But, practically speaking, how do you that? What strategy can you use with a reasonable assurance of success? Well, as you might have guessed, a couple of the major clinicians actually reversing plaque in the field give us a good starting point: targets for HDL, LDL and triglycerides. Their message is simple: get all three of these in line if you want good odds in reversing atherosclerosis (or maintaing clean arteries if you are of the lucky few with no plaque).
What this means is that when you get your lipid panel from your doctor, he is going to say, “Yeah, yeah, that’s great – it all looks good.” Docs generally do not want to mess with cholesterol and lipid numbers – it’s very time consuming and many patients are “religous” in their view and, to be frank, most non-cardiologists have little expertise anyway. The bottom line is that you are probably going to have to be the one to manage the long term care of your precious arteries and below we show you the stance of a couple of the experts with practical field experience:
NOTE: Keep in mind that there are several different alternative pathways to boost NO and I cover those in my link on How to Increase Your Nitric Oxide Naturally.
NOTE: See my link on Does a Low Fat Diet Have to Increase Triclycerides? The answer is no and I show that simply by eating low glycemic carbs, you can keep your triglycerides more than likely below 100 and have stellar LDL numbers, i.e. give yourself a good chance to reverse that nasty arterial plaque that has been lowering your nitric oxide levels!
In any event, he has very rigorous requirements for those with existing heart disease and/or significant familial risk factors. Check out his goals for HDL, LDL and triglycerides:
- HDL > 45
- LDL < 70
- Triglycerides < 90
So how are you going to achieve numbers like this? Well, to be honest, it wouldn’t be easy. I have come close to these numbers with a low fat diet but my LDL was a little higher and my HDL a little lower as well. How did I come close at least? Here is what I did:
- Low levels of fat (10-15% of total calories) to drop LDL.
- All carbs must be low glycemic to decrease triglycerides.
- Starchy carbs (such as grains) must be eliminated in some men to further drop triglycerides.
- Exercise must be increased to pull up HDL.If you can’t achieve the above numbers with just lifestlye changes alone, then you have a decision to make: are you going to take supplements or medications to improve your numbers? My understanding from Dr. Gould’s guidelines is that this is not necessary unless one could be considered a cardiovascular patient or had substantial risk factors for CVD. (See a cardiologist for an official evaulation of course.) In fact, Dr. Gould will even prescribe a low dose statin in these cases to make sure that reversal of plaque is achieved.Now many of you reading this will sigh a sigh of relief, because you do not have known heart disease nor do you have a family history of heart disease, etc. So forget about the numbers then, right? Wrong! I think this is a big mistake for most men coming to this site for several reasons:a) If you have erectile dysfunction, the odds are that you have the beggingings of atherosclerosis. For reasons that I discuss in my page on The Dangers of Erectile Dysfunction, E.D. is a great sign of future heart disease. In fact, one study showed that the typical man had five years after developing some level of impotence before he had a “heart incident,” i.e. angina, a heart attack, etc.b) Many studies – and Dr. Gould lists these in his book by the way – show that men in their 20’s and 30’s already have substantial plaque in their arteries. This is often why young guys start to notice those spontaneous erections disappearing.and some even having the start of E.D.
c) You can measure your plaque now with inexpensive testing that (in most states) does not even require a doctor’s orders. You should be able to get a Heart Scan or Calcium Score for between $50 and $100. Alternatively, a company called Lifeline now offers CIMT’s, which basically measures the arterial plaque via ultrasound in your carotid artery for (the last time I checked) $70. So before you assume you do not have plaque, test it!
CAUTION: Dr. Davis recommends Heart Scans, because IMT’s only predict with 60-80% accuracy the plaque within cardiac arteries and cardiac arterial plaque is the most dangerous. However, a Heart Scan does expose you to some radiation. This is the tradeoff.
d) I would guess at least half of all men over 40 have the early signs of prediabetes or prehypertension in the U.S. These men should probably consider themselves CVD patients. Remember that both of these are very hard on arteries. Again, you can measure your insulin resistance pretty well with at home tests such as post-meal glucose surges and A1C’s. And you can monitor prehypertension with a blood pressure device that you can buy at Walmart or Walgreens. (Omron puts out a couple of great models.)
There are a few “lucky dogs” who seem to have good genetics and just don’t develop plaque. But the great majority of us do not fall in this category and that is why as you enter your 50’s, 60’s and 70’s, you’ll see your friends dropping like flies. So I would recommend managing your HDL, LDL and triclycerides right away.
2. Dr. Davis’ Rule of 60. For God’s sake, don’t fall for the arteriosclerosis-doesn’t-matter argument. This is very common in Paleo and low carb circles. Dr. William Davis just tears this silly thinking apart in his classic book on plaque reversal called Track Your Plaque. He shows how rapidly atherosclerosis typically progresses and his excellent stats will definitely scare you straight. This is more material to keep by your bedside.
Dr. Davis is so convinced of the importance of plaque reversal to that he developed his Rule of 60 where – at least according to one video I saw – he stated that 90-95% of men could reverse plaque if they achieved the following:
- HDL > 60
- LDL < 60
- Triglycerides < 60
These numbers, of course, are even more strict that Dr. Gould’s and he typically achieves them from what I understand through some adjustments in the diet coupled with niacin, Vitamin D, fish oil and a few other supplements. And the clear message of these two men is that
a) Men on low fat diets (like myself) cannot ignore their triglycerides and HDL readings.
b) Men on low carb and classic Paleo diets cannot ignore their LDL numbers.
None of us can be smug and patronizing. We all have work to do.
CAUTION: If you follow these guidelines for HDL, LDL and triglycerides, are you guaranteed to reverse your plaque? The clear answer from both Drs. Gould and Davis is that these are just the starting point. They give you good odds, but there are other cardiovascular that need to checked as well. For the details, I urge you to read the page with Gould’s Guidelines above as well as their two books. It’s really an involved subject and I urge you to learn about it as much as you can.
INFLAMMATION ONLY? I cannot tell you the number of times on The Peak Testosterone Forum that someone has proposed the idea that plaque is “all inflammation.” In other word, lipid number, such as HDL, LDL and cholesterol, do not matter as long as your inflammation is under control. This is very risky thinking, in spite of the fact that inflammation does play a major role in atherosclerosis. And the reason is that no one has any targets for CRP, TNF alpha or any other inflammatory markers that I know of to reverse plaque.
As far as I know, no one is doing what Drs. Gould and Davis are doing by ignoring lipids and just focusing on inflammation. How are you going to know if your inflammation is low enough? Besides, I think it is very unlikely that you can have triglycerides or LDL and expect your arteries to do well. To me this is naive and wishful thinking. A much safer method is to stick to a time tested method and that means lasering in on lipids.