Testosterone Lowers Male Heart Disease Risk

In the last couple of years, studies looking at the correlation between testosterone levels and heart disease in men have yielded mixed results.  However, if you look more closely at the data, most of the reports showing negative associations with testosterone failed to factor in other independent risk factors that can lead to heart disease.  The negative studies also used inaccurate laboratory methods and reference ranges to reach their conclusions, inflating the risks of testosterone.

A late 2011 study published in the Journal of the American College of Cardiology (JACC) demonstrated that men who had the highest levels of testosterone had a 30% lower risk of cardiovascular events.  Men with increasing levels of testosterone also had a decreased prevalence of diabetes, hypertension, and body fat mass.  One of the main reasons for testosterone’s beneficial effect on heart disease is it’s ability to boost HDL levels, and allow the liver to metabolize excess cholesterol more efficiently.  Testosterone also helps to dilate blood vessels and strengthen the muscles of the heart, further lowering the risk of hypertension, heart attacks, and heart failure.

So, with the link between testosterone and cardiovascular risk becoming more clear, why isn’t testosterone being tested routinely in men over the age of 50?  One of the main arguments has been the concern about inducing prostate cancer in men who are using supplemental testosterone.  However, contrary to popular belief, this fear has no basis.  In fact, in his book Testosterone For Life, Dr. Abraham Morgentaler demonstrated that men with low testosterone levels have an increased percentage of prostate cancer-positive biopsies.

Another factor interfering with more routine testing of testosterone levels is the belief that statin drugs are a cure-all for heart disease.  By only lowering cholesterol and ignoring the benefits of testosterone, as well as ignoring the effects of estrogen, insulin, and other hormones, it’s no wonder that heart attacks and strokes continue to be the leading causes of death in this country!  The fact is, if you’re a male over the age of 50, or you already have a history of heart disease, your doctor is doing you a gross disservice by not including testosterone as part of a routine screening for cardiovascular disease risk.

If you have low testosterone levels, this doesn’t necessarily mean you will need to supplement with testosterone injections or cream.  Your doctor should also look at other hormone levels to determine whether low testosterone levels are related to weight gain, insulin resistance, or lack of exercise, vs. a true deficiency.  Then, the appropriate underlying cause can be addressed, rather than just assuming that supplemental testosterone will correct everything.  Just as cholesterol is an important underlying clue when it comes to heart disease, looking at testosterone can be just as valuable, but we should never assume that one treatment is the answer for everything!

Rethinking Fat in the Diet

With all the hype surrounding statin medications this past week (see http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html), it’s a perfect opportunity to take a step back and discuss some basic diet fundamentals.  For the past 40 or more years, the “benefits” of low-fat diets have been ingrained in our consciousness, and advocated by a majority of the medical community.  The thinking behind this was simple: high fat in the diet must lead to a buildup of fat and plaque in the arteries, so the less fat you eat, the better.  In recent years, research evidence has overwhelmingly refuted this concept, yet it continues to be the mainstream recommendation for preventing heart disease.  Even the “Dairy” section in the USDA’s “My Plate” emphasizes low or non-fat sources of dairy.

A scientific analysis of 21 earlier studies showed “no significant evidence” that saturated fat in the diet is associated with an increased risk of coronary heart disease.  In fact, the dietary evidence collected from these thousands of participants found no difference in the risk of coronary heart disease, stroke, or coronary vascular disease between those individuals with the lowest and highest intakes of saturated fat.  The bigger issue appears to be the added amounts of sweeteners and carbohydrates that people are eating instead of fats.  More and more evidence is suggesting that it’s this continuous increase in carbohydrate consumption that is truly responsible for an increased risk in diabetes and coronary artery disease.

I think the main take-away message from this information is that you don’t have to be afraid of good quality sources of saturated fat.  We’ve been so trained to be suspicious of it for so long that it becomes difficult to change our perception of how healthy it can be.  Now, does this mean you should be eating nothing but cheese, bacon, and beef for the rest of your life?  Of course not!  If you’re already consuming low-fat sources of dairy (skim milk, low-fat yogurt, etc.), switch to organic whole milk sources, and use butter instead of margarine or other processed forms of fat.  In general, try to limit your saturated fat intake to 10% of your total diet, while discontinuing the consumption of hydrogenated oils, artificial sweeteners, and high-glycemic carbohydrates.  By doing this, and continuing to emphasize fruits and vegetables as a mainstay, you’ll be much better off in the long run!

