A Common Cause – a case study

Remember that there are three responses of the endothelial tissue: acute inflammation, oxidative stress, and autoimmune disease. Now let’s dig deeper into the most common cause of heart issues as well as strokes and TIAs – autoimmune endothelial dysfunction (AED).

atherosclerosis timeline3
I gave you an overview of autoimmune disease in part 3 of this series, so let’s just concentrate on what happens in the vessels. Remember that we discussed that the single-cell layer that lines the vascular structures acts as a barrier or wall that has hundreds of gates called receptors that allow interaction between the external world (inside the blood vessel) and the internal world (inside the endothelial cell and then under it – in the space between the endothelial cells and the smooth muscles).

This microscopic world cannot be underestimated as the tiny chemicals that enter the gates change the cell and its ability to interact to its environment. Let’s illustrate with a real-life example:

John was 54 years old and went in for his annual check-up. After a thorough exam and blood work his doctor determined that John’s cholesterol, a 203, needed attention. He was also concerned that the slightly elevated blood pressure required medicating and re-assured John that both the Lipitor for his cholesterol and the blood pressure medication at the small dose he was recommending was absolutely necessary to keep John from an early myocardial event like that experienced by John’s father.

But let’s look at what was really happening: Deep inside John’s blood vessels the endothelial layer we’ve detailed has been infiltrated years ago by foreign invaders. Helicobacter Pylori, an enemy that is more commonly known for causing stomach ulcers is perhaps the most common pathogen to crawl past the stomach lining and invade deeper tissue. H. Pylori bacteria have slowly spread into cells in John’s lungs and vessels. Normally an invasion like this would stimulate an all-out attack by local law-enforcement officers (the immune system) but every troop dispersed has found little success as the enemy is cunning and has the ability to enter and hide within the cells it attacks.
Over time, John’s immune system has placed H. Pylori on its top ten most wanted list and has waged a silent war against this elusive enemy, often finding it in different areas in the body. The attacks on the H. Pylori found in the endothelium has caused slow, insidious inflammation in the vessels that has opened gates for chemical responses that increased smooth muscle tone under the vascular wall – this is what caused the increase in John’s blood pressure.

But John’s doctor hasn’t bothered to address the cause of John’s high blood pressure; he’s just prescribed ACE inhibitors to manipulate the numbers. As far as giving him Lipitor for cholesterol levels of less than 400 – well will save that for another time. But it gets worse:

John leaves the doctor’s office feeling that he has just added years to his life by artificially manipulating lab values back into a pre-determined range. Far be it from the truth! The CAUSE of John’s problem has just continued and the H. Pylori bacteria continue to take a foot-hold in various places including the endothelial layer in vessels around the heart. Years go by and the FBI (his immune system) has now declared war on H. Pylori, making it prime enemy number one. This intensifies the inflammatory response in an attempt to kill the bad guy that increases the fluid build-up under the single-cell layer of tissue lining the arteries. This bulges the cell lining further into the lumen slightly blocking the flow of blood through the vessels. It also increases the smooth muscle tone and despite the doctor’s increase in dosage over the past few years, John’s blood pressure required another medication.

Continue the story a few more years and see John lying in a hospital bed after placement of a stent or bypass surgery where the cardiologist found 90% blockage in several arteries. “We’ve done everything we could,” may be a commonly heard at this point. But is that true?

Let’s ask a couple questions:

1. Was CAUSE ever addressed?
2. Everything I’ve taught you to this point is NOT alternative; it’s all in the literature. Why didn’t anyone dig any deeper?
3. If CAUSE is just going to be ignored, is John EVER going to really get better?

Let’s just pretend that John came into my office before deciding to fill his prescriptions:

John enters with some legitimate concerns with his heart that we need to address. We do NOT want to make the mistake of prescribing a ‘natural’ cholesterol and blood pressure reducer without finding the cause as we often see ‘alternative’ clinics do. This isn’t any more correct care than using drugs! I can’t tell you how many patients come to me thinking they are doing good in taking red yeast rice extract instead of Lipitor to reduce cholesterol levels. I simply ask one question, “Did you even bother figuring out WHY your cholesterol levels are high?” This usually gets people thinking. Why in the world would you use drugs OR natural substances to artificially manipulate lab values without figuring out the cause?

