Episode 92 – Endothelial Function

Speaker 1: 00:00 This is Dr Chad Edwards and you’re listening to podcast number 92 of against the grain.

Speaker 2: 00:06 This is Diana Edwards and I’m here with Dr Chad Edwards and we’re talking about a very important topic today. We’re talking about cardiovascular disease,

Speaker 1: 00:15 cardiovascular disease, that seems like a, that like affects a lot of people, right?

Speaker 2: 00:22 Um, mainly men, right?

Speaker 1: 00:24 Actually, you know, a lot of people think that, but it is the number one killer of both men and women, not only in this country but worldwide. It is a major, significant problem. So a couple of stats will throw out some stats you want to throw one out.

Speaker 2: 00:44 Yeah, absolutely. So basically what we’re looking at for cardiovascular diseases, it affects 80 million people in the US. That’s a lot of people and there’s a lot of people. My question is how many of that $80 million actually no, they’re being affected by it.

Speaker 1: 01:02 Well, I would argue, and that’s, that’s actually a great point, a great question because I think, I believe, you know, what we do at revolution, we’re very proactive and preventive and all of those kinds of things. And I see all the time people that are under diagnosed, undertreated, and, and have no idea about what’s going on. And so that’s some of what we’re going to talk about today. Yeah. Because most people don’t know and if you, they might think they have something like hypertension and cardiovascular disease. I just have hypertension, right? You know, it’s like, um, that, that is the beginning, that that’s all part of this continuum. And worldwide cardiovascular disease also accounts for 30 percent of all deaths. So we’re talking about a major, major problem, um, both in the United States and in the world. And again, it’s number one killer for men and women.

Speaker 1: 01:59 So that’s going to be, we’re going to be doing several podcasts about this topic because it’s a huge topic and probably one of the most common things that I hear about patients or hear from patients when they come to the clinic having seen another doctor a and either they’re on a cholesterol medicine or they’ll say it’s just a very common complaint and slash or concerned that you know what, my cholesterol is high and my thought is so well aren’t you concerned? I’m really not. I’m like looking at your face right now so that when they come in with elevated cholesterol and they’re on a cholesterol medicine and you know it’s a 45 year old woman or a 45 year old man and they’re on a cholesterol medication and I just asked him why are you on that medicine? And they said, well, because my cholesterol is high, my doctor told me to write.

Speaker 1: 02:53 And so my question to them is what do you care if your cholesterol is high? And they’re like, well yes. And I said, why do you care? There’s this fear, there’s this element of fear though, around cholesterol. And the fact that it’s elevated and, and where did that come from? And well actually it’s interesting where it came from, and this could be, and we probably should do this at some point, but we should talk about the lipid hypothesis and where that came from, but it started with Ancil keys in the 19 fifties. Uh, and he was initially laughed out of the American Heart Association. We’re the, we’re the board. He was trying to get on a and there’s a whole bunch of politics involved with all of this stuff. And later he actually became one of the board members. And then his theory started to take root. But it started way back then thinking, you know, cholesterol causes heart disease.

Speaker 1: 03:40 And the reality is that it absolutely does not cause heart disease. It just, when you think about it at its core, cholesterol by itself. And when I say cholesterol, let me define that further. So when I’m talking about cholesterol, let’s redefine that and say ldl, if you go to your doctor and have your cholesterol checked, they’re gonna check your total cholesterol and they’re going to check your ldl, which is low density lipoproteins, and those are the ones that most people think is the quote, bad cholesterol, the low density lipoproteins, the abbreviation for it is Ldl, and maybe we’ll think of that. Oh, that’s my bad cholesterol. No, it’s not. There is no difference between Ldl or bad cholesterol and ldl and the cholesterol and hdl. There is no difference. Cholesterol is cholesterol. Cholesterol and cholesterol is not harmful to your body. A bunch of people dumping their cholesterol medicine right?

Speaker 1: 04:41 And they probably should. The the amount of crap out there about this ldl is bad for you is nonsense. When you look at the Framingham data, the Framingham is one of the largest running cardiovascular disease risk studies in the United States. The people that live the longest actually had the highest cholesterol. And when you think about it, you know, almost every cell in your body has the ability to produce ldl on its own. So you can make ldl in these now, most of it’s made in the liver, but each, you know, you’ve got a lot of cells in your body that are capable of producing ldl capable of producing this cholesterol. Um, so this, if your body is making it and it’s a problem, it just, it just doesn’t make sense to me. Why are we all not dead from cardiovascular disease? And why are some people more influenced than the, it just this concept doesn’t make sense now when, and we’ll get into this in the future, but when your ldl is modified, so ldl in its native form, the way your body makes it, which is a carrier molecule for cholesterol.