Rethinking the Risk of Low HDL

Despite plenty of evidence that people with low levels of “good”cholesterol are more prone to heart attacks, a large new study suggests that the lacking lipid is not to blame.

The analysis of data on nearly 70,000 people in Denmark affirmed the link between low levels of high-density lipoprotein (HDL), the so-called “good” cholesterol, and raised heart attack risk in the general population. But in people with a gene mutation that lowers HDL, heart attack risk was not found to be higher at all.

“Association itself doesn’t mean causality,” said lead author Dr. Ruth Frikke-Schmidt, a consultant in the Department of Clinical Biochemistry at Rigshospitalet in Copenhagen.

The results, published in the Journal of Clinical Endocrinology and Metabolism, indicate that just having low HDL is not what raises the likelihood of a heart attack.

“People with low ‘good’ cholesterol also have a whole bunch of other factors that relate to heart disease,” said Dr. Christopher Cannon, professor of medicine at Harvard Medical School and editor of the American College of Cardiology’s website.

It’s difficult to study and isolate “good” cholesterol, added Cannon, who was not involved in the new study. People with low HDL often suffer from obesity, high blood pressure and diabetes and sometimes have higher levels of LDL, or “bad” cholesterol, he said.

To try to isolate the effects of HDL itself, Frikke-Schmidt and her colleagues focused on people with a well-known variant of a gene called LCAT, which lowers HDL levels and occurs in about four percent of the population.

The variant gene is used as a stand-in for low HDL, she noted, but people with the variant don’t necessarily have the other risk factors that usually affect HDL levels in the larger population.

In the new study, a 13 percent decrease in HDL relative to average levels in the population was linked to an 18 percent increase in heart attack risk — if the low HDL was not explained by a gene variant. For people with the variant gene, the same HDL reduction was not linked to any increased risk of heart attack.

The findings fit in with Frikke-Schmidt’s earlier research showing that two other genetic variants that lower “good” cholesterol levels are not associated with an increased risk of heart disease.

According to both Frikke-Schmidt and Cannon, the debate is particularly important, because there are currently drugs in trials that would raise “good” cholesterol.

If low HDL is not a cause of heart attacks, raising HDL may not be protective, they point out.

Ruling out low levels of “good” cholesterol, Frikke-Schmidt said the most likely cause of the increased risk is so-called remnant lipoproteins, which are like “bad” cholesterol and carry fats through the blood.

Until the real mechanisms are sorted out, Cannon said it’s still important for people to try and raise their “good” cholesterol by exercising and losing weight.

“Beyond that there are so many question marks,” he said. “We’re kind of in a wait and see mode.”

SOURCE: http://bit.ly/sWrkZo The Journal of Clinical Endocrinology and Metabolism, online November 16, 2011.

Work Causes Heart Disease

People who regularly work long hours may be significantly increasing their risk of developing heart disease, the world’s biggest killer, British scientists said Monday.

Researchers said a long-term study showed that working more than 11 hours a day increased the risk of heart disease by 67 percent, compared with working a standard 7 to 8 hours a day.

They said the findings suggest that information on working hours — used alongside other factors like blood pressure, diabetes and smoking habits — could help doctors work out a patient’s risk of heart disease.

However, they also said it was not yet clear whether long working hours themselves contribute to heart disease risk, or whether they act as a “marker” of other factors that can harm heart health — like unhealthy eating habits, a lack of exercise or depression.

The study, published in the Annals of Internal Medicine journal, followed nearly 7,100 British workers for 11 years.

“Working long days is associated with a remarkable increase in risk of heart disease,” said Mika Kivimaki of Britain’s University College London, who led the research. He said it may be a “wake-up call for people who overwork themselves.”

Cardiovascular diseases such as heart attacks and strokes are the world’s largest killers, claiming around 17.1 million lives a year, according to the World Health Organization (WHO). Billions of dollars are spent every year on medical devices and drugs to treat them.

The findings of this study support previous research showing a link between working hours and heart disease.

For this study, men and women who worked full time and had no heart disease were selected, giving 7,095 participants.

The researchers collected data on heart risk factors like age, blood pressure, cholesterol, smoking and diabetes and also asked participants how many hours they worked — including work during the day and work brought home — on an average weekday.

During the 11-year study, 192 participants had heart attacks. Those who worked 11 hours or more a day were 67 percent more likely to have a heart attack than those with fewer hours.