It really makes me mad to read ‘natural newsletters’ that just push the sale of nutrients to treat problems going on inside. Remember – a positive lab value or a symptom are just SIGNS, they are SIGNALS, like beacons telling you that there is something wrong – we don’t want to make this same mistake. If you cover up the sign, even with natural treatments without finding and fixing the CAUSE, you are in big trouble!

Let’s get back to John. After explaining the need to find the cause, he agrees to a thorough examination and series of functional labs which may include: Oxidized LDL (oxLDL), Homocysteine, high sensitivity C-Reactive Protein (hsCRP) which may indicate acute inflammation. Tests that may reveal oxidative stress include: 8-hydroxyguanosine (8-OHG) & 8-hydroxy-2’-deoxyguanosine (8-OHdG) – products of oxidized DNA and RNA; Malondialdehyde (MDA) – byproduct of lipid peroxidation; and Glutathione Superoxide Dismutase (SOD) – if decreased suspect oxidative stress.

As far as measuring blood lipid levels, we want to get more specific than just cholesterol, LDL and HDL levels:
LDLs: Lipoprotein (a) is a ‘regular’ LDL with a protein structure attached. This combination increases the risk of CVD. Levels are largely genetic but should be <30 mg/dL. Apolipoprotein B is a carrier protein that helps LDL deposit fat in arterial walls – levels should be <60 mg/dL. IDL (intermediate density lipoprotein) are VLDLs that are depositing some of their cholesterol and fat in the arteries. As VLDLs shed their fat, they become more dense and graduate to become an LDL. LDL-real (LDL-R) – all remaining LDLs. Some are small, some large. The smaller ones are more ‘dangerous’ even though they carry less cholesterol because they can better infiltrate damaged endothelium. In general: the smallest size LDL (LDL-B) is the most dangerous. LDL-A is least dangerous. VLDL or Triglycerides should be <75 mg/dL.

HDLs: HDL-2 – larger and more protective (especially HDL-2b); HDL-3 – smaller, less protective; Normally HDL is anti-oxidant and generally protective BUT…in the presence of a large amount of inflammation (like a chronic Autoimmune disorder), HDL can become oxidized that renders it useless.

An example of a more complete blood work-up for dyslipidemia might include: Total Cholesterol, HDL Cholesterol and its sub factors, LDL Cholesterol and its sub factors, Triglycerides, Lipoprotein (a), Lipoprotein Ratios: LDL/HDL & Total/HDL, Ferritin, Fibrinogen, c-Reactive Protein (HS), Insulin ; Testosterone; Sex Hormone Binding Globulin; Free Androgen Index; Magnesium, Homocysteine ; Coenzyme Q10; Lipid Peroxides. There’s more but that suffices.

Tests to identify autoimmune dysfunction include: specific cytokine tests to measure increases in IL-1, IL-2, IL-6, IL-10; Heavy Metal toxicity testing; specific food antigen testing; environmental toxicity testing, and so on. I use Kinesiology testing and have kits for every know bio-toxin (virus, mold, fungus, parasite, bacteria) known to man.

Whew, this is really getting boring with all these big words so let me summarize:

1. Never take medication based on lab work that doesn’t identify CAUSE
2. There are many more specific labs that can be done that point to one of the three causes of endothelial dysfunction
3. You NEED to identify if you have an local inflammatory process, an oxidative stress response, or an autoimmune disorder that is causing the endothelial dysfunction in order to treat it properly
4. One of the above three reactions in the endothelium will most likely be the cause of an increased cholesterol production by the liver in order to ‘heal’ the damaged artery so fix the endothelial problem first

So let’s pretend that after testing John that we discovered that he had an autoimmune inflammatory reaction in his arteries. If you’ve read any of my material on autoimmune/inflammatory conditions you’ll know that the next question that MUST be answered is “what is the antigen (the thing that the immune system is firing against)”. We’ll pretend that further examination reveals that John’s endothelial dysfunction stemmed from an H. Pylori infection that infiltrated his stomach tissue years ago and embedded in the pulmonary and heart endothelium.

If we don’t address John’s CAUSE, will he ever get better? This is why statistics bear witness to the fact that our current, medical approach to heart disease, though it may be efficient at saving lives in acute crisis, is woefully inadequate at treating chronic disease. In my office, I want to treat the cause therefore in this case we would treat the H. Pylori infection and modulate the immune response.

I know this was a lot of information this week but ‘hang on’; I break it all down in more bite-size bits as we go. Always remember to KEEP ASKING WHY and never settle for a simple diagnosis.

Schedule a time to speak with Dr. Conners HERE

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