My own case study: an integrative medicine approach to heart disease
Every 34 seconds, someone in the U.S. dies from cardiovascular disease—it is the number one cause of death in the U.S., with almost 700,000 dying each year. That’s more than cancer, and far more than COVID.
It is a really shocking number of deaths, and it’s shocking in part because so much of heart disease are the result of lifestyle decisions we make, especially the food we eat and our movement routines as we age.
Yes, I’m talking about lifestyle modification, even though that phrase has always rubbed me the wrong way. It suggests something out of “lifestyles of the rich and famous,” as if a different lifestyle is only accessible to a small number of privileged few. But the fact is that all us can do simple things in our life to significantly reduce risk factors, including from cardiovascular disease.
This is something that comes up with a lot of my patients, but it’s also something I’ve dealt with personally, as I have inherited a genetic condition that predisposes me to having high cholesterol.
In fact, a few years ago, my own doctor came to me and recommended I go on statins to lower my cholesterol. I was resistant at first, but I started taking rosuvastatin, at one point going off it, then back on. But last year, I decided to apply my training in integrative medicine to my cholesterol levels, knowing that they were putting me at increased risk of heart disease.
How we measure cholesterol
In traditional medicine, the phrase is “lipid management.” Lipids are tiny particles that circulate in your blood, and they include all different kinds of cholesterol, including HDL cholesterol, triglycerides, and LDL, or low-density lipoprotein cholesterol.
We know from population studies and long-term cardiovascular risk stratification scores that it’s this last kind, LDL, which is the main marker for being at risk of heart disease. Think of the LDLs as these tiny little balls floating around your blood. You want them to be big and fluffy and few. The small and dense ones are the ones that tend to cause more problems. The more you have the more likely they are to irritate the blood vessel lining and contribute to plaque formation, and eventually a narrowing of your blood vessels—not good.
Taking an integrated approach
I didn’t have any bad side effects from taking rosuvastatin. But still, I wanted to apply the same approach I take with patients on myself.
First, we know that heart disease is a disease of inflammation. Inflammation affects your vascular system and causes irritation leading to plaque formation. We can measure inflammation with a lab test that measures CRP, or the c-reactive protein. It’s a standard blood test that many doctors do, and I usually order it for most of my patients. You want to see a CRP of less than 1—mine is around .5, which is good.
Second, I’ve also talked about the importance of maintaining muscle mass as we age, because muscle mass helps regulate insulin levels, and you want to maintain your insulin sensitivity (I wrote about this recently in a post about moving as we age). I have a good movement routine that gets me building muscle and exercising five days a week.
Next, I had to address my cholesterol levels. A blood test from two years ago revealed real problems. My levels had started creeping up. In 2019, my total cholesterol was 208. My LDL had started going up to 138, and the particle number was over 1700. These numbers put me into a moderate risk range. Then, if you look at my labs from last year, the LDL particle number jumped to 1800. That meant I was now high risk.
I had already experimented with pharmaceutical solutions, but I wasn’t entirely satisfied with the results. So, the major shift I made was to my diet: I tried increasing the amount of vegetables and fruit I was eating until my diet was 75-85% plant-based. I also lowered the amount of saturated fats I was eating, which meant cutting out almost all red meat. I switched one of my sources of protein to tofu which has been shown to independently lower LDL levels in certain people. Finally, I increased the amount of fiber, adding flax, chia seeds, and beans daily to target over 50 grams per day. The recommended intake is 30 grams per day and most people are at 15 grams.
I still eat avocado oil and olive oil on a regular basis, which studies consistently show lowers the long-term risk of heart disease. I also began taking a green tea extract supplement that contains epigallocatechin-3-gallate, or EGCG. This has been shown for some people, though not all, to lower the number of LDL particles in your blood. Finally, I increased the amount of Omega 3 I was getting by eating more sardines and wild-caught salmon.
Simultaneous to these changes in my diet, I actually reduced the amount of statins I took. Instead of daily, I now took them every other day.
Impact of changing diet
Last month, I did another set of labs. My total cholesterol had gone down, from 208 to 166. My triglycerides went from 59 to 44. And my LDL went from 128 all the way down to 84. All of this is a remarkable reduction in cholesterol.
The point is, through trial and error and investigation, I have found what works for me. In traditional medicine, the approach would have been to recommend the statins and trust them more or less as the sole solution.
But with an integrative medicine approach to heart disease, we intentionally take on a holistic view. Not one that ignores pharmaceutical solutions, but one that takes your whole body and mind into account, including the food you eat, your movement routine, how you sleep, and your mental resiliency.