Speaker 1: 05:47 So ldl is composed of a, some proteins. It’s composed of phospholipids, cholesterol and triglycerides. That’s the majority of it. And the composition of that molecule will change it from Ldl, Vldl, idl, hdl, all of those things. Um, but it’s the, this, this entire structure. The ldl molecule is not atherogenic, does not cause heart disease in its native form. It’s when it’s oxidized, inflamed, glycated, altered in some way. The body will then recognize that as a foreign abnormal particle, abnormal substance, and it triggers an inflammatory response and subsequent atherosclerotic heart disease. So this, uh, this notion of cholesterol, a ban, I talked about cholesterol a lot longer than I anticipated. I was about to just jerky off the soap box, but it was getting good, but it’s, I mean it’s so common and so many people are on these medicines for cholesterol and they have no other risk factors. They have normal blood pressure that everyone in their family lived to be 95. Nobody’s had heart attacks, you know, and when you start measuring their liquid particles and you start measuring oxidized Ldl, often they’re doing well. They don’t need a Staton, they don’t need a cholesterol lowering medication. They may need some other things. And again, these will be topics of a future podcast, but it is not cholesterol by itself.

Speaker 2: 07:20 So what we’re looking at today, basically when you kind of brought up inflammation and that kind of stuff is we’re going to be looking at and trying to focus on the endothelial function and how this is a precursor to cardiovascular disease and can begin occurring many, many years before we actually have some evidence of cvd going on for a patient.

Speaker 1: 07:41 Yeah, exactly. So what you’re describing is the is endothelial function, endothelium is we’re going to kind of talk about the endothelium and the endothelial function is how you, that’s a major risk factor for cardiovascular disease and it is influenced by a whole lot of things. And in fact the, you know, the traditional medical paradigm, there are five risk factors for cardiovascular disease. Things like obesity and smoking and hypertension and lipids and things like that. Um, so five traditional risk factors. Yet when, when, when you look at the literature, half of the people that go to the emergency department having a heart attack, have normal lipids. We are missing a tremendous amount of patients based on our current evaluation system. In fact, we’ve maxed out our current evaluation system by using these five risk factors. There’s, we’re not doing any better. We can increase our identification and say, oh, we’ve got all these people that have cardiovascular disease and we need to be aggressive with them and put them on statins.

Speaker 1: 08:52 Yet the cardiovascular disease incidents hasn’t decreased. We’ve made no effect. We’ve made, made no impact on outcomes by giving more and more and more of these medications. And we also increased side effects and all kinds of negative things at a huge cost. Absolutely. We’re great at acute care, but we sec pretty big at preventative care. Absolutely. And that’s something that we’ve talked about multiple times, uh, that, that concept. So a five traditional risk factors. The reality is that there are over 400 risk factors and those five risk factors are often miss. I’m not misidentified, miss evaluated. We don’t measure them correctly there, Mrs measured. And so we don’t identify them correctly and that will probably need to talk about that in the future as well. So you’ve got over 400 different risk factors, which means there are 400 different ways that these external influences will affect your body that increase your risk for cardiovascular disease.

Speaker 1: 09:56 And again, it’s things like hyperhomocysteinemia, so homocysteine and uric acid and, uh, certainly blood pressure when measured correctly and oxidized ldl and these lipid particles and smoking in a nutritional deficiencies and environmental toxins. And there’s all kinds of things that contribute to cardiovascular disease. But interestingly, the body only has three ways that it responds to these infinite numbers of, um, of, of insults. And it’s what Dr Mark Houston, a defy recalls the three finite responses. So it’s like a, you know, when I was in Iraq, we had our compound and if the bad guys came to attack, uh, you know, they could launch a missile or a rocket, I should say at which was probably the most common way that they would attack us. And certainly the only way that when I was there that they had any success with causing damage. So they will send a rocket and, or a couple of rockets and try and, and hit us.

Speaker 1: 10:57 Or they could send mortars or they could send guys to try and attack the front gate, or you could, I mean, just think of all the numbers of different ways that you can attack someone else can shoot him with a gun. You could throw a rock, you can do all these things, but imagine if our response, we only had three responses. What the, um, you know, for, for us, we wanted to tailor our response to each of the different things where your body only responds in three different ways through inflammation, through oxidative stress and through vascular immune response. And so those are what we call the three finite responses. Now those responses are good and appropriate. That’s the way the blood vessel Kinda should respond, so to speak. Um, but when that happens over and over and over again, then it eventually will cause endothelial dysfunction, uh, and, and cause a number of different, uh, effects, which will eventually result in cardiovascular disease, atherosclerosis, vascular, smooth muscle hypertrophy and artery stenosis in these kinds of things. Um, so think about it as a war between the infinite insults and the three finite responses. With your endothelium caught in the crossfire.

