Podcast 32 - Endothelial Function

Endothelial Function


Dr. Chad: This is Dr. Chad Edwards and you are listening to Podcast number 32 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions, then we are the clinic for you. We offer Tulsa prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to help you get back on track to optimal health. Call our clinic at 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org to schedule your appointment today.

Male: Welcome to Against the Grain podcast, with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready, because we are about to go Against the Grain.

Marshal: Hallo, hallo this is the super tall Marshal Morris and I am joined by none other than the Dr. Chad Edwards who believes that 80% of medical recommendations are crap, technically speaking here. He is the author of the book, Revolutionize Your Health with Customized Supplements and he served in the US army for 23 years, as both enlisted soldier and as an officer or as a physician. He graduated from medical school at Oklahoma State University and he is the founder of revolutionhealth.org and Against the Grain Podcast. Dr. Edward’s thank you for joining us today I am pumped to be getting into this topic. I really am Tulsa prolotherapy.

Dr. Chad: That’s awesome because when you hear the title you are like, “how in the world can you be excited about this?” That’s kind of like being excited about rebar and concrete or something.

Marshal: Let’s get into it. I am very pumped to bring you today’s hot topic.

Dr. Chad: I guess, I don’t [unintelligible 0:02:06] turn anybody’s brain off because we are– today we are talking about endothelial function. That sounds boring as watching paint dry or something. But there is so much information coming out about endothelial function and its impact on your health. There is a lot studies and a lot of different ways in this– I mean it is really, pretty darn important stuff.

Marshal: Okay, so you tell me it’s pretty important stuff but I couldn’t tell you where on my body here endothelial function happens, so begin breaking it down for me.

Dr. Chad: You’re a tall dude.

Marshal: Oh yes.

Dr. Chad: It’s from head to toe.

Marshal: Okay.

Dr. Chad: All over your body. Basically endothelial function is a balance between a vesoconstricting and the vesodilating substances that the lining of your arteries produces, and that lining of the arteries is called the endothelium. The endothelium, we used to think about this thing as is just a– as a one-cell layer thick lining of your arteries and we used to think that it was just that. It’s just like a coating Tulsa prolotherapy.

But we found that there is so much more to it. It is a very active substance. Some people would argue that it’s an organ system on itself, because it is so important. We can actually measure it– at least kind of a surrogate measure for it. Today we are going to talk about what it does, how it’s linked to some medical problems and what you can do to optimize your endothelial function which we suspect is going to reduce your risk of some of these other things.

Marshal: What are some of the things that its related to, in terms of maybe some disease or a dysfunction or– what are the things that it contributes to the– maybe are prevalent on a day-to-day basis for people or what’s common, how is it commonly addressed or when does it come up in this discussions with your physician?

Dr. Chad: Yes, so I would argue that most physicians, even if they understand endothelial function, they don’t well understand– there are maybe some cardiologist, probably where most of this information would come from. I don’t know that you’re average family doc and I don’t mean to insult their intelligence but it’s just not something that we deal with on a daily basis even thought, we actually do we just don’t recognize that that’s what we are dealing with Tulsa prolotherapy.

Some things that the endothelial function can have an impact with, would be things like anything circulatory. High blood pressure, cardio vascular disease, peripheral vascular disease, heart attacks, strokes, those kinds of things with– There’s some things Reynold’s phenomenon, vesoconstriction when your hands get really cold and turn blue and white and red and those kind of things. Platelet function, atherosclerosis where the pluck is growing in the arteries, a big one for some guys, erectile dysfunction, we’ve had a podcast about that a couple of episodes ago. There are a lot of things, some kidney functions and flow and that kind of stuff. Anything dealing with blood circulation the endothelial function can have an impact on that function.

Marshal: Sure, okay. I’m kind of like a third grader here, so you’re going to have to help me along. Does what I eat grow my endothelial or my endothelium? Or do I just naturally have it? What contributes to the overall health of it?

