The sum is the answer to an addition problem. This plus that lead to the answer. Over the past couple of months, we’ve been taking a look at our inclination to reductionist thinking. We identified reductionism as our attempt to understand complex things by simplifying them. I’m all for making things as simple as possible; however, what we’ve learned so far is that trying to explain nutrition, or our physiology in this way doesn’t serve us as well as we think. Let’s look at a common example.
Cardiovascular disease is the leading cause of death in Western countries. For half a century, elevated total cholesterol or LDL cholesterol is considered to be the major cause of atherosclerosis and cardiovascular disease. Checking blood cholesterol levels is routine if you are over 40 years old. If your total or LDL cholesterol is significantly elevated, your doctor may discuss the increased risk of heart attack and stroke, and tell you that reducing cholesterol in your blood will help prevent heart disease. In some instances, such as if you’re older, or have a compounding risk factor such as type 2 diabetes, you will more than likely be prescribed a statin medication, which reduces your liver’s ability to make cholesterol. Sounds like a logical treatment plan, doesn’t it? Therefore, statins are the most commonly prescribed medication in the U.S.
However, this approach is being questioned, and some even regard the prevention of a heart attack through statin treatment as “of doubtful benefit.”1 One of the reasons for the increasing lack of confidence in this approach comes from different analyses that report evidence that having a normal to low cholesterol is not a guarantee of healthy arteries or heart attack prevention. In fact, some reports reveal that the majority of people admitted with heart attacks have normal to low LDL cholesterol.2 Other studies conclude that about 50 percent of individuals with normal cholesterol levels also have a dangerous level of plaque built up in their arteries.3,4 While some view this as indicating the need for setting up lower normal cholesterol values, I am inclined to question whether taking a broader approach to this topic might be more beneficial.
Have you heard of insulin resistance? It is a metabolic malfunction that underlies type 2 diabetes. What is not as commonly known, though, is that insulin resistance occurs even without a type 2 diabetes diagnosis. Additionally, insulin resistance also underlies heart disease. In fact, an article written in 2009, the authors state, “In young adults, preventing insulin resistance would prevent approximately 42% of myocardial infarctions …. Insulin resistance is likely the most important single cause of CAD (coronary artery disease).”5 If this is true, we would realize that our reliance on statin treatment is providing us with a false sense of security, and we would address other very important contributors to heart disease.
Insulin resistance is a lot more common than you might realize, even in younger adults. One study estimates that 40 percent of young American adults have some degree of insulin resistance. Nearly half of these are not obese.6
Next month we will identify what insulin resistance is.
- LDL-C Does Not Cause Cardiovascular Disease: A Comprehensive Review of the Current Literature, Taylor & Francis Online.
- Most Heart Attack Patients’ Cholesterol Levels Did Not Indicate Cardiac Risk, Science Daily.
- Normal LDL-Cholesterol Levels Are Associated with Subclinical Atherosclerosis in the Absence of Risk Factors, Journal of the American College of Cardiology.
- Most Heart Attack Patients’ Cholesterol Levels Did Not Indicate Cardiac Risk, UCLA Health.
- Relationship of Insulin Resistance and Related Metabolic Variables to Coronary Artery Disease: A Mathematical Analysis, PubMed, National Library of Medicine.
- Insulin Resistance and Cardiometabolic Risk Profile Among Nondiabetic American Young Adults: Insights from NHANES [National Health and Nutrition Examination Study], The Journal of Clinical Endocrinology & Metabolism.
