{"id":686,"date":"2014-04-24T02:38:36","date_gmt":"2014-04-23T14:38:36","guid":{"rendered":"http:\/\/4abettermemory.com\/memory\/?p=686"},"modified":"2014-04-24T02:38:36","modified_gmt":"2014-04-23T14:38:36","slug":"part-ii-causes-and-prevention-of-strokes-heart-attacks-and-vascular-dementia","status":"publish","type":"post","link":"https:\/\/4abettermemory.com\/memory\/part-ii-causes-and-prevention-of-strokes-heart-attacks-and-vascular-dementia\/","title":{"rendered":"Part II: Causes and Prevention of Strokes, Heart Attacks and Vascular Dementia"},"content":{"rendered":"

\"\"Last month we reviewed a section of Dr. Perlmutter\u2019s new book <\/span>Grain Brian<\/i>, talking about the essential role of<\/span> Cholesterol<\/b> for the brain and body. Many were surprised to learn that cholesterol, even LDL (a cholesterol carrying low density lipoprotein) rather than being bad is really essential for physical and mental health \u2013 unless oxidized or damaged by the forces noted below.<\/span><\/p>\n

However, the question some then asked was: \u201cIf cholesterol does not cause heart or\u00a0 vascular disease, then what does?\u201d Although Dr Perlmutter\u2019s focus in his book is on brain health rather than heart health, he does address that question as well. (Of course vascular disorders like high blood pressure, atherosclerosis, TIA\u2019s, etc. have long been seen as primary contributors to a variety of brain disorders including Alzheimer\u2019s.) But as much as I admire the man, I didn\u2019t want to take Perlmutter\u2019s word for this alone. Fortunately, and coincidentally, one of the top senior research organizations in the world – Life Extension Foundation – just wrote a series of articles on this very subject. In fact their latest, best article (with over 140 scientific references) just came out in their May Issue, which I just received an advanced of last week (that issue is not yet posted on line, but will be in May).<\/span><\/p>\n

So in this Newsletter\/blog (perhaps my most important yet) I will share with you what the latest research and other experts suggest are the greater villains in this drama. And what you and your loved ones can do to protect you heart, and vascular system from the other, more dangerous marauders plaguing your body and brain. \u00a0<\/span><\/p>\n

What Causes Cardio Vascular Disease (CVD)<\/b><\/p>\n

It is interesting\u00a0 to note that the Life Extension Foundation takes a more traditional stance on cholesterol than Perlmutter, agreeing with the CDC that reducing LDL should reduce the risk for adverse vascular events (despite Perlmutter\u2019s convincing evidence to the contrary). However, they believe the traditional medical approach taken in America \u201cunderstates\u201d the facts – that lost in the commercial hype about statins like Lipitor, Crestor, etc is the fact that there are \u201c<\/span>other preventable causes of vascular disease<\/b> overlooked by hurried physicians.\u201d Moreover, several of these, research is now showing (as Perlmutter notes) are likely much greater risk factors for strokes and heart attacks than are cholesterol and LDL – cholesterol carrying proteins.<\/span><\/p>\n

Other Critical Risk Factors\u00a0<\/b><\/p>\n

Not the least of these risk factors is low HDL cholesterol. Some clinics only provide patients with a total cholesterol score. Not only is this meaningless, it\u2019s confusing, as scientists long ago documented the ability of HDL<\/b> (high-density lipoprotein – the \u201cgood\u201d cholesterol carrier) to protect against LDL oxidation and accumulation, and \u00a0remove cholesterol <\/b>affixed to arterial walls and trans\u00adport <\/b>it to the liver for safe disposal.1, 2, 3, \u00a04 \u00a0<\/sup>(Keep in mind that the LDL protein itself in not bad, in fact it is vital to carry essential cholesterol to the brain to nourish our brain cells, and high cholesterol in the brain, as previously noted, is essential to mental\/brain health, especially as we age.)<\/p>\n

HDL does more than just cleanse arterial walls of plaque however. In protecting LDL against oxidation (damage from free radicals) it also reduces chronic inflamma\u00adtion, vascular adhesion molecules, and platelet activation-all factors that can lead to atherosclerosis.<\/p>\n

This is why it is so important to maintain <\/span>HDL <\/b>levels above <\/span>50 mg\/ <\/b>dL <\/b>of blood and follow steps outlined below to ensure optimal \u201c<\/span>reverse cholesterol transport\u201d <\/i><\/b>of lipids away from the arte\u00adrial wall.<\/span><\/p>\n

For HDL to perform its vital functions, an enzyme called paraox-onase-1 (PON-1) is attached to its surface.<\/span>5, <\/sup>6\u00a0 <\/sup>Aging and poor diet result in a marked decline in PON-1 levels, thereby reducing the ability of HDL to protect against heart attack and stroke.<\/span>7, 8<\/sup> This phenomenon helps explain the onset of accel\u00aderated atherosclerosis; where within a period of only a few years, an aging person’s healthy arteries can occlude (narrow) with plaque.<\/span>9<\/sup><\/p>\n

