DrMirkin's eZine: Preventing plaques, high triglycerides, more . . .
Published: Thu, 03/03/22
March 6, 2022
Exercise helps to prevent heart attacks, but exercise does not prevent plaques from forming in arteries. What you eat is far more important in determining how much plaque you have in your arteries, so even competitive master athletes should follow a heart-healthy diet. A recent study showed that lifelong male athletes older than 40 had increased markers that doctors use to predict a future heart attack (European Heart Journal, July
2021;42(28):2737–2744):
• very high Coronary Artery Calcium Scores (>300 Agatston units)
• increased plaques in the heart arteries
• scarring around the heart muscle
Another study of 798 asymptomatic and apparently healthy master athletes (runners, cyclists, triathletes, rowers and hockey players), 35+ years old, who exercised fairly vigorously 3-7 days a week, found that 10 percent had greater than 70 percent blockage of the arteries leading to their hearts (BMJ Open Sport & Exercise Medicine, 2018;4 (1):e000370).
A group of men over 60, who had run marathons for 26-34 years and completed 27-171 marathons, had plaques in their arteries in amounts that were related to their own risk factors for heart attacks and not to the number of miles or marathons they had run (Med & Sci in Sports & Ex, July 17, 2017). This suggests that plaques in arteries are not related to the amount of endurance training, but are caused by other factors such as a pro-inflammatory diet, high blood pressure, high cholesterol or tobacco use.
Heart Attacks Occur When Plaques Break Off from Arteries Leading to the Heart
Heart attacks are not caused by narrowed arteries. They are caused by plaques breaking off from a heart artery, followed by bleeding, and then a clot forms that completely blocks all blood flow to a part of the heart muscle. The part of the heart muscle suddenly deprived of oxygen then dies, which is a heart attack. Exercise helps to prevent heart attacks by making plaques more stable so they do not break off as easily. However, a healthful diet, not exercise, prevents plaques from forming.
Everyone should follow a heart-healthy diet, especially if you have any risk factors for a heart attack such as:
• a family history of heart attacks
• chest pain
• irregular heartbeats
• a big belly (particularly if you also have small buttocks)
• high blood pressure
• high cholesterol
• high blood sugar
A Diet to Prevent Plaques
Master athletes burn a lot of calories, so they can be expected to eat more food than sedentary people do. If they eat a lot of sugar or a lot of meat, they can expect to have plaques in their arteries. A diet that is high in vegetables, fruits, whole grains, legumes and nuts is associated with reduced risk for cardiovascular disease, while less healthful diets that are high in sweets, refined grains, juices, red meats and processed meats are associated with increased risk (Journal of the
American College of Cardiology, July 2017; 70(4)).
How Doctors Measure Plaque Stability
A CT scan can show how stable plaques are (American Journal of Roentgenology, March 2015;204(3):W249-W260). X-rays and sonograms can also show the difference between stable plaques that are usually safe, and those that are unstable and more likely to break off to cause heart attacks. Stable plaques contain more calcium and are smoother and more homogeneous than unstable plaques. The radiologist estimates plaque stability by looking for an extensive calcification cap on the inner lining
of plaques that prevent them from breaking off, less fat content inside the plaque, increased fibrous areas and less structural change. See Exercisers Have More Stable Plaques
My Recommendations
• To help prevent or reduce plaque formation, follow a heart-attack-preventing diet that is high in anti-inflammatory foods and low in pro-inflammatory foods. This means that you should eat plenty of plants and restrict red meat, processed meats, sugar-added foods, all sugared drinks and fried foods.
• Avoid overweight
• Do not smoke
• Limit or avoid alcohol
• To stabilize existing plaques and widen your coronary arteries, try to exercise every day for at least a half hour. Exercising more than that may be even more protective.
Having blood triglyceride levels above 150 mg/dL (1.7 mmol/L) puts you at increased risk for a heart attack, stroke, or heart valve disease, even if your blood cholesterol levels are normal (Eur Heart J, Dec 2021;42(47):4791-4806). About 10 percent of North Americans suffer from high triglyceride levels. High triglycerides are often found in people who:
• are diabetic, obese or alcoholic
• have high blood pressure
• have liver damage
• have pancreatic disease
• have kidney disease
• have low thyroid function
• have genetic disorders of fat metabolism
• take beta-blockers, birth control pills, estrogen, diuretics or drugs that suppress a person’s immunity
You can lower high blood triglyceride levels with lifestyle changes including diet and exercise, and with established prescription treatments such as fibrates, omega-3 fatty acid preparations, and various biological agents (Eur Heart J, 2020;41(1):99-109c).
What Causes High Triglyceride Levels?
