My grandmother died in her sleep from a heart attack. All 11 of her brothers and sisters also died from heart disease. This got my attention early on, and I’m not alone. For anyone reading this, the most likely way you will die is from some problem linked to your cardiovascular system. Treatment of cardiovascular disease has advanced dramatically, and there are drug and surgical options for those at risk. A functional medicine approach to treating cardiovascular disease focuses on how to prevent the damage to blood vessels in the first place.
The mechanisms are all well-studied and well-understood by modern science. The process by which cardiovascular disease progresses is straightforward; Blood vessels are sensitive structures and they don’t do well when bathed in fat, especially if those lipids are being oxidized or damaged. High levels of cholesterol, combined with a lot of oxidative stress are the perfect formula for the development of atherosclerosis. The factors that drive the process of arterial plaque formation put one at risk for heart attack, stroke and high blood pressure. The same basic biochemistry forms the basis of metabolic syndrome and mitochondrial problems.
If we eat too many carbs, especially if they are in the form of sugar and refined grains, i.e. sweets, softdrinks, white bread, pasta and so on, we accrue an excess of energy. Your body can’t utilize this energy in the moment, so it's stored as fats or lipids. The liver takes the excess carbs and creates cholesterol and triglycerides, which means your cholesterol levels go up and you pack on body fat. If you eat too much fat, then of course you’ll also have a rise in cholesterol and body fat. It’s the excess energy or excess calories that gets you.
Much of this can be prevented or reversed through diet, exercise and lifestyle changes, and the truth is, we all know that. No one wants to be fat or eat in such a way that their cholesterol shoots up and they put themselves at risk for a heart attack or stroke. At the same time, very few people can just wake up one morning and adjust their entire lives for the better and stop the progressive nature of these diseases. Most of the time, something catastrophic has to occur first - like surviving a heart attack or losing one’s best friend to a stroke - before people will embrace the changes required. However we don’t want our patients to wait until it’s too late, so how to proceed?
What I’ve found to be the most impactful way to address patient motivation is to present the patient with a full metabolomic panel and genomic panel to give them a real-time view of all the major risk factors for cardiometabolic problems. Part of any good functional medicine training program is training doctors how to approach these issues from the root cause of the problem.
To oversimplify everything, we can think of heart disease as a disease of excess energy, and this energy is stored in the body in fatty tumors. If these fat accumulations block a blood vessel or break off, then we can experience a heart attack or stroke. If this process damages the ability of blood vessels to work properly, people can experience high blood pressure. If this same process damages our insulin response we become insulin-resistant, and further metabolic disturbances can come into the picture.
Again, there is no mystery; a disease of excess energy in the form of fatty tumors called plaques can be prevented or reversed if we stop the body from experiencing this excess energy. Obviously, that has to include diet changes. Less obviously, a comprehensive approach should also include testing and correcting every aspect of metabolism and checking for genetic issues that can predispose people to these types of problems in the first place.
Using organic acids, you can measure beta oxidation (the burning of fat for energy), carbohydrate metabolism (how we break down carbs), the citric acid cycle (how mitochondria produce energy in the form of ATP) and even the electron transport chain. Every single key step in producing energy can be tested, monitored and corrected. Additionally we can screen for fatty acid levels themselves to be sure there are appropriately low enough levels of saturated fats in the body and appropriately high enough levels of Omega 3 and Omega 6 fatty acids in the body. You can even test for the amino acids, 20 of which are required for producing all the complex enzyme systems that make up your metabolism.
And, perhaps my favorite of all, you can easily test functional levels for the B vitamins using organic acids, which means you can see if the amount of each B vitamin in the body is sufficient to run normal metabolic processes.
In a person with the beginnings of heart disease or a strong family history of cardiovascular problems, it’s most likely you will see a wide range of problems. A typical set of labs will reveal high stress hormones, poor microbiome health, and at least a few metabolic blocks to the proper burning of energy.
Mitochondrial health, gut health, even hormone health all are intertwined and require correcting in order to achieve a long lasting result. The lab tests also allow for a personalized medicine approach where you focus on exactly which Omega 3 is low or which amino acid is missing or which B vitamin is functionally not all there. Knowing exactly where the metabolic dysfunction is allows you to design a program to correct the underlying issues quickly and effectively.
Very few people are aware that you can accurately test for and correct individual problems with energy production. Sluggish beta oxidation can be seen with high adipate and suberic acid levels from organic acids. By giving a therapeutic dose of riboflavin and carnitine you can restore the normal functioning of beta oxidation and repair a person’s fat metabolism. That’s pretty incredible in and of itself, and there are literally a hundred or more other examples of commonly seen metabolic blocks that occur and can be reversed.
Functional medicine training has fallen behind in that there are so many new practitioners coming into the field and the old model of teaming up with an experienced doctor to learn the trade as I did just doesn’t work anymore; There aren’t enough open slots for internships and mentorships, so we find ourselves with a new generation of enthusiastic but lab-skills-deficient folks. My primary professional goal is to get the word out on how to develop lab interpretation skills, and nowhere is this more important than in the early detection and prevention of cardiovascular disease.