Your Road to Wellness

Cardiovascular Disease

What you don't know can harm you.

Posted by on Cardiovascular Disease | 0 comments

You may not have heard about trimethylamine-N-oxide (TMAO), but this is an interesting substance, especially since research indicates that it is causing atherosclerosis.

TMAO increases the accumulation of cholesterol in macrophages (a type of white blood cell) also causing foam cell formation (Wang Z, et al. 2011). This results in increased inflammation and oxidation of cholesterol which is deposited in atherosclerotic plaque (Wang Z, et al. 2011).

Where do we find TMAO?

TMAO is produced by the bacterial flora in the gut by metabolizing trimethylamine (TMA) found in dietary phosphatidylcholine, choline and L-carnitine (Brown JM, Hazen SL, 2014). Sources of phosphatidylcholine, choline and L-carnitine are especially meats, egg yolk and high fat dairy products.

The following is a study published in the New England Journal of Medicine, one of the most prestigious medical journals in the world.

When 4007 patients having coronary angiography were followed for 3 years, increased levels of TMAO were associated with an increased risk of major cardiovascular events (Tang WH, et al. 2013). Angiography is a medical imaging technique used to visualize the inside, or lumen of blood vessels.

What can you do?

A plant based diet will not produce high levels of TMAO because it contains less phosphatidylcholine, choline and L-carnitine , but also because of another interesting reason.

When omnivores and vegans were given the same amount of carnitine it was found that vegans had a markedly reduced capacity to produce TMAO because their bacterial flora was very different (Koeth RA, et al. 2013).

By eating a plant based diet you can avoid high levels of TMAO.



Learn to Eat:  Recommendations that work. This is not a regular diet program.




Brown JM1, Hazen SL. Metaorganismal nutrient metabolism as a basis of cardiovascular disease. Curr Opin Lipidol. 2014 Feb;25(1):48-53. doi: 10.1097/MOL.0000000000000036.
Koeth RA1, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, DiDonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013 May;19(5):576-85. doi: 10.1038/nm.3145. Epub 2013 Apr 7.
Tang WH1, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med. 2013 Apr 25;368(17):1575-84. doi: 10.1056/NEJMoa1109400. 
Wang Z1, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith JD, Allayee H, Tang WH, DiDonato JA, Lusis AJ, Hazen SL. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011 Apr 7;472(7341):57-63. doi: 10.1038/nature09922.


What nutritional supplements can you take to support healthy endothelium function?

Posted by on Cardiovascular Disease, General Health | 0 comments



I have already reviewed some of the reasons for endothelium dysfunction (buildup in the arteries) and how you can use food to help prevent or reduce it. So let’s take a look at what else you can do.

Plaque ( buildup in the arteries), especially the unstable plaque, will increase the risk for cardiovascular disease. We know that low grade inflammation and free radical damage are big risk factors making high cholesterol, triglycerides and LDL cholesterol dangerous.
It makes sense for that reason to do what we can to reduce both low grade inflammation and free radical damage.

Not only does it make sense for the health of the cardiovascular system, but it may make you feel more comfortable, experience less pain and stiffness, and also make you feel better emotionally.

I will talk more about all the problems inflammation and excessive free radical damage may cause at a later date.

First let’s see what you can do to reduce inflammation.


Curcumin is an ingredient of the Indian spice Turmeric.

Curcumin is one of the most researched natural ingredients there is, and it has been documented to have anti-inflammatory effects by reducing the levels of some well known inflammatory cytokines like TNF-alpha, IL-1beta and CRP(Ren J, Sowers JR, 2014, Gupta SC, et al. 2013).

Why not use anti inflammatory drugs instead?

Anti inflammatory drugs will not reduce cardiovascular disease risk, they will instead increase the risk, that’s one of the side effects of these medications.

Here is an interesting study for you.

Post menopausal women were assigned to either a moderate exercise group for 8 weeks, a group taking curcumin orally for 8 weeks or a placebo group(Akazawa N, et al. 2012). Flow mediated dilation was measured before the start of the study and at the end as a way of evaluating vascular endothelial function, because declining endothelial function is associated with increased cardiovascular disease risk.

Surprisingly, flow mediated dilation increased equally in both the exercise group and the group taking curcumin.

I don’t suggest not exercising, I think the best solution would be to both exercise and to take curcumin, but that combination was not tested in this study.

