

      However, I believe that cooked foods in the paleo era were cooked over an open flame (i.e. hunted meat roasted on a wooden spit). This form of cooking is similar to modern grilling, char broiling, etc. the identified carcinogenic prime culprits.

      Like so many other health mediating factors, the issues here are complex and contextual.

      rrustad wrote on January 19th, 2012
  8. What is your recommended action plan for folks with famialial hypercholesterolemia besides staying calm and carrying on? I can never get anyone to answer my question (other than the lipid specialists who seem to want to band-aide one issue and create another. Please respond. I beg you. :0)

    Susan wrote on January 18th, 2012
    • +1 !!

      Amy wrote on January 18th, 2012
    • + 2 (see above!)

      Scott wrote on January 18th, 2012
    • Familial hypercholesterolemia is where the LDL receptor is heavily downregulated. LDL receptor activity is largely controlled by the thyroid. I would suggest you should look into optimising thyroid function.

      Steven wrote on January 18th, 2012
  9. Don’t leave us hanging, please. It seems that you have several FH patients asking the same thing….

    Susan wrote on January 18th, 2012
    • I have hypercholesterolemia. I am 59Y/O with no cardiac symptoms, and take no statins. If you have access to a family tree that goes back into the 1800’s you can check the age at death of your ancestors. I did this and found it easy to decide not to take statins.

      DRK wrote on January 18th, 2012
  10. Mark,
    You forgot gum disease! The contribution to the overall inflammation of the body by gum disease is well documented and highly correlated with heart disease. The main cause of gum disease is eating sweets and starches and then not flossing and brushing. Grok had much lower incidents of caries and gum disease than the Western population. Eating primal, and flossing and brushing will keep this contributor to inflammation at bay.

    Gene Banman wrote on January 18th, 2012
    • So that sounds as though gum health is a marker of your inflammation right? I know my father has a very bad heart and poor circulation (he’s in bad shape overall) AND his teeth have been falling out and his gums are in awful shape. I was told by a dentist that when you have bad teeth and gums you often have heart problems.

      EZ wrote on January 18th, 2012
      • 35 years ago, I knew a doc whose patients had heart and gastrointestinal problems, big ones. She noticed they also had very poor mouth health. Her patients could afford to go to her for a bandaid, but not go to a dentist. She (correctly, I believe) identified poor oral health as the real culprit. Of course, in the mid-70s, almost no one was looking at the SAD. This doc had common sense, and I’m sure if she had lived a little longer would have made the SAD connection as well.

        Mary Anne wrote on January 18th, 2012
    • Amen!

      Even our vets now encourage routine dental care for our cats and dogs. Vet research indicates not only associated heart disease but also renal (kidney) disease. Renal failure is a major cause of death in cats in particular but also in dogs (and humans).

      But, inflammation is not the only factor involved. We now know that the bacteria present in dental disease is present through out the body. The inflammation involved MAY be caused by this bacteria or it may simply be associated. Still more research is needed to pin down mechanisms; but, meanwhile the overall need for good oral health is clear.

      rrustad wrote on January 19th, 2012
      • My dogs have been eating raw since puppyhood and turn 6 this year.
        Non of them have gum disease or cavities.

        It’s the kibble (carbs) that cause all that crap.

        Al wrote on February 26th, 2014
  11. Chronic stress theory is ridiculous. During World War II heart disease was nowhere to be found amoung the occupied countries or in the death camps. You can’t get anymore chronic stress than that. This was well documented by post mortem exams before occupation where heart disease was common to virtually nothing after occupation. Then during the 50’s rates went back up. Nowadays there is no heart disease in Somalia where as a parent you have to watch your children die of stavation on a daily basis yet cancer and heart disease is no where to be found except among the elite rulers. The biggest cause of inflammation is the introduction of processed foods mainly refined sugars. Can you say Carb loading for atheletes? Just look how they chug gatoraid and eat other pure sugar products like white pasta. You hardly ever see a person run a marathon and sit down to nuts, fruits and vegatables. Like our ancestors chronic stress and vigilance of danger AT ALL TIMES only makes us stronger and more resilient. Just ask any navy seal.

    Greg wrote on January 18th, 2012
    • I have thought about this too. Previous generations had more stressful times than we do today. I think it’s the diet, the diet, the diet.

      HillsideGina wrote on January 18th, 2012
    • When I was a child, my (American) family was friends with a Dutch family that had immigrated to America following WWII. This Dutch family ate astonishing amounts of butter.

