Listen to the MP3
Mark C. Houston, MD, MS, ABAARM, FACP, FAHA, FASH
Dr. Houston is Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine; Director of the Hypertension Institute and Vascular Biology; and Medical Director of the Division of Human Nutrition at Saint Thomas Medical Group, Saint Thomas Hospital in Nashville, Tennessee.
Dr. Houston has presented over 10,000 lectures nationally and internationally and has published more than 200 articles and scientific abstracts in peer reviewed medical journals. He is on the consulting editorial board for many medical journals and is Editor-in-Chief for JANA (Journal of the American Nutraceutical Association). He is an author and teacher and is active in clinical research.
Learn More About Dr. Houston’s Best-Selling Books
Essential Fatty Acids
#1 Lifestyle Tip
4:11 Dr. Houston’s Unique Clinic: Dr. Houston is an internal medicine doctor with certifications in hypertension and anti-aging. He also has a master’s degree in human nutrition and one in metabolic medicine. His clinic combines all of these into cardiovascular integrative medicine. He wants to prevent cardiovascular disease, not just treat it.
5:01 Advanced Lipid Testing: In the U.S., we tend to think that if we get lipids/fats under control, no one will have heart attacks. Measuring only blood cholesterol ignores other important risk factors. The methodologies that measures lipids are not done with advanced testing. Doctors perform the obsolete total quantity testing for HDL, LDL, cholesterol, and triglycerides. For over 15 years, Dr. Houston has done advanced lipid testing, which quantifies not only the levels, but particle size, particle number and, in some cases, the functionality of HDL, with reverse cholesterol transport. This is the ability to take cholesterol out of the cells and get it out of the body. Advanced lipid testing outstrips basic testing by revealing the risk of the patient and provides adequate treatment.
6:35 Big LDLs and Small LDLs. It makes a difference: Heart disease and heart attack risk is driven by the number of LDL particles and the size of LDL particles. If LDL particles are small and in great number, they slip through the lining of the vascular system and cause inflammation, oxidative stress, and immune dysfunction. It creates a plaque formation with ruptures and causes a heart attack. Think of the lining of the vascular system as the net on a tennis court. A tennis ball won’t go through the net, but a golf ball will. The tennis ball is a large LDL and a golf ball is a small LDL. A lot of golf balls going through the net, begins the inflammatory process. Generally, the tennis ball, larger LDL is not a problem.
8:10 HDL is the Cleanup Crew: If you have a lot of golf balls on the wrong side of the net, you might be able to fill your wheelbarrow with them in one trip. If you only have a bucket, you might have to make multiple trips to pick up the golf balls. If your wheelbarrow has a flat tire or broken handle, you still won’t be able to remove very many golf balls. You want your HDLs to be big and you want them to function well. You want a lot of wheelbarrows and you want them operating optimally.
9:22 What Causes Dysfunctional HDL? It is most often caused by inflammation from any cause, but it could be from things like rheumatoid arthritis or chronic infection. Heavy metals could be the cause. Dysfunctional HDL can also be caused by poor micronutrient intake or poor macronutrient intake. When HDL is damaged, there is no oxidative defense, there is poor reverse cholesterol transport and there are none of the other activities that HDL does to prevent atherosclerosis. Basic lipid testing does not differentiate between adequately functioning HDL and poorly functioning HDL. Advanced lipid testing shows the various conditions and activities of HDL.
10:53 What Happens When Small LDL’s Get into Our Cardiovascular System? Small LDLs are more likely to be modified. Glucose can cause oxidation, inflammation, glycation, or acetylation of HDL. It is common in people who are diabetic or have insulin resistance, obesity, or metabolic syndrome. Small LDLs stick in the subendothelial layer and you cannot get them out. A type of white cell, called macrophages, moves into the layer below the endothelium because they love to eat small LDLs. They have no appetite control. They eat small LDLs until they burst. The mess literally ruptures into the subendothelial layer and even into the lumen, causing the area to clot, eventually creating a myocardial infarction/heart attack.
12:36 How Can We Stop the Golf Balls? There are 38 different mechanisms that you can use to interrupt the process of heart disease. Exercise and nutraceuticals are the keys. There is lycopene, from tomatoes and grapefruit, lipoic acid, N-acetylcysteine, resveratrol, berberine, red yeast rice, niacin, omega 3 fatty acids from cold water fish and many more. The Mediterranean diet with lots of extra virgin olive oil helps too. It is important to stay on a low carbohydrate diet.
14:22 Top Lipid Testing Labs: Dr. Houston’s top recommendations for labs are SpectraCell Laboratories, LipoScience, Boston Heart Lab, and Atherotech Diagnostics Lab.
15:06 Causes of Endothelial Dysfunction: Dr. Houston can list over 400 causes for ED. The top 5 that are typically talked about are blood pressure, lipid, diabetes, obesity and smoking. They cause insult to the endothelial lining, causing endothelial dysfunction. Dysfunction is related to inflammation, oxidative stress, immune dysfunction within the arteries, clotting and abnormal growth factors that make the arteries stiff and enlarges the heart, causing heart failure as well as heart attacks.