Dr. Chad: Yes, so let’s think about this endothelial function. Let’s first think about the endothelium and then let’s think about the endothelial function.

Marshal: Okay.

Dr. Chad: When you go to sleep at night and you are lying down and you are asleep Marshal still exists. But you are not doing anything when sleeping. You are not moving, you are not being productive other then– I would argue that sleep is productive but you are not otherwise doing anything. You are not producing podcasts and none of that stuff is happening in your sleep. You are just a lamp on a log same as you’d be in a comma. That’s Marshal, that’s endothelium. It’s just the presence or absence of that. The endothelium is there and it’s just that one cell layer thick lining of the arteries. It’s just there.

But when you think about arteries, if you are listening and you want to know more about erectile dysfunction, then you can go back and listen about the erectile dysfunction discussion where we talk about the arteries expanding and contracting allowing a change of blood flow into the penis, allowing for that erection to occur. It’s that function that we’re talking about when we talk about high blood pressure. The artery is not relaxing enough to allow the volume of blood going through there.

When you talk about cardio vascular disease, you have the adhesion of certain molecules to that endothelium. When you have a blood clot, you have clot inside, whether it’s the venous system, the arterial system. When you have a blood clot, that is the platelets sticking to the endothelium and stimulating that all coagulation cascade Tulsa prolotherapy.

All of those things have to do with endothelial function. The endothelium is there, just like you are there when you are asleep. But when you are asleep you are not doing anything. The endothelium if we are not to worry about its function it’s just there. But you have to be productive, you have to do things, you have to get some things done, you have certain jobs that you have to do. The endothelium also has certain jobs that it has to do. Its ability to do that job– If you came to work and you didn’t do anything but drink coffee all day and just take up space and steal our oxygen–

Marshal: Often times that is all I do its just–

Dr. Chad: Right. Yes I know better than that, but you have certain jobs that you have to do and if you didn’t do those jobs you’d get fired. Now you can’t fire your epithelium, it’s just that certain things won’t happen or they’ll happen poorly. There are consequences to that. The endothelial function affects how platelets interact with it., how they expand and contract. Multiple of these different things and making sure that that endothelium is able to function and function well has an impact on how likely you are to get blood clots, cardio vascular diseases, erectile dysfunction, all of these different things. We want to make sure that you’ve got really good endothelial function Tulsa prolotherapy.

Marshal: What are some of the things that contribute to maybe at not operating at its tip-top shape? Or what are some of the things that maybe could cause the root of some of these bigger problems, the endothelium not performing as well?

Dr. Chad: The cheating answer is poor health. That’s an easy way to say poor health. One of the things that we focus on a revolutionhealth.org is optimizing health across the board. Generally we use that three tiered approach, exercise, nutrition, the three R’s: reducing stress, recovering from exercise and rest, sleep.