The age-related reduction in PON-1 may also explain studies show\u00ading statin drugs lose their benefit in certain aging populations, since the effects of statins are no longer sufficient to protect against the multiple factors involved in the development of atherosclerosis in the elderly.<\/span>8, 9,10<\/sup><\/p>\n

\u00a0<\/sup>Sweet & Slow Poison<\/b><\/p>\n

Other than low HDL perhaps the other greatest risk factor for atherosclerosis or vascular disease is high sugar intake and a condition called insulin resistance (IR).<\/span>18, 19<\/sup> IR is\u00a0 characterized by high blood sugar levels and high insulin, both of which have been proven in high amounts to increase risk for atherosclerosis.<\/span>19, 20<\/sup> Insulin is required to transport glucose into the cells mitochondria for energy production. However, if our cells are exposed to too much glucose or refined carbohydrates i.e. sugar and flour (which is readily converted to sugar in the body) they will begin to block insulin from entering their cells. When sugar is not metabolized for energy it can end up damaging enzymes and other protein and lipid structures in a process called glycation. Excess insulin \u00a0spikes in arteries can also cause serious damage.<\/span>18-20<\/sup><\/p>\n

As Dr. Perlmutter notes: “Glycosylated proteins, which are the products of these reactions between proteins and sugar molecules, are associated with <\/span>a fifty-fold increase<\/b> in <\/span>free radical<\/b> formation.\u201d<\/span>21<\/sup> \u00a0These free radicals are like sparks from a bonfire, that can damage other proteins and cells they come in contact with, resulting in at least 3 adverse effects commonly suffered by individuals with vascular or Alzheimer\u2019s disease.<\/span><\/p>\n

1. These free radicals can alter proteins and create protein bits or\u00a0peptides\u00a0called oligomers, which then compete with insulin, blocking insulin receptor sites, thus preventing insulin and glucose from entering the cell and being converted into energy in the mitochondria.\u00a0As a result these cells become weak and dysfunctional, rather they are in our arteries or brain.<\/span>22<\/sup><\/p>\n

2. These free radicals can then oxidize and damage LDL, lipoproteins, rendering them less capable of delivering cholesterol to the brain, making it more likely that they will become stuck to arterial walls, thus creating the plaques that can lead to a stroke.<\/span>21<\/sup>\u00a0<\/span><\/p>\n

3. Free radicals create damaged proteins called amyloid, which have long been tied to Alzheimer’s. The latest insights suggest these are like tooth picks that prick holes in brain cells, leading to their destruction.<\/span>22, 23<\/sup>\u00a0When quarried on this topic one leading Alzheimer\u2019s researcher recently wrote me that refined “sugar is like poison to the brain plain and simple.”<\/span>26<\/sup>\u00a0<\/span><\/p>\n

So how much difference can this make for our vascular health? A recent study from JAMA (Journal of the American Medical Association) Internal Medicine<\/span> 45<\/sup> suggests that a high sugar diet could significantly increase the risk of dying from cardiovascular dis\u00adease.<\/span><\/p>\n

Researchers at the Center for Disease Control evaluated data from participants in the National Health and Nutrition Examination Surveys (NHANES) of the US population. While 71.4% of adults consumed al least 10% or more of their calories from added sugar during 2005-2010, sugar counted for at least 25% of the calories among 10% of the group. When the research\u00aders examined the association between added sugar and the risk of cardiovascular death over 14.6 years of follow-up, subjects whose intake was among the top one-fifth of par\u00adticipants had an adjusted risk that was <\/span>twice<\/span> <\/b>that of partici\u00adpants whose intake was among the lowest fifth. In other words, if you consume high amounts of sugars (or other simple carbs for that matter) especially from beverages, reducing those <\/span>could cut your risk in half.<\/b> That is far better than any statin has been shown to do! Moreover, an<\/span> <\/b>intake of sugar that accounted for 25% or more of one’s calories was associated with a 2.75 or nearly <\/span>3 <\/b>times greater risk<\/b> of death due to cardiovascular disease in comparison to those whose intake comprised less than\u00a0<\/span>10% of their total calories.25<\/sup><\/p>\n

Sugar substitutes are no better. A study presented early in 2011 from the University of Miami Miller School of Medicine showed those who drink a diet soda a day die 61% sooner than those who do not, and the study showed those are primarily from cardiovascular complications (These usually contain aspartame or NutraSweet.)53<\/sup><\/p>\n

Bottom line, many good studies both in the US and abroad have now shown that when people eat too many sugars, sweets and simple or refined carbohydrates (flour, pasta, etc) and not enough good high fiber, nutrient dense vegetables, and fats (as from fish, olive oil, and nuts) it creates insulin resistance and other problems which we can lead to serious inflammation in the arteries as well as the brain, and more than double their risk for diabetes, strokes, neuropathy, metabolic syndrome and even Alzheimer’s.<\/span>19-25<\/sup><\/p>\n

That’s why many of the top cardiologists as well as Alzheimer’s researchers, and others throughout the world are now warning against eating too many sweets, treats, bread and pastas (simple processed carbs) and not enough vegetables, nuts and beans.25, 21<\/sup><\/p>\n