Speaker 2: 12:14 So basically when we’re talking about the endothelium and then what it is and where it is, is in your vessel, uh, this is going to be a thin layer of cells that are stationed between the vessel itself and the, what we would say is the lumen or the opening of that vessel. So where the blood, where the blood is going to be going. Um, so one of the things I think about is the endothelium lining is like the pantyhose, so you, you put your knee high on or you put your pantyhose on and that is the endothelial lining that is between your leg and the pant.

Speaker 1: 12:51 So that, that’s uh, that’s a one little layer. That’s a great example. And that, you know, the vascular wall is composed of a few things. The artery wall has the advantage of which is kind of the outer most layer. And then it’s got the media and the intimate. And finally the endothelium, which is this very thin one cell thick layer separating from the blood vessel, from the lumen of the blood flow. Just exactly like you said. So you know, the pantyhose very thin, endothelium, very thin, but the endothelium has incredible function. In fact, it’s kind of its own organ system, Arizona, Oregon in and of itself and might as well go over this statistics on this, uh, now, uh, the, the, uh, the endothelium is the largest endocrine organ in the body and it’s even the largest organ in the body. So it’s huge, much larger than, than we would give it credit for.

Speaker 2: 13:51 So when you say endocrine, you mean that it is going to be able to respond and do things through chemical messaging. You got it. Okay.

Speaker 1: 13:57 Yep, exactly. And again, a lot of people don’t really think of it in, in that way, but it is so big that the square footage of the surface area of the endothelium is 14,000 square feet in excess of 14,000 square feet. That is like six and a half tennis courts. Exactly. Huge, huge, good grief. And by weight, if you wanted to like take all of those individual cells and just set it on a weight scale, it is five times the weight of the human heart.

Speaker 2: 14:27 So my heart is really important connected to CVD, but at this point when you’ve got five times the mass and my endothelial lining, my attention just shifted.

Speaker 1: 14:38 Absolutely. Yeah, exactly. Because this is where all of the cardiovascular disease, when I say cardiovascular disease, I’m talking about Atherosclerosis, heart attacks, those kinds of things. And this is where it starts. And so times bigger than heart mass, it’s about two kilograms or you know, almost five pounds. That’s a lot of space for something to go wrong. Exactly. And whatever happens, you know, you get guys that come in and they complain of a erections like they, they have erectile dysfunction, which you know, ed interestingly is because of endothelial dysfunction, at least you know, in a, in a large portion of the population. So Ed Causes Ed endothelial dysfunction, causes erectile dysfunction. And so when you have erectile dysfunction, you almost guaranteed have endothelial dysfunction because what’s happening down there is also happening in your heart and also happening in your brain and also happening in your feet.

Speaker 1: 15:36 It doesn’t selectively just affect the artery in your heart. It affects all of them much in the same way. Uh, so it’s, it’s, uh, it’s very interesting. The endothelium is metabolically active. It produces exactly. It’s got a lot of, uh, a lot of job, but it is a membrane and the membrane is a membrane is a membrane in the body, sort of a. So what affects the gut health and causes a leaky gut in many ways can cause endothelial dysfunction or, or leaky endothelium, which is also bad. Uh, so one of the best things that you can do for your membranes is omega three fatty acids. Fish oil often recommend about five grams, four to five grams per day of that, uh, and recommend that both by nutritional supplementation, by my nutrition. So eating fish as well as nutritional supplementation. I don’t think I can eat that much fish.

Speaker 1: 16:31 Yeah. So, you know, when we’re talking about cardiovascular disease, everyone has different genetics and some people think, oh, I’ve got bad genetics, I’m going to get a heart attack. You know, my dad had a heart attack at 40 or 45 and my grandpa had a heart attack at 45. And all those things, and yes, there’s no question. Family history is one of those five traditional risk factors and there’s no question that, that changes your risk. However, how much of a heart and cardiovascular disease is genetic? We only 20 percent, which means a lot of grace in there. We’ve got a lot of room that we can control some things. Exactly. Eighty percent of cardiovascular disease is environmental, but everyone has a different risk and you have different genetic snips or single nucleotide polymorphisms, which we just talked about on some of our last podcast, which increase or decrease the risk of cardiovascular disease.

