How do I optimize my diet for prevention of chronic disease?

The cause of most chronic diseases can be summed up using the Bad S’s: Sweets, Starches, Snacks, Seed oils, and Sitting, Smoking, Salt, Sleep Disturbance and Stress. 

Should I go on a diet?

There are so many diets out there: Paleo, Vegan, Ketogenic, Atkins, Zone, Mediterranean, Whole 30, Weight Watchers, and Nutrisystem to name a few. One of the main issues with dieting is that eventually you will go off, and then what happens? The whole plan falls to pieces and we typically regress to our original habits. The common promotion of eating three meals a day, “healthy” snacking, and counting calories create and perpetuate the problem. We are encouraged to graze like cows and eat to satisfy emotions. But we are not well adapted to that behavior.

We recommend watching this interview with Dr. Mark Hyman, one of the foremost leaders of health, from the Cleveland Clinic.

Our goal is to improve the way you view food and how it fits into your life and your health. 

How can I optimize my diet without “dieting”?

First, we recommend you start with a baseline body composition analysis. You improve what you measure, so don’t be discouraged by your initial reading if it is not ideal. This measurement helps you set an attainable goal and achieve it.

Weighing on a scale alone is not adequate. The body composition test allows you to know your muscle and fat mass, including your visceral fat. Visceral fat leads to diabetes and heart disease, so knowing this measurement is crucial to your overall health.

Come back regularly for additional body composition analyses. Seeing “The Judge” for detailed, measurable improvement over time will help you stay motivated.

Drink more water. Your urine should be copious and clear in appearance.

Avoid sweets (both natural and artificial). There is added, hidden sugar in every processed food. Avoid them all!

A rare sweet treat can be handled by most, but sugar is a toxin that should be avoided like tobacco.  Processed food companies became the new employers for the scientists who increased the addictive nature of tobacco.

Artificial sweeteners raise insulin levels without also raising glucose. Elevated insulin is THE MOST COMMON inflammatory stimulus, promoting prediabetes and arterial disease, among other chronic inflammatory conditions. These conditions dramatically flare when acute triggers, such as a virus, cause additional inflammatory sickness. Covid-19 is an extreme illustration of this effect. Artificial sweeteners are a “gateway drug” that strengthens your sweet tooth. They are a slippery slope to more sugar and carb cravings.  

Avoid starches including bread, pasta, white potatoes, and rice. Eat real food with no limits on vegetables, including sweet potatoes. 

Limited amounts of fruit provide micronutrients and fiber, but come with sugar. Do not juice. It removes  fiber that makes the sugar in fruits absorb more slowly with less rise in insulin. Avoid dried fruit, as it is almost pure sugar.

Stop snacking. Snacks are typically full of sugar and undermine our need to have periods of fasting to allow our insulin levels to drop. Fasting for 12-16 hours daily is a great “house cleaning” strategy.

Include good fats in your diet such as olive oil, coconut oil, nuts, seeds, olives, and avocados. Include lean protein such as salmon, sardines, and poultry, in your diet. Eat red meat on a limited basis. When purchasing red meat, look for grass fed and organic options if you can afford them.

Intermittent fasting (only drinking water, black coffee, and unsweetened tea) for 12-16 hours per day allows your insulin sensitivity to be regained by allowing your insulin levels to fall. I call it “window feeding” because you eat within a window or 6 hours as a goal.

Learn about the influence of your Microbiome. While probiotic supplements may help, eating a probiotic diet is even better. This includes fermented foods such as unpasteurized sauerkraut and KimChi. High fiber vegetables feed your good bacteria and can fix a great deal of health issues.

Get connected, motivated, and informed to support your changes.

Need help getting started? Request a complementary Discovery Call with Dr. Backs and begin your journey to better health.

Statins: The Rest of the Story

There is a rise in the religion of “antistatinism.” Another way to put it: There is a “War on Statins.” Just like there was a war on early treatment of a serious viral illness with safe repurposed medication. I prefer to share a positive fact based message.

But I must fight back to promote optimal outcomes and maximize quality and quantity of life. If antistatinism is your religion, no need to read further. You won’t be convinced by data or admit you're being fooled. I can’t coach someone who already knows everything.

