Cardiometabolic disease is rampant in the United States and our current approach to treating it is broken. For years, doctors and patients have been taught that cholesterol is the underlying cause of heart disease. The American Heart Association has recommended a low-fat, low-cholesterol diet based on the guidelines of the USDA food pyramid. Unfortunately, following this pathway has led to increased obesity and diabetes, thanks to a calorie intake of mostly sugar and high glycemic carbohydrates.

The number needed to treat (NNT) to prevent one death from heart disease with primary prevention is about 1,000 for men and 5,000 for women younger than 50 years old, with price tags of $300,000 and $1.5 million, respectively.¹ Emerging evidence demonstrates that the underlying cause of cardiometabolic disease is related to insulin resistance and inflammation, especially in the gut.²

The symbiotic relationship between humans and the gut microbiome is ancient. We have co-evolved to live in peaceful coexistence with our microbiota in a mutually beneficial arrangement: When we feed the microbiota properly they help synthesize nutrients, extract extra energy from food, and modulate the immune system to maintain a state of dynamic immune tolerance. However, compelling evidence suggests that disturbances in this delicate internal ecosystem are involved in the development and perpetuation of widespread health problems ranging from metabolic syndrome, obesity, diabetes, depression, autism, Alzheimer’s, and heart disease.

Modern society’s daily consumption of processed foods in place of whole foods has caused a shift in our microbiome that most clinicians simply don’t recognize. Clinicians are not testing or treating patients based on this emerging evidence. A current hypothesis suggests that not only is there the harmful effects of sugars on dental enamel and periodontal health but acellular flours, sugars and processed foods produce an inflammatory oral microbiota that gets transported to the upper gastrointestinal tract. The allows fat to affect a “double hit” by increasing systemic absorption of lipopolysaccharide. ³

First coined by pharmaceutical companies, the mantra of “How low can you go?” when it comes to LDL cholesterol, is dead. Recent research shows there is an inverse relationship with LDL cholesterol and mortality. This finding is inconsistent with the cholesterol hypothesis (i.e., that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis.⁴ Only by understanding the complex interactions of the food we eat and, more importantly, the food our microbiota doesn’t eat, can we begin to better understand and treat the epidemic of cardiometabolic disease.

_{¹Grimes DS. Statins and Changing Number Needed to Treat (NNT). J Cardiovasc Disord. 2015; 2(3): 1018.
²Demasi M, Lustig RH, Malhotra A. The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance. Clinical Pharmacist 14 JUL 2017.
³Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2012:5 175–189
⁴Ravnskov U, et al. Lack of an association or an inverse association between low-density- lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open 2016;6:e010401. doi:10.1136/bmjopen-2015-010401}

	About Todd R. LePine, MD Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine, and has advanced clinical training through the Institute for Functional Medicine. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 15 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include Optimal Aging, Bio-Detoxification, Functional Gastrointestinal Health, Systemic Inflammation, Autoimmune disorders and the Neurobiology of mood and cognitive disorders. Dr. LePine teaches around the world, and has given lectures to doctors and patients at American College for the Advancement in Medicine; Age Management Medicine Group, Whole Foods Market; and The Kripalu Center in Lenox, MA. Dr. LePine is the current Clinical Medical Director for Metametrix Laboratories, where he teaches physicians the clinical application of advanced biochemical laboratory testing. He enjoys skiing, kayaking, hiking, camping and golfing in the beautiful Berkshires, and is a fitness enthusiast.

Join Dr. Todd R. LePine at the upcoming Crossroads of Cardiovascular Care Conference.