      I once asked them why they liked butter so much. They explained about how food had been rationed during the years of WWII. Butter was simply never available to the average Dutch person – for several years.

      I believe that food rationing was common during WWII, even in the US. My mother mentioned never being able to get certain spices (like real vanilla) that came from certain areas of the world.

      Now, that said, as someone following a Primal diet I have no objections to butter. I use organic, unsalted butter myself. I think the problems occur when butter is consumed along with equally large amounts of sugar and other refined carbs – which were also rationed. So, of course, baked pastries and other such potentially triglyceride (and inflammation) raising foods were just not available like they are today.

      rrustad wrote on January 19th, 2012
  12. Lots of people ask me why I am so concerned with eating well and exercising properly since I’m pretty thin and in good shape…I’m actually not that “concerned” because this is way easier than the diet and exercise I used to do (which was low fat and chronic cardio)! The thing I have the hardest time managing within the context of the primal blueprint is my stress levels. I have a job that can be very stressful at times and that always carries some form of chronic low level stress due to the everyday responsibilities I have.
    I want the odds to be as good as possible in my favor. Since I know I get ramped up from stress…(I can feel it in my shoulders and neck…and in my chest…that I haven’t been breathing in fully when I have had a particularly stressful day)…I have taken active steps to improve this. I get a 15 min massage at work every week (nice perk!) and I go to Yoga class once a week. I’ve also started some deep breathing exercises which have really helped me become more aware of my stress levels during the day.
    I tell people that it’s not really the diet or the exercise or my weight that I’m “concerned” with, but rather the total primal approach to life that is what I am going for…
    I’m hoping to break the family cycle here…my father had a heart attack at 41 and was lifting close to 300 lbs, was in the “best” shape of his life, and had cholesterol numbers the doctor’s dream of for their patients. But he has a similar personality to me (or I rather have a similar personality to him)…and he does the same kind of work that I do.
    I don’t want to be another statistic!

    primalpal wrote on January 18th, 2012
  13. What other parts of the body does oxidized LDL affect and what is the impact?

    palo wrote on January 18th, 2012
  14. The product Antabloc is an anti-inflammatory nutraceutical delivered as a breathmint.

    Anatabine is a natural alkaloid found in Solanaceous plants (tomato, peppers, tobacco) that reduces NF-κB activity. (Source: antabloc’s wesbite)

    The fact that Star Scientific (the parent company of Antabloc) is in a lengthy court battle with RJ Reynold over tobacco curing methods, that for me, adds credence to Antabloc.

    I purchased a case from Amazon and will be testing it out. Any other MDA goers use this product?

    liberty1776 wrote on January 18th, 2012
  15. If someone got a VAP test and the results showed a high pattern of oxidized LDL, what could they do to reverse this? Simply stick to the primal blueprint? Or is there something they can do in addition to specifically target their oxidized LDL levels. Eat more antioxidant foods like berries, red-wine, etc?

    JC wrote on January 18th, 2012
    • Get your triglycerides below 70 and most (or all) of your LDL turn billowy, fluffy.
      To get TG below 70 you have to follow the PB 99.9% of the time.
      A week end of splurging on sugary ice cream, soda and lasagne can raise your points by 20 or more.

      Arty wrote on January 18th, 2012
      • I think you have hit the nail on the head.

        That’s why I’m striving for 100% Primal. At age 59, I find that even that “healthy” bowl of organic steel cut oatmeal raises my triglycerides. My glucose and all other markers (other than cholesterol) are all good to excellent.

        I don’t worry about the total cholesterol or the LDL even as much as I do about lowering the triglycerides and raising HDL. Looks like for me that means NO grains or legumes, little fruit, and more Primal type exercise. Plus, losing some weight. evidently just the simple fact of being overweight sets us up for out of range lipids.

        rrustad wrote on January 19th, 2012
  16. This is actually part of what my lab researches. Fancy that.

    It looks like its more of the issue of antibodies binding to the oxidized fats (that your body oxidizes by itself) which then causes your immune system to fly into overdrive and putting your system into a chronic loop of inflammation.

    Sky wrote on January 18th, 2012
  17. The work of Weston Price shows how the condition of your teeth is a very good guide to your general health. This would indicate that the condition of the teeth and gums would be a reflection of what is going on inside the body including your heart.

    patrick wrote on January 18th, 2012
  18. Yesterday a new book came out called the End of Illness – David Agus and he deals extensively with Inflammation in the book. I was watching the author on the today show and he talked mainly about inflammation and how much it hurts us. I am going to get this book.