But many are struggling with the threat of disability or death vs the propaganda designed to lure you to drive your money to their “solution” and their profit.

I'm frustrated almost daily by patients when, in addition to prescribing healthier lifestyle and correction of deficiencies, I explain the benefits and reversible risks and prescribe statins while monitoring for their benefit and harm. They are stable or improving on very well tolerated low dose rosuvastatin but stop this life saving treatment in spite of demonstrated life threatening atherosclerosis with measurable personal improvement in inflammation, arterial age, plaque healing and inflammatory markers because of "something I've read." 🤦‍♂️🤦‍♂️🤦‍♂️

I don’t blame the patients. We are susceptible to “fear porn” propaganda. I blame the opportunistic writers who are pushing people toward far more costly and more profitable PCSK9 inhibitors, expensive and less effective nutraceuticals, stents, surgery, cardiac/stroke rehab, dialysis, memory care centers and funeral expenses in their pursuit of likes, followers, and speaking fees based more on charisma and charm than interest in you personally!

Every one of these messengers has a business plan counting on growth!

Everything must be read with a filter of "what is offered as an alternative and what is the financial conflict of interest?" And "what does the author know or care about my individual circumstances, results and needs?"

I get it, but let’s put facts before feelings on this issue. Are statins mis/over prescribed? For sure. Is it driven by profit motive? It’s hard to blame this when almost all statins are cheap generics. Mostly, the driver is the guidelines that employed providers must follow and check the box under financial incentives and penalties to adhere. Reducing arterial disease progression or achieving remission doesn’t support a multibillion dollar procedural intervention and rehabilitation business model projecting and depending on growth. This is why I’m suspicious of any interventional cardiologist who disputes efforts to achieve remission, including statins to reduce inflammation. I’d prefer to hear more about the useless and potentially harmful stents placed over the years in asymptomatic individuals provoked by the “oculostenotic reflex” and provider revenue incentives.

Statin fear drives demand for more profitable pharma options like PCSK9 inhibitors (more than $500/month vs $5/month for generic rosuvastatin on GoodRx) and nutraceutical alternatives.

Statins are the most proven pharmaceutical treatment (in addition to a healthy diet and exercise) for remission of arterial disease and the reduction of heart attack and stroke for those with arterial injury/disease/plaque.

Evidence strongly supports that statins prevent death and disability from heart attack and stroke in patients with arterial disease. That evidence guides us to recommend statins at lower but still effective and well tolerated doses for those with atherosclerosis, which we identify and measure using carotid ultrasound and coronary calcium scoring. We monitor inflammation levels with ultrasound (intima media thickness measurement) and blood tests: C reactive protein, LpPLA2, microalbumin/creatinine ratio and myeloperoxidase. We consistently see improvement in these measures on statins and deterioration when stopped. I recently documented an 18 year improvement in arterial age in less than 5 months in a 66 year old clean living man while on rosuvastatin 5 mg 3 times weekly in addition to his continued healthy lifestyle. It is common for patients to admit to stopping their statin when confronted with mysterious adverse results on these measures after maintaining they were adherent prior to seeing the numbers. The numbers don’t lie!

You should be far more afraid of untreated inflamed plaque killing or disabling you than concerns about reversible annoying symptoms from an inexpensive generic medication that offers reliable protection. There is little controversy about statin benefit after an event (heart attack, stroke, bypass surgery or stent). When we find plaque (ultrasound or coronary calcium score) we consider those findings as essentially a near miss, an event that, fortunately, did not cause damage. Next time plaque develops, you might not be so lucky.

The foundation of health is nutrition/lifestyle/toxin avoidance. Think of this as the “belt” that keeps our pants from falling down. Statins are like “suspenders” that cover our lapses in optimal lifestyle choices. Safety programs, like airlines and the space program, are built on redundancy and backup plans. Belts AND Suspenders provided by the Department of Redundancy Department. 🙂

Where does the negative information about statins come from?