Are Your Arteries Inflamed?<\/b><\/p>\n

Another undisputable major contributor to atherosclerosis, strokes and heart attacks is inflammation, characterized by high homocysteine and\/or C-reactive protein in the blood. Inflammation is part of our normal immune response, but it\u2019s somewhat like renovating your kitchen. If it persists and becomes chronic it creates more of a mess, making it harder for our cells to function properly and eventually they die. In our arteries, chronic inflammation not only initiates injuries to the endothelium, but also accelerates the progression of existing atherosclerotic lesions caused by other toxins.<\/span><\/p>\n

A new study published just last year (2013) dramatically documented this point. The investigators reported on a large group of older individuals who were followed for <\/span>17<\/b> years. Those with the highest levels of inflammatory blood markers were more than 3 times as likely to suffer sudden cardiac death as those with the lowest levels.<\/span>27<\/sup><\/p>\n

Unfortunately there are numerous things that have been shown to contribute to vascular inflammation. Basically anything that might damage the walls (endothelium) of our arteries and blood vessels can initiate this inflammatory response, as our body flies into action to patch up the damage. As noted above, these caustic contributors include excess intake of the wrong kinds of sugars (and sugar substitutes like aspartame and high fructose corn syrup), and resulting insulin spikes, but also the wrongs kinds of fats (TRANS or fried fats), tobacco smoke, smog, excess animal protein, food additives, a sedentary lifestyle, deficiencies of the B-vitamins, genetic abnormali\u00adties, prolonged exposure to cortisol from stress, unabsorbed calcium, excess iron and fibrin.<\/span>28\u00a0 <\/sup>Also often overlooked is<\/span> <\/b>the continuous toxic exposure our arteries and kidney\u2019s bear from cellular waste<\/span> <\/b>products that are released into our bloodstream for filtration and excretion primarily through the kidneys.<\/span>29<\/sup><\/p>\n

In small amounts when we are young our amazing arteries can handle all of these toxins, but their effects are cumulative so as we age, these, along with the chronic inflammation they provoke, take their toll.<\/p>\n

Two other key factors, as we age, that leaves us vulnerable to this toxic takeover are the loss of hormones and nitric oxide.\u00a0<\/span><\/p>\n

Low Testosterone <\/b><\/p>\n

Low testosterone in men is associated with excess abdomi\u00adnal fat,<\/span>30,31 <\/sup>insulin resistance or loss of insulin sensi\u00adtivity,<\/span>32,33<\/sup> atherosclerosis,<\/span>34,35<\/sup> and increased incidence of cardiovas\u00adcular disease.<\/span>36<\/sup><\/p>\n

A review of data gathered between 1970 and 2013 provided further evidence that low<\/span> testos\u00adterone in men may be linked to a higher risk of developing or dying from cardiovascular disease.37 <\/sup><\/p>\n

Another 2013 study confirmed the increase of metabolic syn\u00addrome in men that are testosterone deficient.<\/span>38<\/sup> Metabolic syndrome is a cluster of cardiovascular risk factors that include insulin resis\u00adtance, hypertension, elevated tri-glycerides\/LDL and low HDL,<\/span>39 <\/sup>This study found that men <\/span>treated <\/span>with testosterone showed across the board improvements as indi\u00adcated by:<\/span>38<\/sup><\/p>\n

\u2022 Reduced LDL.
\n\u2022 Reduced triglycerides.
\n\u2022 Reduced glucose.
\n\u2022 Reduced C-reactive protein.
\n\u2022 Reduced measures of liver damage.
\n\u2022 Reduced blood pressure.
\n\u2022 Reduced hemoglobin Alc
\n\u2022 Increased HDL (removes cholesterol buildup from arterial walls).<\/p>\n

Fortunately there are various effective ways to increase testosterone in men as we age. (See below)<\/span><\/p>\n

Nitric Oxide Decline in Arterial Walls <\/b><\/p>\n

An early step in the initiation of atherosclerosis is reduced nitric oxide bioavailabilily and the resulting endothelial dysfunction.<\/span>40 <\/sup>Research in the last decade has shown that aging results in further impairment in our ability to synthesize endothelial nitric oxide that results in markedly accelerates atherosclerosis.<\/span>41-43<\/sup><\/p>\n

In case you are not familiar with this new superstar in the fight against CVD: Nitric oxide is a gas with the chemical formula N-O (one molecule of nitrogen bound to one molecule of oxygen). In 1992 the journal Science proclaimed it \u201cThe Molecule of the Year.\u201d In 1998, three pharmacologists were jointly awarded the Nobel Prize in Physiology or Medicine for their discovery that nitric oxide is a major signaling molecule in the cardiovascular system, where it signals the smooth muscles surrounding our arteries to relax, thus allowing for greater flexibility, dilation and improved blood flow. But it plays other roles as well. A large and growing body of research points to nitric oxide\u2019s broad impact on health.40-44<\/sup><\/p>\n

In the endothelium N-O works to:<\/span><\/p>\n