Life Extension Magazine May 2005
As We See It
Doctors Overlook Novel Methods to Prevent Heart Attack
By William Faloon
Two recent studies published in the New England Journal of Medicine validate the role that C-reactive protein plays in increasing cardiovascular disease risk.1,2
C-reactive protein is a blood marker that reveals the level of inflammatory reactions in the body. Chronic inflammation is a major cause of atherosclerosis.3 Published studies have demonstrated that elevated C-reactive protein is a greater risk factor than high cholesterol in predicting heart attack and stroke.4-9
Life Extension members were warned about the dangers of C-reactive protein long ago, and they take steps to keep their blood levels of this inflammatory marker as low as possible.
The findings reported in the New England Journal of Medicine show that people who attained the lowest levels of C-reactive protein and LDL (low-density lipoprotein) had significantly reduced rates of heart attack. The studies also showed that reducing C-reactive protein (CRP) levels alone cuts heart attack risk and slows the progression of atherosclerosis. The authors of one of the studies recommend basing heart disease treatment on the results of blood tests that measure CRP as well as LDL levels.
In these New England Journal of Medicine studies, researchers administered moderate to high doses of “statin” drugs to heart disease patients in order to lower their LDL and CRP levels. We at Life Extension are not averse to the use of low-dose statin drugs for those who cannot achieve optimal LDL and CRP blood ranges using natural approaches. We take issue, however, with the blanket recommendation that virtually everyone could benefit from statin drug therapy. Statin drugs have proven side effects, and there are safer approaches that people can try first to attain the same benefits of statins.
Some doctors tell their patients to eat anything they want as long as they take their statin drug. This is bad medicine, and patients who rely on this kind of advice face severe health consequences.
How Diet Affects C-Reactive Protein Levels
An increasing body of evidence demonstrates that eating too much saturated fat or high-glycemic carbohydrates increases C-reactive protein.10
One study showed a 39% decrease in CRP levels after only eight weeks of consuming a diet low in saturated fat and cholesterol. The study participants also saw reductions in their LDL, total cholesterol, body weight, and arterial stiffness after eight weeks.11
Other studies show that eating high-glycemic foods increases CRP by promoting excess production of a pro-inflammatory cytokine called interleukin-6 (IL-6).12 CRP is produced in the liver primarily by excess levels of IL-6. One study showed a 28% reduction in CRP levels when women consumed a whole-food vegan diet rich in soluble fiber. One researcher suggested that it might be possible to achieve meaningful reductions in CRP by avoiding high-glycemic foods and ingesting soluble fiber at mealtime.13
In the September 2004 issue of Life Extension, we published an extensive article (“Novel Fiber Limits Sugar Absorption”) showing that consuming soluble fiber before a meal slows the absorption of high-glycemic foods and lowers post-meal blood glucose and insulin levels. Excess insulin is a significant cause of elevated CRP.13,14-19
Perhaps the most notable study compared the effects of three different dietary regimens on LDL and CRP blood levels. Group 1 consumed a diet very low in saturated fat, which included whole-grain fiber and dairy protein. Group 2 consumed the same low-fat diet plus a statin drug. Group 3 ingested cholesterol-lowering foods such as almonds, soy protein, plant sterols, and soluble fibers.
The striking results showed that the cholesterol-lowering foods worked almost as well as the very low-fat diet plus statin drug therapy. After 30 days, those who ate the cholesterol-lowering foods showed a 28.2% reduction in CRP and a 28.6% reduction in LDL. Those who received the statin drug and consumed a very low-fat diet showed a 33.3% reduction in CRP and a 30.9% reduction in LDL. (Group 1, which consumed a very low-fat diet only, saw a mere 10% reduction in CRP and 8% reduction in LDL.)20
Few people can follow a rigorous low-fat diet. What this study revealed is that functional foods—such as almonds, soy protein, fiber, and plant sterols—are almost as effective as a very low-fat diet plus a statin drug in reducing markers of cardiovascular risk. It is easier and safer to consume functional foods than to follow a very low-fat diet and take a statin drug.
Although published in the Journal of the American Medical Association, this impressive study received scant media attention. Since drug companies have no interest in the public finding out that functional foods are a more efficient way than drugs to lower LDL and CRP, there was no public relations campaign to announce these findings in the media.20
For doctors to not counsel patients about healthy diet but instead prescribe high-dose statin drug therapy is scientifically inappropriate. What is apparent from the recent New England Journal of Medicine studies, however, is that testing one’s blood to ascertain LDL and CRP levels is more important than ever. The New England Journal of Medicine studies clearly show that reduced heart attack risk directly correlates with therapeutic lowering of CRP and LDL.
Carnitine Supplements Lower CRP
A number of dietary supplements are known to lower C-reactive protein, but new studies indicate that the amino acid L-carnitine may also be effective. One study evaluated patients undergoing kidney dialysis, which causes increased CRP levels. Treatment using about 1500 mg of L-carnitine only three times a week resulted in a reduction of CRP levels with a corresponding improvement in other indicators of patient health. Most Life Extension members take around 1500 mg of carnitine every day.21
Another study revealed that in addition to lowering CRP levels in dialysis patients, supplemental L-carnitine also resulted in improved body mass index, most likely the result of reducing insulin resistance. The authors concluded that supplemental L-carnitine both suppresses inflammatory reactions and improves metabolic (glucose control) status.22
Fish Oil May Not Lower CRP
Fish oil is one of the better-documented nutrients for preventing heart attacks. A study published by the American Heart Association showed that people who consumed a low-dose fish oil supplement (1000 mg a day) were 45% less likely to die from a heart-related disease over a 3.5-year period.24
Previous studies have indicated that fish oil reduces C-reactive protein. A recent study showed that women with high levels of EPA and DHA fatty acids in their blood had 56% lower CRP.25 Other recent studies show reductions in CRP in response to supplemental fish oil intake.26,27
In response to positive evidence that fish oil reduces inflammatory blood markers,28 researchers initiated studies to ascertain exactly how effective fish oil supplements are in lowering CRP. Some of these studies showed that fish oil does not lower CRP. One study showed no CRP reduction in response to moderate intake of fish oil (1.35 grams of EPA/DHA).29 Another study found that 1.5 grams of EPA/DHA did not lower CRP.30 Most Life Extension members take 2.4 grams of EPA/DHA that also contains sesame lignans to augment its anti-inflammatory effect.
A study of type II diabetic patients showed that 4 grams of EPA/DHA significantly reduced markers of oxidative stress but did not lower CRP compared to placebo. This study’s potential flaw is that the placebo was olive oil, which has its own CRP-lowering effects.31 The fact that fish oil did not lower CRP compared to olive oil may not be that significant.32
Another study compared the effects of varying doses of fish oil to an olive oil placebo. The results showed no effect on CRP levels in the fish oil group, but by again using olive oil as the placebo, these findings are not conclusive because the olive oil may have also lowered CRP.33
Contradicting these recent negative studies is a recent positive study showing that fish oil reduced CRP levels when safflower oil was used as a placebo. Unlike olive oil, safflower oil has not shown CRP-lowering properties and is therefore a more appropriate placebo.34
Fish oil has documented anti-inflammatory properties, but it may not be the most effective way to lower CRP.