The biggest problem with statins is higher than needed doses of the wrong statin prescribed for the wrong reason. This is particularly true of the least effective but most effectively marketed statins (e.g. atorvastatin) for the lowering of LDL to target cholesterol levels based on general guidelines. The focus should be on reduced inflammation as measured by LpPLA2, myeloperoxidase and intima media thickness/arterial age by ultrasound in the individual.

At the CureCenter, I don’t prescribe statins if the arteries are healthy, no matter how “bad” the cholesterol is. I prescribe lower doses of rosuvastatin (has shown the strongest evidence of reduction in cardiovascular events while not crossing the blood brain barrier or promoting diabetes) based on documented atherosclerotic arterial plaque or inflammation, identification and monitoring of LpPLA2, myeloperoxidase and carotid intima media thickness/arterial age.

Event risk reduction begins in hours, but not for the reason most think. Statins lower LDL cholesterol levels, but their most potent benefit is reduced inflammation in the artery wall. I have seen this repeatedly by monitoring LpPLA2 and carotid intima media thickness trends.

Statin adherence consistently yields improvement. I can tell when they have been stopped by unfavorable trends in LpPLA2 and CIMT. In other words, they stabilize/heal plaque and improve the health and age of diseased arteries! There is evidence they reduced COVID deaths, probably due to suppression of baseline inflammation and mitigating the inflammatory effect of spike protein. Is it possible they protect my from vaccine injury as well?

When encountering negative propaganda about statins, ask the following questions:

• Is the alternative offered a more expensive and profitable proprietary supplement or pharmaceutical? Statins should cost less than $10/month and are usually covered by insurance. Supplements will cost 2-4 times that amount and not covered by insurance. Ezetimibe is less effective at reducing inflammation. PCSK9 cost more than $500/month. To get coverage, it helps if you are “statin intolerant” which can be promoted by the “nocebo” effect. They cannot claim superior results except with extreme familial hyperlipidemia. But that would make them “orphan drugs. Pharma prefers blockbuster profits.

• Does the reduction or elimination of heart attack, stroke, bypass surgery, stents, and rehab for heart attack and stroke undermine their business plan and revenue from treating late stage disease with stents, surgery, rehab, dialysis, memory care centers and funeral expenses?

• Is the goal reduction of cholesterol or prevention of heart attack, stroke, premature death, surgery, stents or rehab by suppressing inflammation due to oxidative stress?

• Is the advisor using the optimal measurement tools that show improvement in arterial health/age as we do at The CureCenter with Carotid Intima Media Thickness ultrasound or blood markers of arterial inflammation? Or are they solely focused on LDL cholesterol?

• Is the advisor like a child with a hammer pounding on everything that looks like a nail? Are they using all the tools and options available from a program in pursuit of optimal quality of life and longevity?

How does the CureCenter prescribe and measure the benefits of statin use?

When prescribing statins, the only reason we monitor lipid levels is that we are expected to do so AND as a way to verify that the medication is being taken. We measure benefit by demonstrating a reduction in measures of inflammation and arterial wall thickness using CIMT.

In some cases, we will pay less attention to elevated cholesterol levels if we know that arteries are healthy based on healthy carotid ultrasound and coronary calcium score.

In other cases, if we know that arteries are sick in spite of normal cholesterol levels, we generally prescribe statins unless we know of prior intolerance based on personal experience. Arteries improve with statins in spite of "normal" cholesterol because statins reduce inflammation. We generally use lower doses of statins (fewer side effects) because we are treating for artery health improvement, not the lowest possible LDL cholesterol levels.

Has Dr. Backs had his own personal experience with statin use?

Dr. Backs personally takes a daily statin called rosuvastatin. When he stopped it for a time (to see if his muscles ached from hard workouts or the drug), his arterial age increased by 10 years while he experienced the same sore muscles. This is all while he continued to exercise and live the “cleanest” lifestyle possible. When the statin was resumed, the arterial age returned to lower levels. 

Do statins have any side effects?

Statins can provoke dose dependent side effects in a minority of users most commonly muscle aching. The vast majority of individuals can take them safely with benefit with no adverse results. Untreated sleep apnea and low vitamin D levels increase the likelihood of muscle aches. Correction of these issues reduces these side effects and has other benefits. Coenzyme Q may be helpful, but reducing the dose of the statin or changing to a better tolerated option is the best first step for someone whose arteries are a threat.

