Just like that, another dogma is reversed. I learned way back in pharmacy school that low dose aspirin, while not free of risk, was a good way to prevent cardiovascular risk. I even remember the Costco sized bottle of 81mg aspirin I took daily – in my late 20s!
I learned enough to become a pharmacist, but was still clueless on the effects of dogma and group think.
Cardiovascular disease is a major killer. Among the contributors identified is an excess of clotting, leading to blockages. This is what aspirin is after. It can irreversibly bind to platelets (which live about 7 days) so they cannot take part in the clotting cascade. By advocating a lower dose, typically less than 100mg, the theory was downgrading the clotting response could help prevent events where clotting is contributory.
We took this advice as a given. There were precautions surrounding gastrointestinal (GI) bleeding concerns, especially with any history of ulcers, but the number of low
The new guidelines now recommend against taking aspirin for primary prevention in most cases. It may be used in some active treatment
Cause of Excess Clotting
We have an identified problem, excessive clotting. Aside from some rare disorders, we are missing what can precipitate excessive clotting for such a large percentage of the population
The guidelines came close to providing information on the
T2DM (Type 2 Diabetes) remains a highly prevalent disease and a major ASCVD risk factor. An aggressive, comprehensive approach to ASCVD risk factor treatment in adults with T2DM reduces ASCVD events. Management of cholesterol and hypertension in adults with T2DM is discussed in the relevant sections of the present guideline.2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease2
Cholesterol as a causative agent in ASCVD is controversial. It plays a role, but not singularly causal for most cases. Certain types of cholesterol-carrying proteins Lp(a), apoB, and various presentations of these lipoproteins (sugar modified and altered structure (small dense LDL) are relevant in cardiovascular disease – but these tend to be effects rather than causes. Lp(a) is a fascinating topic for another day, and I recommend having that measured and monitored. Interestingly, it precipitates increased clotting activity, so there is an angle for this lipoprotein to cause excess clotting.
Now we are getting somewhere! I can almost smell a real cause!
Hyperglycemia and Hyperinsulinemia Cause Excess Clotting
High blood sugars from dietary carbohydrates cause an increased insulin response to transport glucose from the bloodstream into cells. When the cells are full, we ignore the insulin signals, resulting in more insulin production to get that glucose out of the blood. This is insulin resistance (and resultant hyperinsulinemia), caused by too many net carbohydrates.
As I wrote about in my detailed whitepaper, Avoiding Insulin in Type 2 Diabetes, insulin impacts many biological signaling pathways – and they are NOT consequence free.
On our topic:
present data strongly suggest that hyperglycemia due to insulin resistance renders the patient more susceptible to thrombotic events by an insulin-driven impairment of fibrinolysis and a glucose-driven activation of coagulation3.
It isn’t just one article, there are lots more asserting the same finding.
Here is the first takeaway, we can reduce our clotting propensity thru diet! This is
Your Fork in the Road
You have a choice, follow the dogma or retake control. Getting exercise and avoiding tobacco are easy recommendations. But let’s look at the current recommendation for diet (2 clips from the guidelines):
“All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.”
“A diet high in fruits, vegetables, and whole grains
This is not all bad. Yes, avoid refined carbohydrates and sweetened beverages. However, if you follow these recommendations to a T, your blood sugar and insulin response will continue on the same march toward diabetes and ASCVD.
I exposed this recommendation here before, but vegetable oils are trash and will do more to precipitate ASCVD than almost any other single indiscretion. Canola (and similar oils) set off a pronounced oxidative reaction (think rust) in the vasculature. Oxidation leads to inflammation, and both damage cholesterol (LDL is considered and antioxidant). Just throw them out and avoid at all costs.
I also debunked the low salt charade previously. Unfortunately, this advice is dead wrong and precipitates the things we are trying to avoid.
When you don’t have enough salt, it activates a process called the Renin-Angiotensin-Aldosterone (RAS) system. Besides constriction blood vessels causing high blood pressure, it increases CLOTTING! Guess what? It is this same system we prescribe common medications called ACE inhibitor s (lisinopril) and Angiotensin Receptor Blockers (losartan) for – to the tune of millions of prescriptions annually.
You read that right: restrict salt, activate RAS, prescribe medication to block RAS. Pass the salt, please.
Here is another.
SODIUM RESTRICTION INCREASES INSULIN RESISTANCE.
When you start restricting your salt intake, your body will do anything to try to hold on to it. Unfortunately, one of the body’s defense mechanisms is to increase insulin levels. It does this by creating a state of insulin resistance. When insulin resistance kicks in, the body is less able to shuttle glucose into cells, and it needs to secrete more insulin in order to control blood glucose levels. Also, remember that when a person’s intake of dietary salt is on the paltry side, hormones that compensate to help the body retain salt (such as renin, angiotensin, and aldosterone) are released in greater amounts. Well, these hormones end up increasing fat absorption, too. In essence, compared to someone who hasn’t slashed his or her salt intake, a low-salt diet may cause you to absorb twice as much fat for every gram you consume.The Salt Fix: Why the Experts Got It All Wrong–and How Eating More Might Save Your Life4
Seriously, can this advice get any worse?
Red Meats / Saturated Fats
Quality pasture raised,
The guidelines advocate poultry, without specifying how they were raised and fed. This is not an ideal food source.
Whole grains will raise your blood sugar, just slightly less than processed grains. Slightly.
|FOOD||Glycemic index (glucose = 100)|
|White wheat bread*||75 ± 2|
|Whole wheat/whole meal bread||74 ± 27|
The whole part of these grains is the protecting shell around the grain, its job is to defend the seed via its lectins. These lectins precipitate immune responses in anything trying to eat it, including us. Many people are sensitive to lectins. Further, these lectins can precipitate a host of other problems such as gallbladder disease.
A Better Path
A diet full of
There is a better way. Please reach out if you want assistance
- James DiNicolantonio, The Salt Fix: Why the Experts Got It All Wrong–and How Eating More Might Save Your Life, loc. 1727