Speaker 1: 17:23 And we can actually measure that, but we will do, we will be doing some podcasts about those genetics in the near future I’m in, but this, uh, this endothelial function, atherosclerosis, these kinds of things, this is an inflammatory problem involving the immune system and the blood vessels and these kinds of things. And in fact, a Rudolph virchow in 18, 45 identified these plaques in the arteries as an invalid and as an inflammatory problem. And he said Atheroma, which is the plaque as a product of an inflammatory process within the Intima, and he called this process, this plaque stuff he called the indoor to rightest deformance. So an inflammatory process inside the artery that deforms it because of these plaques. So

Speaker 2: 18:08 one second, you’re talking about inflammation a lot and I’m an immune response. So my question I guess is if you have an individual who’s suffering from any kind of autoimmune disorder, um, are they going to be more at risk?

Speaker 1: 18:22 Well, there’s, by definition there is, there is increased inflammation and their, their immune system is imbalanced and which is causing more inflammation. So yes, that is one of the risks for increasing cardiovascular disease. Okay. That’s one of the 400, one or $400. Yes. So if you have an autoimmune problem, you have an inflammatory problem which is causing. This is part of, uh, the, uh, getting crossed caught in the crossfire. So Damn, short answer, yes. Okay. So the endothelium is incredibly important and it is critical for cardiovascular disease or at least the beginnings of cardiovascular disease. And when you have a good, healthy endothelium, you don’t have a ton of cardiovascular disease. Uh, we minimize that process. When your endothelium becomes unhealthy, then that starts the process, the door. Exactly. And there are a number of things that can be done to enhance the endothelial function. One of the biggest ones is nitric oxide. Nitric oxide is incredibly important and I would argue that most people are horrifically nitric oxide deficient. And we’re going to be talking about that in our next podcast. Okay?

Speaker 2: 19:44 Absolutely. Real fast. Before we leave, let’s talk specifically about what the endothelial function is like, what is its job, what are so that they understand how important it is to make sure that it’s healthy. Sure. Okay.

Speaker 1: 19:57 So this one cell layer thick of the endothelium lining of the blood vasculature. And its primary focus is to maintain vascular homeostasis. So when you go balance exactly. Uh, so when you go for a run or you go exercise, you need to increase blood flow. When you know you’re more quiet and things like your calm and relaxing, then you don’t need your blood vessels is wide open. When you need more blood vessel or when you need more blood volume, but blood flow, you increase the size of the artery, you know, do what we call vasodilation and that increases blood flow and you know for like your kidney function, for example, the way you affect how much urine you make is by causing the blood vessels on either side, what’s called the Glomerulus to open or close. You’ve got a fair in any fair arterials and they will open and close to regulate blood flow and create your own and things like that. So and that the endothelium plays an important role in that whole thing. So just as an example of one of the many things that it does,

Speaker 2: 21:06 I a very, very basic level. You can actually visually see this happening. Let’s say if you go and you do some exercising a, you get really hot and you’ll see those people who get really red in the face. That is because you are dilating those vessels because your body’s trying to cool off, so it’s sending more blood towards the surface so that the heat can be exchanged with the atmosphere. And so then you see that redness come to this room.

Speaker 1: 21:29 Yeah, that’s a, that’s a great point. And the endothelium plays a role in all of that. Perfect. What’s next? So the, the endothelium also is like the bucket for the blood. It’s the, the coating on the blood vessels that kind of carries the blood. It is selectively permeable, meaning that things can get across it and threw it on a selected basis, uh, with an intact endothelium. It maintains a blood or monitors bloodborne signals. So if there’s stuff in the blood that needs to send a message to the blood vessel that the endothelium is kind of monitoring that whole signaling process. It is a target for a response modifiers. So when we’re trying to affect change, the endothelium is, is a target. There is dynamic regulation of hemostasis thrombosis, which is a clotting, you know, creating a clots and things like that. Vascular tone, vascular growth and remodeling, which is a whole concept with both health and disease for the blood vasculature arteries based on a number of these infinite insults and the three finite responses, um, and the endothelium has a definite inflammatory and immune reactions, which is very interesting how the immune system plays in that specifically, but beyond the scope of this podcast.

Speaker 1: 22:52 And in short, ultimately what it does is it maintains vascular health period. Bottom line. I love it. We could have skipped all those and just said that. I’m just kidding. Yeah. The other good little nuggets in there to somebody probably heard one of those and was like, oh, that’s me. Yup. So hopefully that’s the case. Well guys, thank you so much for listening to us. If you like the podcast, please go to itunes and write us a review on itunes. If you’re one of our patients, don’t hesitate to go google and leave us a Google review. All of those things help us and we appreciate your help and effort in that. Until next time, until next time already, you guys take care.

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