A small minority of users have reported cognitive harm in relation to statins. This is less likely with rosuvastatin, our preference, because it does not cross the blood brain barrier like Lipitor/atorvastatin, the most successfully marketed statin.

Reduction in arterial disease-related dementia is far greater than the incidence of reversible cognitive compromise from statins. If you experience cognitive changes after starting a statin, they will reverse when the drug is stopped if due to the statin. Don’t get stuck on this worry. Dementia and Alzheimer’s are a far greater risk with arterial disease and insulin resistance driven chronic inflammation. Therefore, addressing this risk is far more important than fearing a temporary side effect.

Increased diabetes risk and insulin resistance have also been a concern. In many cases, patients are not counseled to or fail to reduce sweets and starches in their diets, thinking they are protected by the statin prescription. In fact, the focus on salt, fat and cholesterol leads to increased inflammatory addicting sugar intake. Therefore, it is no wonder that they progress from insulin resistance to prediabetes to Type 2 Diabetes, the progression caused by the western processed glycemic diet. Reduced Sweets, Starches and Snacks in the diet can offset fears about increased risk of diabetes or insulin resistance. Our patients are constantly coached and monitored for evidence of progression to prediabetes or Type 2 Diabetes.

Without personally trying a drug, predicting how you will tolerate it is impossible! The experience of a friend or family member, while provoking understandable concern and fear, will not predict your experience with statins or any other drug. Fears of statin intolerance tend to be self-fulfilling. This is known as the “nocebo” effect.

Intolerance of one statin doesn’t necessarily predict intolerance of all statins. Some side effects disappear with lower doses that will still have benefit measurable by blood and ultrasound measurements of inflammation.

At the CureCenter, we monitor reaction to any medication we recommend, both good and bad. Our bottom line:  If you have atherosclerosis, you will generally benefit from a statin (if you can tolerate it) to reverse arterial inflammation, heal plaque and prevent life altering events: heart attack, stroke, and dementia.

If you are still skeptical, we offer alternatives like Bergamot BPF or niacin. None of these have the same degree of net favorable track record of statins, and side effects are not zero. They offer benefits that vary by individual. 

Open minded willingness to consider risks AND benefits of any treatment leads to the best outcomes. But if your mind is made up, and you decline to take a statin, I won’t “have a stroke” over it.

I hope and pray the same is true for my patients

What tests are done at the CureCenter to measure arterial disease and its root causes?

The true inflammation nature of arterial disease (which causes heart attack, stroke and dementia) is not the basis of mainstream medical care. New testing methods and technology enable the CureCenter to offer more individualized and effective treatments. 

Tests we perform and recommend not generally available from standard care include (but are not limited to):

• Carotid Intima Media Thickness (CIMT) Testing: CIMT measures arterial wall thickness and documents atherosclerotic plaque stage and thickness. A thicker artery wall is an inflamed, older and sicker artery wall. This indicator of arterial inflammation predicts formation of atherosclerotic plaque and related events such as heart attack and stroke.

  Arterial wall thickness (inflammation) is more relevant than luminal flow “blockage” in predicting new and unstable plaque formation. Unstable plaque rupture is the event we experience as a heart attack or stroke. This is more likely with new homogeneous unstable plaque. It becomes less likely as plaque becomes more homogeneous/healing and is minimal when plaque is calcified/healed/stable. Proactive optimal care can heal arterial disease and make your arteries healthier and younger with less risk of disability, death or need for rescue procedures.

• Screening carotid ultrasound (CureScreen): This limited lower cost carotid ultrasound using point of care Butterfly iQ probe and system) is like a screening pap smear, mammogram or PSA to detect early cancer. If we find no disease, peace of mind is the benefit. If, however, even a little bit of arterial disease is found (like a little bit of cancer) the images can be sent for a CIMT report (see above) and then followed to make sure you are safer by following your CurePlan.