When blood sugar levels rise too high after meals, sugar is converted to a type of fat called triglycerides, so high blood triglyceride levels are usually caused by a high rise in blood sugar after meals and usually mean that a person is already diabetic or pre-diabetic (J Clin Endocrinol Metab, Oct 2011;96(10):E1596–E1605). High rises in blood sugar after meals cause sugar to stick to the outer membranes of every type of cell in your body and eventually destroy these cells. Sugar can
stick to:
• brain cells, to cause dementia
• nerve cells, to cause pain or loss of feeling
• matrix cells of bones, to weaken bones and cause osteoporosis
• the DNA of cells, which can cause the uncontrolled growth that is cancer
• the inner lining of arteries, to form plaques
• plaques that have already formed, causing them to break off, leading to a heart attack or stroke
This is why diabetes has so many devastating side effects.
Normal fasting blood sugar is below 100, but a normal fasting blood sugar does not rule out diabetes because having a high blood sugar after meals usually happens earlier than having a high fasting blood sugar. You suffer cell damage even if your blood sugar levels are normal when you fast, but rise too high only after you eat. Many studies show that having a blood sugar greater than 140 one hour after eating a meal causes cell damage and indicates that you are already pre-diabetic or diabetic (Atherosclerosis, 2016 Nov 17;256:15-20). A high rise in blood sugar after a meal causes your liver to convert the extra sugar to fatty triglycerides, and a triglyceride level >150 usually means that your blood sugar is also too high.
How High Triglycerides Cause a Fatty Liver
When you have high triglycerides, you use up your good HDL cholesterol because it tries to protect you by carrying triglycerides from your bloodstream into your liver. This is the most common cause of a low HDL (below 40). Your HDL has helped you by clearing excess triglycerides from your bloodstream, but the excess fat collects in your liver to eventually form a fatty liver.
Your body tries to protect you from high rises in blood sugar after meals that cause cell damage. Your pancreas releases insulin that lowers blood sugar levels by driving sugar from your bloodstream into your liver. However, if your liver is full of fat, it cannot accept the sugar and the liver then releases even more sugar from its cells to drive blood sugar levels even higher.
How to Predict High Risk for Diabetes
You are at high risk for diabetes if your:
• triglycerides are higher than 150
• blood sugar is higher than 140 one hour after eating a meal
• good HDL cholesterol is lower than 40
A sonogram of your liver can be used to show whether you have excess fat stored there (“fatty liver“).
Triglycerides Can Also Lead Directly to Heart Attacks
Having high blood triglycerides also puts a person at increased risk for a heart attack because triglycerides can penetrate the inner lining of arteries to start plaques forming in them (Arterioscler Thromb, Nov 1994;14(11):1767-74). Once that has happened, the high triglycerides are associated with inflammation that causes plaques to break off and form clots (Circa Res, 2014;114:214–26) that cause heart attacks (Mymensingh Med J, Jul 2004;13(2):185-7).
Other Reasons for High Triglycerides
Many other medical conditions are associated with high triglycerides, such as poorly controlled diabetes, chronic kidney disease, rheumatoid arthritis or low thyroid function. Several medications can also raise triglycerides; check with your health care provider or pharmacist.
Dietary Treatment for High Triglycerides
• Eat lots of vegetables, but limit starchy root vegetables such as potatoes and sweet potatoes
• Eat lots of legumes (beans, lentils, chickpeas, soybeans, peanuts) and nuts
• Eat whole (unground) grains and restrict refined grains (bakery products, pasta, white rice and so forth)
• Restrict mammal meat and processed meats
• Eat seafood twice a week or more
• Avoid sugar-sweetened and artificially sweetened beverages
• Avoid sugar-added foods
• Restrict salt
• Restrict alcohol
My Recommendations
If your fasting blood triglyceride levels are greater than 150, you are likely to be pre-diabetic or diabetic and susceptible to cell damage from high blood sugar levels. If you have a big belly and small buttocks, the odds are that you are already diabetic. Check with your doctor immediately and go on a lifestyle program to cure diabetes and prevent heart attacks.
On March 1, 1953, after an all-night dinner with heavy drinking among four of the highest Russian government officials, the 74 year-old Joseph Stalin collapsed at his house. Later he was found unconscious on the floor, yet no doctors were summoned until the next morning. Four days later, he was reported to have died of a stroke. The official story was that he had been drunk at dinner, his companions assumed that he had fallen out of bed, and that the autopsy showed that he had died of a hemorrhage into his brain.
His last supper was with four members of his Politburo. All eventually became Prime Minister of Russia. The Chief of Secret Police, Lavrenti Beria, was the interim successor who, by the end of the year, was killed by a firing squad. Georgi M. Malenkov took over as his successor, Nikolai Bulganin became Prime Minister in 1955 and Nikita S. Khrushchev became Prime Minister in 1958.
The medical account of Joseph Stalin’s death, presented to the Communist Party Central Committee in June 1953, reported that he became ill in the early hours of March 2, a full day after he apparently suffered a stroke. The official autopsy report was hidden for the next 40 years, but after the collapse of the USSR, the full report was released. Read more
With 100+ of Diana's recipes!
An easy way to get all of my latest reports
on your iPhone or iPad
Invite them to subscribe at DrMirkin.com
For more information visit DrMirkin.com
We DO NOT sell, rent or give your e-mail address to anyone.
Copyright 2022 The Sportsmedicine Institute, Inc.