    Dave wrote on January 18th, 2012
  19. How much can inflammation caused by these factors be mitigated with anti-inflammatory foods? Would CRP in somebody who has chronic stress and a head of garlic a day be comparable to somebody who has neither, or can food only go so far?

    Mark wrote on January 18th, 2012
  20. #1 problem?
    Getting your physician on board to
    actually do the specific medical tests needed for finding your body’s weaknesses &/or needs for changing to a more productive, healthy & long lifestyle.

    Donna J. wrote on January 18th, 2012
    • No kidding!

      rrustad wrote on January 19th, 2012
  21. what proportion of the population seems to be prey to these genetic predispositions? i’m always a bit annoyed when the media carries on about something like this, then you find out it’s like 0.1% of the population or only applies to pygmies or something….

    tess wrote on January 18th, 2012
    • I agree.
      My mom and dad ate the same foods for last 40 years, yet my dad is in excellent health and my mother lost all of her hair, ALL of her teeth, is on several meds for blood pressure, cholesterol whatnot (lipids were bad before taking statins), has diabetes and gallbladder disease and is starting to break bones now.

      My dad has….nothing that is detectable.

      Mother is a nordic and my dad is from the middle east. They should be eating 2 different diets, my Mom should be on a diet high in fish and blubber (which she craves but won’t eat).

      Arty wrote on January 18th, 2012
      • I just discovered Primal Blueprint. I’m liking what I’m seeing. Perhaps your mom should look into the diet I’ve already been following for about 6 years, which is called the “Blood Type Diet,” based on your blood type and what foods you should avoid and which you should consume. I swear by it. I’m going to begin work in PB and take the best of both.

        Michael H. wrote on January 18th, 2012
  22. I”m still not sure what oxidation means. Can somebody please explain it?

    thanks

    jack wrote on January 18th, 2012
    • Oxidation of a fat basically means it has gone rancid. Oxidation in your body generally equates to cellular damage.

      Johna wrote on January 18th, 2012
      • Thanks! What does oxidized Cholesterol mean?

        jack wrote on January 18th, 2012
  23. Has there been any mention on this site about reversing atherosclerosis? If so, where? Thank you!

    Brian Kozmo wrote on January 18th, 2012
  24. There’s an herbal product called Zyflamend that in combination with fish oil and vit D supplements has practically eliminated all my tendonitis (i had it in my elbow and achilles). I’m 51 and I play tennis weekly – i was having a lot of discomfort before I started on Zyflamend, now I swear by it. Of course, eating Primal as often as possible also seems to help.

    Bryan wrote on January 18th, 2012
  25. I have a FH diagnosis (adopted, no family history, but cholesterol +300 consistently since at least 6 years of age). BUT, ratios are good, c-reactive protein levels normal (no inflammation), and LDL particles are large & fluffy. Cardiologist still wants me on statins. I say no, but am I putting myself at risk?? There doesn’t seem to be a lot of info out there for those of us with FH. Maybe Mark can comment further?

    Amy wrote on January 18th, 2012
    • You might look at this article I found at Seth Roberts’ site recently:
      http://people.csail.mit.edu/seneff/why_statins_dont_really_work.html

      Gayle wrote on January 18th, 2012
    • When my cholesterol was around 321 I was taking simvastatin (Zocor) to get it down. Then I read about it in Good Pills, Bad Pills: it is a carcinogen – they recommend that if high cholesterol is your only risk factor, that you’d be safer not taking the drug. Since I didn’t smoke, exercised regularly, and wasn’t too overweight, I stopped taking them.

      Since I’ve been eating mostly primal for a couple of years, the cholesterol came down to “borderline high” which is the sweet spot (from what I’ve been reading).

      W. J. Purifoy wrote on January 18th, 2012
  26. Perfect post, Mark, this is why I believe so strongly in your belief of “move frequently at a slow pace” (3-5 times per week @ no more than 75% of max heart rate) and LHT. (Only twice a week)
    My father preached nutrition all his life, but was always stressed out ‘bout everything; he had a quadruple bypass at 75 and everyone he preached to, have discounted his wisdom on nutrition. Too bad, because meditation is the only additional nutrient needed.

    dasbutch wrote on January 18th, 2012
  27. Inflammation is the cause of so many issues and one which often holds people back from progress in their training. I’ve recently began upped my intake of fish oil from fatty fish and supplements to help combat these effects. My new favourite food is sardines….such a nutrition powerhouse!!! And I have to agree with Mark about endurance training….it can be super taxing on the body. Best to workout in more intense shorter bursts of exercise.