17:39 Heart Health Testing: The endoPAT test measures the endothelial lining of the blood vessel. It is an accurate, specific test that can be done in about 20 minutes. It correlates risk of heart attack, stroke, and renal failure in the future. It also measures heartrate variability, which is the beat to beat change in your heart rhythm which can predict the risk for sudden death and arrhythmia. It also has an augmentation index, which also measures arterial stiffness in the large and medium size arteries. The other test done at Dr. Houston’s clinic is the computerized arterial pulse wave analysis. It measures elasticity both the large and the small arteries, reaching the very small arteries. There are very few clinics that do this latter test. These functional tests are far more predictive of disease early on than typically done structural tests. There are many more tests for progressed heart disease.
20:43 The Progression of Heart Disease: Atherosclerosis, coronary heart disease and vascular disease usually begins in your teen years with functional changes. Those progress into structural/functional changes. Later, they turn into serious structural changes. You want to catch them when they are functional, not structural, so it is easier to reverse. The different tests run in his clinic tell you where you are on the spectrum.
21:37 Blood Sugar and the Inflammatory Response: There are many studies that show that increases in fasting blood sugar and 2 hour after eating blood sugar levels, correlates directly with your risk for heart attack. Dr. Houston believes that the set points in most labs are too high. In fasting blood sugar, the risk for heart disease and heart attack starts at 75 mg/desolator. Most labs have their upper limit at 99. After you eat, your blood sugar goes out of the normal level. Most labs use an upper level of 140, when it should be more like 110. Going over 110 increases your risk for heart disease. Atherosclerosis is a post meal event. This is when your carbohydrates, triglycerides, inflammatory foods, and bacteria from leaky gut, can cause huge amounts of inflammation.
24:02 Poor Gut Health and Heart Disease: Gastrointestinal problems are directly linked to cardiovascular problems. You must clean up the diet and repair the gut to reduce metabolic endotoxemia after eating. This is actually low grade sepsis, producing a huge inflammatory response, oxidative stress, and immune dysfunction in the gut that is transported into the vascular system.
24:58 Reducing Inflammation in the Vascular System: Statins work in the arterial wall to lessen the inflammatory response. They increase the beneficial nitric oxide. Red yeast rice has the same anti-inflammatory capabilities. Antioxidants, like co-enzyme Q10, lipoic acid, vitamin C and vitamin E, at your meal can help as well. Eat lots of cruciferous vegetables, olive oil, monounsaturated fats, and omega-3 fatty acids.
26:55 24 Hour Blood Pressure Testing: There is a direct correlation between your diastolic and systolic blood pressure numbers and the risk for a cardiovascular event, stroke, heart attack, heart failure and kidney disease. It starts at a level of 110/70 to 120/80. After 120/80 the risk curve steepens greatly. We call people pre-hypertensive when they are between 120/80 and 140/90. Above that is clearly hypertensive. With higher pressure comes greater the risk of an event. The driving force for all cardiovascular events, whether they are heart attack, stroke or kidney disease, is your night time blood pressure. High night time blood pressure is the best indicator of risk of an event. It is called dipping status. Your night time blood pressure should drop by 10% of your average daytime pressure. If your blood pressure does not dip by 10%, this indicates risk. There is even greater risk for those whose blood pressure increases at night. Excessive dippers, which are rare, have a greater risk for stroke. The 24 hour blood pressure testing is needed to determine which medications to use and when.
31:14 Medications: Dr. Houston believes that the best medications are ACE inhibitors, angiotensin receptor blockers, and certain calcium channel blockers. Indapamide is his favorite diuretic. These are just a few of the drugs he uses with his patients.
33:36 Lifestyle Activities That Improve Cardiovascular Health: The number one thing you can do to reduce your risk is to restrict your sodium to no more than 2 grams per day, and increase your potassium to about 10 grams per day. Second, implement an exercise program daily for 1 hour, 40 minutes of resistance training and 20 minutes of correctly done interval training. If not daily, try to do it at least 4 days per week. Third, do the Mediterranean diet, minimize red meat and eat organic foods. Fourth, get your ideal body composition. Eliminate belly/visceral fat. Do not use any tobacco products.
35:00 Dr. Houston’s one Herb, Supplement, or Botanical that He Cannot Live Without: His clear choice is omega-3 fatty acids. They have the best data for reducing heart attack and stroke, improving endothelial function, changing your lipid profile for the better, and improving your glucose profile.
35:45 Omega-3 and Omega-6 Balancing: If you take omega-3 fatty acids (DHA/EPA) long term, you deplete your GLA, a good omega-6. If you take GLA long term, you deplete your omega-3s (DHA/EPA). You need to keep your GLA at 50% the level of Omega-3. Potential oxidative damage needs to be addressed as well. Dr. Houston developed a product called EFA-Sirt Supreme to deal with these complicated processes.
37:34 Dr. Houston on Health Policy: With proper diet, nutrition, exercise, and weight management, cardiovascular disease could be reduced by 80% in the US. Numbers are probably similar for cancer. Instead of paying for drugs, pay for support for diet, nutrition and weight management.