Optimizing those three things plays a role and we’ll talk a little bit more about how nutrition plays a role with this. We’ll talk a little bit about couple of those kinds of things. But we know that nitric oxide specifically has a big role on the endothelial function and a really good way to drive this point home. You know I work in the emergency room…
Dr. Chad: I love being in an emergency room. And when a patient comes in, and they’re having chest pain, and I get and EKG, and I’m getting labs, and I look at that EKG, based on their symptoms, their risk for having a heart attack, all of those things, then will often give nitroglycerin. That’s the spray or the tablet under the tongue, sometimes we’ll use a paste, sometimes I use it in an IV. But nitroglycerin, we use for chest pain, because we know that it allows these blood vessels to open up and to dilate. And it reduces some congestion and increases circulation. But that nitroglycerine, it works through nitric oxide. It enhances nitric oxide and that nitric oxide allows that endothelial function to kick in, and allows everything to relax and open up. So we can also use nitroglycerin to lower blood pressure, because it allows the arteries to dilate. Nitric oxide is very, very important in endothelial function. And we’ll talk a little bit more about this, about what you can do to optimize your endothelial function. But, in my clinic, one of the things that I check routinely is MTHFR, and I don’t think we’ve done a podcast on that yet. We will be doing it. Its methylenetetrahydrofolate reductase. Say that three times as fast.
Marshall: Wow.
Dr. Chad: But MTHFR and homocysteine. The reason that I bring those two up is both of them have to do with this process called methylation. But homocysteine itself, it should, through biochemical mechanisms and the MTHFR gene, should get methylated to L-methionine, two different amino acids. When you can’t methylate, homocysteine levels rise. That has a two-pronged effect. One of them is that you’re not methylating well, which has a whole different set of consequences that we’ll talk about in that podcast, but homocysteine, we know, robs the body of nitric oxide. So, when I get someone’s labs and I see their homocysteine levels are high, and high homocysteine levels have an independent association with cardiovascular disease. When you have high homocysteine, you are at higher risk for cardiovascular disease. Independent of smoking status, LDL cholesterol levels, and all the other supposedly risks for cardiovascular disease, high homocysteine levels are a risk. And they’re a risk for cardiovascular disease, because homocysteine robs nitric oxide, so you don’t have enough nitric oxide to allow the endothelial lining to function normally. So of course it’s going to disrupt the endothelial function and precipitate all the other problems that can come along with endothelial function. And there are things that we can do for that. There’s a whole lot of things that we can do.
Multiple different things that impact endothelial function. We know that trans-fats — making sure that you get good, healthy fats. Partially hydrogenated fats dramatically increased intake of trans-fats, and we know that trans-fats are associated with a number of health disorders and strongly, strongly, strongly recommend that you completely eliminate trans-fats from your diet. They’re not found in nature, except for, to my knowledge, the only one is CLA, or conjugated linoleic acid. CLA, it is found in nature. The homocysteine levels, the trans-fats, all of those things can impact endothelial function.
Marshall: Okay. We’re going to take a quick break, and when we come back I want to get into a little bit of more of the specifics of the things that you can do that contribute to more optimal endothelial function.
Dr. Chad: You bet.
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Marshall: And we are back. We are here with Dr. Chad Edwards, talking about endothelial function here. And, how do I know whether or not I have good or bad endothelial function? I can’t see it. I don’t know, so how would I know whether it’s performing well? Maybe I have one of these larger issues going on, but how do I test for that?

Dr. Chad: Some of the things that you can consider are what we already talked about: the homocysteine levels, and the MTHFR, and vitamin B levels and some of those things. They don’t tell me how your endothelial function looks, but they do suggest some risk. So that’s one thing that we can do. It’s really easy. It’s on a blood test, and I routinely do that on my patients.
The gold standard test for endothelial function is angiography, so putting a needle in the artery and looking at the blood flow through that, with an acetylcholine injection. Acetylcholine is a medication that changes the vasoconstriction and dilation of the arteries. This is an invasive test. You got to get a needle stuck in the artery, and they’re injecting stuff, and usually dial, and watching the blood flow works they’re giving you acetylcholine and all these kinds of things. Not really practical most of the time, and certainly much more expensive in those kinds of things.
So what most people have done, and this has actually been fairly well-studied and validated fairly well, is flow-mediated dilation. And, ultimately what they’re measuring is reactive hyperemia. Usually, the classic one is they put a blood pressure cuff on, or some kind of vasoconstrictive device and then they’ll use an ultrasound and watch– it’s either the Doppler ultrasound measuring– I think it’s Doppler. But they’ll measure the blood flow and with that reactive hyperemia, after a period of a few minutes, where there’s no blood flow through there, then you get this increase in blood flow following that ischemic time so to speak, when there’s not blood flow. So you have blood flow constricted off. The response should be a rush of blood after that. That’s kind of what they’re measuring. And there is a test called an EndoPat, which is, basically, it’s a little thing that you put on your finger and they put a blood pressure cuff, and they’re measuring the pulse oximetry, and they’re looking at certain waves, and those kinds of things. It’s a great test. My understanding is they’re using it in Framingham 3, which is the longest-running cardiovascular disease risk, Framingham study, and the third iteration of that is Framingham three. My understanding is that they’re using that in the– EndoPat in that test, looking at cardiovascular disease and things.
So obviously there’s a lot more information about endothelial function and about all those kinds of things. Those are some of the tests specifically that we can do– and of course the EndoPAd is a non-invasive test. It can be done at the bedside. You’re looking at a couple hundred bucks if insurance doesn’t cover it, but there is a procedure code and insurance can cover it for many patients.
Marshall: Okay, so that gets into the testing a little bit.
Dr. Chad: Yes.

