Frequently Asked Questions About Metabolism and Heart Health
Why do I need to worry about blood sugar, cholesterol, and heart disease all at the same time?
These issues are all interconnected. We often hear about the related problems of blood glucose levels, pre-diabetes and diabetes, cholesterol issues and questions around the use of statins, as well as cardiovascular disease risk.
Cardiovascular disease continues to be the number one killer, but it's also a major cause of disability, especially if a person has a significant stroke or a heart attack that results in reduced heart function. That's why we take a comprehensive approach to these metabolic issues.
How does functional medicine approach heart health differently?
In my practice, I address these issues by focusing first on the gut microbiome. We know that gut bacteria play a critical role in regulating how your pancreas reacts to glucose in your diet, and also how your liver reacts to glucose levels in the bloodstream, and also determines cholesterol levels.
The same bacteria also play a role in brain health, bone health, and the health of all the other organs in the body that tend to become problematic along with the cardiovascular system.
Are heart disease and other health problems really connected?
Absolutely. We know that people with cardiovascular disease also tend to have osteoporosis. We know that women who have had breast cancer are most likely to die of heart disease. We know that people with heart disease tend to have depression.
In other words, all the systems in the body are related. Getting to the root cause of high glucose, high cholesterol, or high cardiovascular disease risk means optimizing the gut microbiome and supporting your entire body.
What tools do you use to optimize metabolic health?
We have many approaches, including:
Should I take a statin for my high cholesterol?
This is one of the most common questions I get, and the answer is: it depends. We have extensive research on these medications, yet they're sometimes used inappropriately.
I do believe there are cases in which statins are likely to be beneficial and where it makes sense for people to use them. I follow the American Heart Association guidelines and usually run their PREVENT calculator score to see where people fall in the decision tree based on research from the U.S. Preventive Services Task Force. For people in their 50s and 60s, and even older, I find they don't meet the guidelines for statin use.
Are there people who won't benefit from statins?
Yes. Research has shown that patients with very low inflammation and patients with no soft plaque in their coronary arteries are very unlikely to benefit from statins. That's why we should do comprehensive testing before making recommendations.
What are the downsides of statins?
There are several reasons someone might want to avoid statins:
How do you decide whether to recommend a statin?
As is typical in functional medicine, we go into a lot of depth evaluating cardiovascular risk from a holistic picture. We look at:
Can I reverse my glucose or cholesterol problems without medication?
In many cases, yes! By optimizing your gut health, nutrition, exercise, sleep, and stress management, many people can significantly improve their metabolic markers. However, each person is unique, and some may benefit from medication as part of a comprehensive approach. The key is making an informed decision based on your individual risk profile and health goals.
Why do I need to worry about blood sugar, cholesterol, and heart disease all at the same time?
These issues are all interconnected. We often hear about the related problems of blood glucose levels, pre-diabetes and diabetes, cholesterol issues and questions around the use of statins, as well as cardiovascular disease risk.
Cardiovascular disease continues to be the number one killer, but it's also a major cause of disability, especially if a person has a significant stroke or a heart attack that results in reduced heart function. That's why we take a comprehensive approach to these metabolic issues.
How does functional medicine approach heart health differently?
In my practice, I address these issues by focusing first on the gut microbiome. We know that gut bacteria play a critical role in regulating how your pancreas reacts to glucose in your diet, and also how your liver reacts to glucose levels in the bloodstream, and also determines cholesterol levels.
The same bacteria also play a role in brain health, bone health, and the health of all the other organs in the body that tend to become problematic along with the cardiovascular system.
Are heart disease and other health problems really connected?
Absolutely. We know that people with cardiovascular disease also tend to have osteoporosis. We know that women who have had breast cancer are most likely to die of heart disease. We know that people with heart disease tend to have depression.
In other words, all the systems in the body are related. Getting to the root cause of high glucose, high cholesterol, or high cardiovascular disease risk means optimizing the gut microbiome and supporting your entire body.
What tools do you use to optimize metabolic health?
We have many approaches, including:
- Dietary changes - Different diets work for different people, tailored to your specific situation.
- Gut optimization - Addressing beneficial bacteria and reducing intestinal permeability.
- Exercise - High-intensity exercise and resistance training are crucial.
- Lifestyle factors - Addressing stress and sleep issues, which have enormous impacts on metabolic health.
- Targeted nutrients - A number of nutrients are critical to liver health (the regulator of cholesterol and glucose) and cardiovascular health. These include omega-3 fatty acids, vitamin D, magnesium, and others.
Should I take a statin for my high cholesterol?
This is one of the most common questions I get, and the answer is: it depends. We have extensive research on these medications, yet they're sometimes used inappropriately.
I do believe there are cases in which statins are likely to be beneficial and where it makes sense for people to use them. I follow the American Heart Association guidelines and usually run their PREVENT calculator score to see where people fall in the decision tree based on research from the U.S. Preventive Services Task Force. For people in their 50s and 60s, and even older, I find they don't meet the guidelines for statin use.
Are there people who won't benefit from statins?
Yes. Research has shown that patients with very low inflammation and patients with no soft plaque in their coronary arteries are very unlikely to benefit from statins. That's why we should do comprehensive testing before making recommendations.
What are the downsides of statins?
There are several reasons someone might want to avoid statins:
- Diabetes risk - They are well understood to cause diabetes, and some people are more prone to this than others.
- Mitochondrial effects - They are mitochondrial toxins, though it's not always clear how this impacts the average person.
- Brain effects - Some people are very sensitive to the impact of statins on brain cholesterol synthesis, and these people can suffer adverse consequences including memory problems. There is a test for that!
How do you decide whether to recommend a statin?
As is typical in functional medicine, we go into a lot of depth evaluating cardiovascular risk from a holistic picture. We look at:
- - Glucose regulation
- - Sleep quality
- - Stress levels
- - Omega-3 levels
- - Blood pressure
- - Exercise levels
- - Inflammation markers
- - Coronary artery plaque
- - And more!
Can I reverse my glucose or cholesterol problems without medication?
In many cases, yes! By optimizing your gut health, nutrition, exercise, sleep, and stress management, many people can significantly improve their metabolic markers. However, each person is unique, and some may benefit from medication as part of a comprehensive approach. The key is making an informed decision based on your individual risk profile and health goals.