• LpPLA2 (PLAC) Test: This enzyme rises when plaque and artery walls are inflamed or “hot.” You want your arteries to be “cool.” LpPLA2 drops with a less inflammatory diet, exercise, reduced insulin resistance, supplements (niacin, and bergamot and statins. It is a fire alarm or “meat thermometer.”

• Myeloperoxidase (MPO): A rise in MPO should trigger a search for neutrophil involved inflammation, especially from the mouth. MPO indicates inflammation and erosion of the inner lining of the artery known as endothelium. A sudden rise should trigger a search for the inflammation that can cause arterial inflammation, leading to heart attack or stroke. Think of a caustic chemical spill inside your arteries. Like a skin abrasion, blood clots form and can occlude flow.

• Microalbumin/Creatinine Ratio (MACR): MACR rises most commonly when blood pressure and blood glucose are poorly controlled.  This causes dysfunction of the arterial wall endothelium, allowing albumin to leak into the urine in greater amounts. A leaky endothelium fails to protect the intima from processes that lead to inflammation. Think of it as another fire alarm.

For more information about these and other tests, go to

https://www.knowyourrisk.com/

and other information from Cleveland Heart Lab, a major source of our testing

• Haptoglobin Genotype: Your Haptoglobin genotype determines if Vitamin E offers protection or increases risk of arterial disease. In addition, individuals with the Hp 2-2 genome are more sensitive to gluten, forming an inflammatory mediator called zonulin that makes your gut “leaky” and raises the risk of autoimmune disease. 

• Insulin Resistance Testing: Optimally measured through an oral glucose tolerance test, insulin resistance (prediabetes) testing is important in identifying individuals who could be developing vascular complications before a Type 2 Diabetes diagnosis. The glucose tolerance test can identify insulin resistance long before the glucose starts to rise.

  • However, if there is other evidence of insulin resistance that does not require a visit to the lab, we can skip this step. Clues are seen in levels of nonoptimal HbA1c, glucose, triglycerides above 100, low HDL, and presence of small dense LDL (Pattern B).

    The earliest detection for insulin resistance can be measured through body composition testing. At the CureCenter, we use the InBody 570, a device that can monitor insulin resistance response to changes in diet. Reducing insulin resistance is generally healthy for everyone, regardless of risk.

• Homocysteine: Elevation increases risk of:

• Osteoporosis - bone thinning

• Atherosclerosis 

• Thrombosis (blood clotting)

• Heart Attack

• Stroke

• Dementia

• Kidney failure

• Neuropathy

Treatment is supplementation with methylated folic acid. Dietary sources of folic acid are leafy greens like spinach and kale.

This paper from the American Heart Association offers a good summary of Homocysteine.

• Coronary Artery Calcium Score (CACS): This CT scan detects mature calcified plaque in the coronary arteries. However, it can miss new noncalcified plaque. This test is not useful in monitoring therapy progress/benefit. We recommend CACS when CIMT does not reveal disease but there is still suspicion of coronary artery disease. If this test detects disease that would have otherwise been undetected, a more proactive approach to address root causes will be encouraged. Beware of the slippery slope to a stress test, stents or surgery. Coronary Calcium Score is a “loss leader”for interventional cardiology programs. Call us first before scheduling further tests.

• Home Sleep Testing and Auto Titrated CPAP: These tests have made diagnosis and management of sleep apnea more affordable and effective. Sleep apnea is a root cause of heart attack, stroke, atrial fibrillation, hypertension and heart failure. Treating it can lower your risk of these events, lower your blood pressure, and reduce arterial inflammation.

• Oral Microbiome Testing: Oral microbiome testing involves taking a sample of saliva, and analyzing it in a laboratory to identify the types of bacteria present. If high risk bacteria species are found, they can contribute to arterial inflammation. In some cases, this can affect management of periodontal disease, which contributes to heart attack and stroke risk. 

  Knowing the nature of your oral “neighborhood” can prompt a more proactive approach to your oral hygiene. If there are dangerous criminals in your neighborhood, you will be more careful to “lock your doors” and augment your security for protection. The chronic diseases affected by your oral microbiome include periodontal disease, cardiovascular disease, Type 2 Diabetes and prediabetes, and even some cancers and dementia.