Marshall: You test to identify that maybe my endothelium isn’t performing as well as possible. What do I do?

Dr. Chad: There’s several things that you can do. The very first thing that I would say is exercise. Again it goes back to that healthy trinity that we talked about. Number one: exercise. Number two: if you smoke, stop smoking. That definitely inhibits endothelial function. Number three: weight loss. It goes back into obesity. So many problems associated with obesity. We optimize our lean muscle mass, reduce excess body fat, improves endothelial function. Number four is the optimizing nutrition, improving your diet. Again got that healthy trinity component again. Number five: using an ACE inhibitor. It’s a certain medication that you use for hypertension. We can use it for some kidney stuff, but it has been shown to increase endothelial function as well. Number six. Not a big fan of these medications, but statins have been shown to increase endothelial function a little bit. The interesting component with that is I don’t believe it has to do with cholesterol. I think it has to do with the anti-inflammatory effects of statins, and there is without question benefit in that regard. The statins can be anti-inflammatory. Number seven: avoid trans-fats. It kind of goes back to that improving the diet thing, but specifically because studies are showing an association between poor endothelial function and the trans-fats. Number eight: arginine. You can take this as a supplement. It’s an amino acid, the one that I recommend is N.O. max, which has arginine, GlutarAde, or L-arginine is a more common one. But arginine helps to enhance nitric oxide and L-citrulline helps to kind of maintain that nitric oxide. And the last thing is measure homocysteine levels, and if your homocysteine is messed up, fix it.

Marshall: Okay. You listed these nine different things here. Do I need to wait until I have a problem to begin managing some of these things right now, or some of these things that I can do proactively?

Dr. Chad: Absolutely be proactive about it. Do not wait. Ounce of prevention is worth a pound of cure. Don’t wait until you have a problem. It’s much harder to put the cat in the box than it is to keep the cat from getting out of the box to begin with. Optimizing health across the board. There’s so many problems that we see that when you optimize that healthy trinity: exercise, nutrition and the three Rs, then we see these problems get better and it’s because of the effect on all of these little things: the endothelial function and weight and blood pressure, and all that stuff. So, yes. Get started today.

Marshal: Okay. So if you or, excuse me, if any of the listeners or people out there want to learn more about this type of stuff, what are some of the places that they can go?

Dr. Chad: Certainly you can start at revolutionhealth.org. Got the search bar up there. You can search for homocysteine, MTHFR, endothelial function, nitric oxide, N.O. max, those kinds of things. You can certainly start googling around looking at — you can look at endothelial function. You can search really any of the things that improve the endothelial function. PubMed is a great resource for scientific studies. There are studies on the trans-fats and endothelial function. There are studies on homocysteine. There are studies on nitric oxide. PubMed is a great resource.

Marshal: Well, Dr. Edwards, thank you so much for breaking this down for — so my third grade brain can understand it a little bit more. Okay.

Dr. Chad: Hopefully I made endothelial function better than watching paint dry.

Marshal: Yes. Pretty exciting stuff here and I appreciate you joining us today.

Dr. Chad: Yes men. Thanks Marshal.

Male: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week where we’ll be going against the grain.