Of course, heart disease is a multi-factorial issue, but those working more than 11 hours per day need to take even further precautions to lower their heart disease risk. Talk to your naturopathic doctor about laboratory studies that can help to identify numerous cardiovascular risk factors, so the proper steps can be taken to help prevent heart disease and stroke in the future. 

Diet Soda and Heart Disease

As many of my patients know, I often discourage the use of diet sodas and other sources of artificial sweeteners. The reasons for this are numerous, but here is yet another suggestion that diet soft drinks may not be the best choice: 

http://www.latimes.com/health/boostershots/lat-heb-dietsodastrokeheartattack20110209,0,4324389.story

More Evidence That Olive Oil and Veggies Lower Heart Disease Risk

It’s no secret that eating well is good for both body and mind, so it may not come as a surprise that a new study finds women who eat more olive oil and leafy vegetables such as salads and cooked spinach are significantly less likely to develop heart disease.

A group of Italian researchers found that women who ate at least 1 serving of leafy vegetables per day were more than 40 percent less likely to develop heart disease over an average of eight years, relative to women who ate two or fewer portions of those vegetables each week.

Women who downed at least 3 tablespoons of olive oil daily – such as in salad dressing – were also 40 percent less likely to be diagnosed with heart disease, compared to women who ate the least olive oil.

It’s not exactly clear why specifically leafy vegetables and olive oil may protect the heart, study author Dr. Domenico Palli of the Cancer Research and Prevention Institute in Florence told Reuters Health. “Probably the mechanisms responsible for the protective effect of plant-origin foods on cardiovascular diseases involve micronutrients such as folate, antioxidant vitamins and potassium, all present in green leafy vegetables.”

Folate reduces blood levels of homocysteine, Palli explained, which is thought to increase the risk of cardiovascular disease by damaging the inner lining of arteries. Other studies have shown people who eat more potassium have lower blood pressure, which can protect the cardiovascular system. Virgin olive oil may be particularly effective at lowering heart disease risk because of its high level of antioxidant plant compounds, he added.

This is not the first study to link olive oil or vegetables to good heart health. Most famously, the traditional Mediterranean diet — rich in vegetables and monounsaturated fats from olive oil and nuts, but low in saturated fat from meat and dairy — has been tied to a decreased risk of heart disease.

Mediterranean-style eating has also been credited with lowering risk for some cancers, diabetes, and, more recently, with slowing brain aging.

Cardiovascular disease is a major killer, responsible for 30 percent of all deaths worldwide and the leading cause of death for both men and women in the U.S.

To look more closely at the role of foods in protecting against heart disease, Palli and colleagues reviewed dietary information collected from nearly 30,000 Italian women participating in a large national health study. Researchers followed the women, whose mean age was 50 at the beginning of the study, for an average of 8 years, noting who developed heart disease.

In that time, the women experienced 144 major heart disease-related events, such as heart attack or bypass surgery, the authors report in the American Journal of Clinical Nutrition.

Women who ate at least one daily serving (about two ounces) of leafy vegetables – such as raw lettuce or endives, or cooked vegetables like spinach or chard — had a 46 percent lower risk of developing heart disease than women who ate at most two portions per week.

Consuming at least an ounce of olive oil per day lowered their risk by 44 percent relative to women who consumed a half-ounce or less daily, the authors found.

The women’s intake of other types of vegetables, such as roots and cabbages, and their consumption of tomatoes or fruit did not seem to be linked to their risk for major heart events.

When visiting your Naturopathic physician, make sure you request homocysteine, cardio-CRP, and fractionated lipid levels, to make sure a thorough evaluation of your cardiovascular health is being performed. You can then use these levels to track your progress, especially if you’re just transitioning to a Mediterranean-style diet. 

Don’t Skip Your Breakfast!

Prior research suggests that breakfast eaters may be healthier than people who skip breakfast, and now a study in the American Journal of Clinical Nutrition suggests a nutritious breakfast may be especially good for your heart. Specifically, the recent study shows that regular breakfast eaters may reduce risk factors linked to heart disease.

Breakfast eaters reduce heart disease risk factors

While prior research has shown that skipping breakfast may lower a person’s energy level and increase the risk of weight gain, less is known about the effects of skipping breakfast on other body organs and functions.