    Sarah wrote on January 18th, 2012
  28. I live in Adelaide and at the moment we are hosting the ‘Tour Down Under’ for those who don’t know is a bike marathon across the state.
    I have to shake my head when I see things like “The Pasta festival” night where normal people are encouraged to come and ‘Carb load’ with the athletes….Oh if only they knew…..

    Rio wrote on January 18th, 2012
    • I knew a runner who ate 3 to 4 BigMacs everyday when she was training. Lost track of her, but even then that seemed like a ‘not’ to me.

      Mary Anne wrote on January 18th, 2012
  29. Another person from Adelaide.. There are Primal people everywhere…

    mick wrote on January 18th, 2012
  30. My grandfather died of a massive stroke at age 77. You might say it is possibly in my genes for heart problems except one fact a lot of doctors won’t tell you. My grandfather was also on a beta blocker for many years before the stroke and the thing you don’t hear about a lot in regards to medications is some of their side effects which for beta blockers is heart attack and stroke. I always wonder if my grandfather would have lived into his 90’s like his father did if he wasn’t on the beta blocker and a low fat diet his doctor prescribed.

    Also I would like to add there is some really interesting work by Dr. Malcolm Kendrick on heart attacks being caused by clot formations in blood vessels. He spoke about this in the England Weston Price meeting.

    Edward wrote on January 18th, 2012
  31. Me, I was sort of tickled to see that personality traits like “anger” and “cynicism” were positively linked to heart disease. There’s a moral or three to that story.

    Bennett wrote on January 18th, 2012
    • Well, I dunno about that – my mother is one of the most angriest/paranoid/uptight persons I know and she’s almost 92 years old. Plus my ex mother-in-law is not only angry/paranoid/uptight but down-right nasty and she’s pushing 93 – and still going very strong.

      PrimalGrandma wrote on January 18th, 2012
      • well even if it could be proven that stress does not kill you(and i’m not saying it does’nt) , it sure would seem wise to avoid it as much as possible seeing as it makes life unpleasant and miserable,even if i die at a young age i want to be able to say i was happy and at peace during the time i had,eating healthy is very important but so is looking after your emotional health,for a happy life filled with laughs,smiles,joy… excersize and a healthy body to carry you through is a life worth living:))so far i have the primal diet locked in as my nutrional base thats almost the easy part,what i have to really focus on is not letting the stress of life rob me of simple daily joys like a peaceful moment with my kids or an afternoon nap or just being able to fall asleep at ight withour tons on my mind.

        emma wrote on January 18th, 2012
      • I had grandmothers like that. We used to say that they were too mean to die – that was a common “saying” in those days. And neither of them cared a whit about diet or exercise.

        One of them was a Southerner who fried everything and made mud gravy for many dishes. She also drank (a single) Coke Classic every day for her “dyspepsia”. She had classic central obesity (pot belly) her entire adult life. Yet, she never had high blood pressure, diabetes, heart attack, stroke, etc. We used to joke that she just gave other people high blood pressure, etc. primarily via the stress she caused others. Anyway, she died peacefully in her sleep at nearly 100 years of age. Go figure.

        rrustad wrote on January 19th, 2012
  32. Think how fortunate you all are.In the past most of you would be dead by now.Mosr people live much longer now.
    Stress,i read where just driveing down the road elevates our flight reflex
    I wouldnt doubt that modern life and the amount news in your life isnt good for you.

    Ron wrote on January 18th, 2012
  33. Best information on reversing heart disease is a book written by Herman Hellerstein,M.D. called Healing your heart. I got mine off Amazon. He was the cardiologist that did all the research during the second world war and was present at countless post mortems while serving in the military. He stated it was virtually impossible to show new pathology students what a clogged coronary artery looked like but only scar tissue where the fatty plaques once were in an occupied country right after the war. Here is what he said to keep away inflammation, don’t smoke, keep blood pressure under control, don’t eat processed foods, don’t have high blood sugar, EXERCISE and stay busy, get down to your ideal weight, don’t let blood triglycerides, cholesterol or LDL get too high. I would also add have your teeth cleaned every THREE months and brush, floss daily. Remember that too high of blood Cholesterol including LDL can be inflammatory in itself. Cholesterol can’t travel in the blood because it is too oily so it rides to the cells in packet of lipoproteins. LDL are small dangerous packets that can slip into small cracks and crevices of inflammed arteries whereas HDL are large high density lipoproteins which help clean up LDL. Low thyroid is also an independent rish factor for coronary artery disease. Get that fiber up to AT LEAST 35 grams a day and that will soak up a lot of bowel cholesterol so it can’t be recycled by the liver. Remember most people make over 900mg of cholesterol per day from the liver. Once again look at Stess as a fun friend. I welcome it with the cortisol and adrenaline rush. NEVER lose your CONFIDENCE. Always be an adrenaline junkie to get rid of it and the cortisol. Lastly, if you starve ANYBODY to the point of barely being able to survive, it is viturally impossible to clog arteries no matter how much other STRESS you put on them.