There is however one problem with curcumin, it’s not well absorbed. I did not use curcumin before just for that reason, because the dose had to be so high that it would be impractical to take it. This however, has changed. There are now ways to make curcumin better absorbed so the daily dose to achieve results is not very high.

When 30 mg of regular curcumin powder was compared with 30 mg of a formula called Theracurmin, which used nano particles, the Theracurmin was absorbed 27 times better(Sasaki H, et al. 2011).

Now it is practical to use it. One capsule twice daily is all you need.


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  Akazawa N1, Choi Y, Miyaki A, Tanabe Y, Sugawara J, Ajisaka R, Maeda S. Curcumin ingestion and exercise training improve vascular endothelial function in postmenopausal women. Nutr Res. 2012 Oct;32(10):795-9. doi: 10.1016/j.nutres.2012.09.002. Epub 2012 Oct 15.


Carbohydrates and cardiovascular disease risk.

Posted by on Cardiovascular Disease | 0 comments


Maybe you have been told that it’s the fat in your diet that will increase your cholesterol, triglycerides and LDL cholesterol. To improve your numbers and cardiovascular risk you should decrease your fat intake and eat more carbohydrates, but will that produce good results?

If you’ve tried that without paying attention to what kinds of carbohydrates you ate, you probably discovered that it did not work very well.
Maybe you were told as the advertisements say, if diet and exercise does not work you should take medication. What the advertisements did not say was that you need to try an effective diet.
Not all carbohydrates are the same and will produce the same results. We all know that sugar is not healthy, but did you know that sugar will increase your cholesterol, triglycerides and LDL cholesterol(Te Morenga LA, et al. 2014)?

It’s not only sugar that is having this effect. Other carbohydrates which have a high glycemic index(the type that elevates the blood glucose high) will also increase cholesterol, triglycerides and LDL. If you instead eat low glycemic index carbohydrates(that’s the type that will stabilize your blood glucose at a low normal level) you will see your cholesterol, triglycerides and LDL decrease(Jenkins DJ, et al. 1985). This was even known in 1985 so it is not exactly news, but some research is still conducted today where this is not taken into consideration, where all carbohydrates are presented like they were producing the same results.

Here is an interesting example for you comparing white rice with beans(Mattei J, et al. 2011). An increase in servings of white rice increased systolic blood pressure, increased triglycerides and fasting blood glucose, while it decreased HDL cholesterol, the so called good cholesterol.
An increase in servings of beans were instead associated with lower blood pressure, lower triglycerides and an increase in HDL.
How about inflammation, that’s one of the most important risk factors for cardiovascular disease. Is inflammation affected by the type of carbohydrates you eat?
Absolutely, glycemic load which is another way of rating how high a food will elevate the blood glucose, was found to be significantly associated with hs-CRP, the main inflammatory marker for cardiovascular risk(Liu S, et al. 2002).
Eating food with a higher glycemic load increased inflammation.

The more fiber the food contains, the more it tends to slow down the absorption of the glucose in the food.
So when high fiber intake was compared with low fiber intake it was found that the higher fiber intake lowered hs-CRP(Ma Y, et al. 2006).
Does that mean that food with the same fiber content will produce the same results?
Even if that sounds reasonable, that’s not the way it works.
When a low glycemic index diet were type 2 diabetes participants were encouraged to increase their daily legume(beans,lentils) intake with at least 1 cup per day were compared with another group eating a high wheat fiber diet, this is what they found.
The legume diet was more effective than the diet high in wheat fiber when it came to lowering HbA1c, a measurement of long term glucose control. It was also more effective in reducing the cardiovascular risk score(Jenkins DJ, et al. 2012).

As a low glycemic index carbohydrate source, nothing seems to be as effective as beans and lentils.

Learn to Eat:  Recommendations that work. This is not a regular diet program.