In this study, 2,184 participants, 9 to 15 years old, initially filled out a questionnaire about diet and physical activity and stated whether they usually ate breakfast before school or not. Twenty years later, one third of the original participants filled out a meal frequency questionnaire, had their waist size measured, and had blood levels of triglycerides, total and LDL (“bad”) cholesterol, and fasting insulin (insulin levels after no food has been eaten overnight) checked. Participants were then classified into four groups:

• skipped breakfast in neither childhood nor adulthood,

• skipped breakfast only in childhood,

• skipped breakfast only in adulthood, or

• skipped breakfast in both childhood and adulthood.

Results showed that people who skipped breakfast in both childhood and adulthood had a larger waist size and total cholesterol and LDL cholesterol levels compared with people who ate breakfast in both childhood and adulthood. They also had higher fasting insulin levels, which indicates they have insulin resistance, a risk factor for diabetes and heart disease.

Breakfast skippers also tended to be single, have a lower education level, and were more likely to smoke, watch TV, get less physical activity, and have a less healthy diet compared with breakfast eaters.

The authors comment, “Skipping breakfast was associated with a larger waist circumference, cardiometabolic risk factors, poorer diet quality, and unhealthy lifestyle behaviors.” They add that promoting the benefits of eating breakfast may be an important public health message.

M
ore reasons to be a breakfast eater

There are many good reasons to eat breakfast, and prior research has shown that compared with breakfast skippers, breakfast eaters tend to have:

Better habits. People who eat breakfast tend to have healthier diets and get more physical activity.

A more nutritious diet. Breakfast eaters tend to eat less daily fat and cholesterol and more fiber, vitamins, and minerals.

A healthier weight. Some studies suggest that breakfast eaters have a lower weight compared with breakfast skippers.

Heart Disease and Anxiety

The July issue of the Archives of General Psychiatry contains a study that demonstrates a 74% increased risk for adverse cardiovascular events (stroke, heart attack, and sudden death) in patients with general anxiety disorder (GAD). While it’s often been speculated that many patients with coronary heart disease (CHD) are also anxious, this study is the first of it’s kind to prove that there is indeed a definitive link between anxiety and heart disease. 

This study is further proof that the mind-body connection cannot be ignored. If your stress level is consistently high, don’t wait until you begin to experience symptoms before taking the necessary steps to address your anxiety. Naturopathic medicine can offer a number of therapies, including botanical, nutritional, acupuncture, and biofeedback, to help you manage stress more effectively. The Heart Math Institute (www.heartmath.org) offers tips and products that help you “retrain” your stress response, making you less prone to the adverse effects of anxiety. MoodGym (http://moodgym.anu.edu.au/welcome) is another online resource that is recommended for this purpose. 

Who’s Bad? (Not Fats)

There continues to be a false assumption in the medical community that increased fat consumption leads to heart disease and other long-term problems. I often find it difficult to reprogram people, after they’ve been brainwashed for so many years to avoid fats, and eat only low-fat foods. This topic warrants much more detail than what I can cover in one blog post, but evidence continues to mount that refutes the low-fat concept. For example, a recent study in the American Journal of Clinical Nutrition (2010 May 12) demonstrates that people with higher levels of omega-3s and fats derived from olive oil and nuts had an inverse correlation with coronary artery disease. This further supports the advantages of following a Mediterranean Diet, and disregarding the “Food Pyramid” recommended by the USDA.

Carbohydrates and Heart Disease

Clinically, I’ve seen consistent improvements in heart disease markers when implementing a low glycemic diet. The glycemic index is an indicator of how high the carbohydrate portion of a food causes blood sugar to rise-this is especially important for diabetic patients, but is also useful when trying to limit the effect of carbohydrates on the body. A new study published in the Archives of Internal Medicine found that eating lots of high-glycemic-index foods puts women at higher risk of developing heart disease. Some highlights from the study are as follows:


• Women with the highest carbohydrate intake were twice as likely to develop heart disease as women with the lowest intake.

• Only high-glycemic-index carbohydrates were associated with heart disease risk; low-glycemic-index carbohydrates were not.

• Having a high dietary glycemic load more than doubled the risk of heart disease in women.

• No relationship between heart disease and carbohydrate intake, high-glycemic index food consumption, or dietary glycemic load was seen in men.


The bottom line is that all carbohydrates aren’t created equal-paying close attention to the glycemic-index of foods, along with incorporating foods that help to keep the glycemic load down (nuts, beans, lentils, seeds), is a proven method of lowering your heart disease risk.