    Greg wrote on January 18th, 2012
  34. Uh-oh, anger and cynicism as a precursor to heart disease? I may be doomed.

    IvyBlue wrote on January 19th, 2012
  35. Inflammation cannot be a cause. It is a physiologic reaction to an actual or perceived body invasion. It’s a normal reaction….not a cause.
    All trials with anti-inflammatory drugs have resulted in increased heart mortality.
    Patients with severe and prolonged infections (bacterial) have MORE atherosclerotic plaques. Thus the cause of the observed inflammation is bacterial infection of the arteries.
    Periodontal disease is a risk factor for CHD and its treatment improves the carotid arteries.
    Simple inflammation cannot be THE cause when bacterial infections are suspect.
    Dr. John

    Dr. John wrote on January 19th, 2012
  36. I’m one that the cholesterol medicines seemed to cause pain in the muscles. So focusing on diet and exercise seems to be a better way to go.

    John W. Zimmer wrote on January 19th, 2012
  37. Thanks for the inflammation post, it’s something people should be more aware of. I just wanted to add something for you to think about, if you are doing full body natural movement in alignment (not running on a elliptical trainer or treadmill,that is not natural) you don’t need to do CV workouts, in fact CV can cause more damage to the arteries if you are not in alignment (it’s a matter of blood geometry). Optimal blood geometry and having your muscles at the correct length are extremely important to CV health and decreasing inflammation. If your alignment is off, turbulent flow is created (just like with smoking and stress) the blood cells then scar the inside of your blood vessels and your body repairs the area by patching it up with cholesterol, which leads to plaque.

    Barbara wrote on January 22nd, 2012
  38. Mark’s guidelines for healthy living are spot on, but if you are suffering from a disease that involves chronic inflammation (sarcoidosis, rheumatoid arthritis, inflammatory bowel disease, etc) you may need to remove the source of infection that is causing the inflammation (ie: gum disease). I am being treated for chronic inflammation with the Marshall Protocol. But it is not a quick fix.

    sean wrote on January 23rd, 2012
  39. While this article, like most on this site, is in general very good, the point about stress is quite off the mark. So far in fact that it is a terribly outdated view when the medical research is examined. One only has to look at the award to Warren and Marshall (not the same referenced in the Marshall Protocol) of the Nobel Prize in 2005 for the discovery that peptic ulcers were caused by bacteria living in the stomach, something which the medical community previously believed impossible and so attributed the cause of the illness to the vague term “stress”.

    Stress has been used this way by the medical and wider community for decades. Stress is nothing more than a causal dumping ground for occurances which can’t be otherwise explained by the state of medical research at the time.

    Thinking of stress in this way is dangerous, as it takes the focus away from examining other aspects of lifestyle and diet, that will inevitably be revealed in time to be responsuible for the condition being observed. Far better that we state that the cause of a certain condition is unknown at present, than lump it in with the vague and unhelpful term “stress”.

    If past advancement in research is any indicator (and it most certainly is) then one would expect that by the middle of this century, the concept of stress will be resigned to the area of medical curiosity and ridicule with which we hold the likes of medieval blood-letting. Let’s face it, it’s about as useful.

    Jeff wrote on January 24th, 2012
  40. just found the site and am going through the 1st 7 emails. I enjoyed good health until suddenly 5 years ago went into a-fib and got some heart failure as a result. My 100 hr/wk job certainly contributed. anyway, long story short…I’m on the usual collection of heart meds and an attempt to cure the afib by going inside the heart failed because I have scar tissue throughout my atria – possibly due to Rheumatic fever I had as a kid. I’m taking 4g high DHA fish oil and 2000 units D3 daily and trying to get my diet over to the anti-inflammatory side. I’m not inclined to quickly start shedding prescribed drugs but am looking for guidance on how to improve my long term outlook and what to look for specifically to work with my doctors to reduce some of the meds over time. My BP and cholesterol numbers have been great for years…they’re not the source of the problem, but how do I reduce scar tissue buildup in my heart? Any help GREATLY appreciated

    Mike wrote on January 25th, 2012

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