  Jenkins DJ1, Kendall CW, Augustin LS, Mitchell S, Sahye-Pudaruth S, Blanco Mejia S, Chiavaroli L, Mirrahimi A, Ireland C, Bashyam B, Vidgen E, de Souza RJ, Sievenpiper JL, Coveney J, Leiter LA, Josse RG. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2012 Nov 26;172(21):1653-60.
 Jenkins DJ, Wolever TM, Kalmusky J, Giudici S, Giordano C, Wong GS, Bird JN, Patten R, Hall M, Buckley G, et al. Low glycemic index carbohydrate foods in the management of hyperlipidemia. Am J Clin Nutr. 1985 Oct;42(4):604-17.
 Liu S1, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002 Mar;75(3):492-8.
Mattei J1, Hu FB, Campos H. A higher ratio of beans to white rice is associated with lower cardiometabolic risk factors in Costa Rican adults. Am J Clin Nutr. 2011 Sep;94(3):869-76. doi: 10.3945/ajcn.111.013219. Epub 2011 Aug 3.
 Ma Y1, Griffith JA, Chasan-Taber L, Olendzki BC, Jackson E, Stanek EJ 3rd, Li W, Pagoto SL, Hafner AR, Ockene IS. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr. 2006 Apr;83(4):760-6.
Te Morenga LA1, Howatson AJ1, Jones RM1, Mann J1. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014 Jul;100(1):65-79. doi: 10.3945/ajcn.113.081521. Epub 2014 May 7.


More on salt, how much do you need?

Posted by on Cardiovascular Disease, General Health, Health Risk, Heart disease, Salt, Tissue Recovery Blog | 0 comments

Salt and rosemaryThis research is interesting because it measured sodium and potassium excretion and examined the association between major cardiovascular events and death(O’Donnell M et al. 2014).
Urine samples from 101,945 persons in 17 countries were included in the study with a follow up time of an average 3.7 years. The average estimated sodium excretion was 4.93 g per day and the potassium was 2.12 g per day.

So how does this relate to sodium intake?

Based on the urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or a lower intake.

Higher potassium excretion was also associated with lower risks.

These findings are higher than what’s been recommended for sodium intake in the U.S.. The recommendations in the U.S. are now being questioned by many.




O’Donnell M1, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, Yan H, Lee SF, Mony P, Devanath A, Rosengren A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Yusoff K, Iqbal R, Ilow R, Mohammadifard N, Gulec S, Yusufali AH, Kruger L, Yusuf R, Chifamba J, Kabali C, Dagenais G, Lear SA, Teo K, Yusuf S; PURE Investigators. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014 Aug 14;371(7):612-23. doi: 10.1056/NEJMoa1311889.

Is reducing your salt intake really that healthy?

Posted by on Cardiovascular Disease, Eating, Exercise, Risk of death, Salt, Supplements, Vigorous Activity | 0 comments

Salt is not bad salt shaker

We don’t need the same amount of salt all the time. Why is that?

When it is hot and we perspire more, or when we exercise and perspire more, we lose more salt which needs to be replaced. On days like that, we need to eat more salt. One of the reasons why runners sometimes get cramps is because of a high salt loss and not enough salt intake to compensate.

The reviewed research is interesting because it looked at salt intake and mortality related to all cause mortality and cardiovascular disease events(Graudal N,et al. 2014). Looking at data from 25 studies it was found that both low salt intake and high salt intake are associated with increased mortality.

This makes sense. Before you cut out all salt, make an assessment of how much you perspire and take into consideration what your blood pressure is.

If your blood pressure is high and your ankles are swollen, obviously you may need to reduce your salt intake. On the other hand if you perspire a lot because you exercise and your blood pressure is normal, you probably don’t need to reduce your salt intake.




Graudal N1, Jürgens G, Baslund B, Alderman MH. Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis. Am J Hypertens. 2014 Mar 20. [Epub ahead of print]

Reduce your cardiovascular risk with the right fat.

Posted by on Cardiovascular Disease, Fat, General Health, Heart disease, The Learn to Eat Plan | 0 comments

Common opinion goes like this: fat creates heart disease. New research is questioning that assumption and proving the opposite, that fat can be heart protective. The research reviewed is one of these studies.

7447 participants were assigned to one of three diets:

  1. A Mediterranean diet supplemented with extra-virgin olive oil
  2. A Mediterranean diet supplemented with mixed nuts
  3. A control diet where the participants were advised to reduce fat intake (Estruch R,et al. 2013).

The results showed that the Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.
Good sources of healthy fat are avocados, nuts, seeds and olive oil. Fish like wild salmon is a good source of omega 3 fat which is also very important.

The Learn to Eat program explains how to create healthy meals that are even more effective than the standard Mediterranean diet.





Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279-90. doi: 10.1056/NEJMoa1200303. Epub 2013 Feb 25.