cardiovascular diseases

How much exercise is optimal to slow cardiovascular aging?

In general, exercising two to three times a week through walking, running, cycling or sports keeps our blood vessels young.

From four to five sessions, the heart also remains youthful, according to recent general research. This knowledge helps develop exercise programs that combat aging.

Arteries

As people age, the arteries that carry blood in and out of the heart can become stiffer. This can increase the risk of cardiovascular disease.

While any form of exercise reduces the risk of death from heart problems, recent research shows that it matters to arteries how often a person moves per week.

Exercising two to three times a week for 30 minutes may be enough to counteract the stiffening of medium-sized arteries.

However, training four to five times a week is required to keep even the larger central arteries youthful.

The recent general survey

The aforementioned study, called "Movement history under the microscope, was published in The Journal of Physiology [1].

To arrive at the findings mentioned above, the researchers conducted a cross-sectional study of 102 people aged 60 years and older whose exercise history was known. Detailed information was collected from all participants about the degree of arterial stiffness.

Participants were then divided into four groups:

1. People with sedentary lifestyles: exercise less than twice a week.
2. Relaxed movers: two to three workouts per week.
3. Serious athletes: four to five workouts weekly.
4. Athletes: exercise six to seven times each week.

The duration of a training session was at least thirty minutes.

"Exercising four to five times helps heart rate"

The research team concluded that two to three exercise sessions a week resulted in younger, less stiff medium-sized arteries. These are the arteries that carry oxygen-rich blood to the head and neck.

However, people who exercised four to five times a week also had more younger, larger central arteries. These are the arteries that supply oxygen to the abdomen and chest (including the heart).

Research limitations.

The researchers also mentioned the limitations of their study:

the individuals were classified by the number of past workouts and not by intensity, duration (except at least thirty minutes per session) or mode of exercise which can all have a major impact on the cardiovascular system.

Furthermore, they had also not included the participants' dietary habits and social background.

Developing exercise programs

The researchers are committed to continuing this study:

"The outcomes offer us the opportunity to develop exercise programs to keep the heart young and even turn back time for older cardiovascular patients." [2]

A new study, regarding orthomolecular lifestyle tips, focuses on a two-year workout of middle-aged men and women, with and without risk factors for cardiovascular disease.

The survey includes a cross-section of the total population through sampling.

Orthomolecular lifestyle tips for good cholesterol

There has been a lot of talk for some time about treating elevated cholesterol with statins (=cholesterol-lowering drugs or inhibitors).

But what exactly is cholesterol? Is there such a thing as "good" and "bad" cholesterol? How unfavorable is elevated cholesterol anyway? And can we do without statins? We have listed our most important lifestyle tips for you.

• Cholesterol is a lipid, more specifically a sterol compound. That sterol compound is an extremely important substance for the body: in fact, it is the building block for all steroid hormones (such as estrogen and testosterone) and for vitamin D production in the body. In addition, it plays a role in the integrity and fluidity of cell membranes.
• In addition, the body uses cholesterol to produce bile acid salts that are important for fat digestion in the small intestine.
• Also, research shows that cholesterol can be a repair agent in case of damage and that it can neutralize bacteria, viruses and toxins and along this pathway reduce endotoxemia (= toxic substances) in the blood (Ravnskov, 2003). Endotoxemia is a source of inflammation, and it is becoming increasingly clear that inflammation is at the root of numerous diseases of affluence, including cardiovascular disease (Muskiet, 2011). In our evolutionary past, we had more to contend with inflammation and infection; in resolving these, cholesterol had an important role to play.
• If we look at our current living conditions, we see that in recent decades the risk of infection due to bacteria and viruses has greatly decreased although the current Covid 19 virus has now made its entrance. However, diet, exercise and stress have also changed greatly. That we suffer from cholesterol problems today does not make cholesterol the culprit so much as the evolutionary mismatch that has occurred as a result of our changed lifestyle. Therefore, it would be wiser to identify the current lifestyle as the culprit and take appropriate action on it.

Different types of cholesterol

Cholesterol is mainly produced in the liver and we get it through our diet. Rich sources of cholesterol include eggs, cheese, full-fat yogurt, shrimp and (organ) meat. In recent decades, there has been much discussion about foods high in cholesterol and saturated fats.

In the blood one finds 4 cholesterol types, mainly bound to protein fraction (lipoprotein):

• the HDL-
• IDL-,
• LDL and
• VLDL cholesterol.

The first letters in these compositions stand for, respectively:

• High,
• Intermediate,
• Low and
• Very Low.

The D stands for "Density," and this says something about the ratio of "protein" to lipids (=fats) in the lipoprotein.

The less protein, the less density.

So the different lipoproteins are all slightly different and therefore all have slightly different functions.

Below we discuss two commonly discussed types of cholesterol:

1. HDL and
2. LDL cholesterol,

which popularly and in the media have quickly come to be called "good" and "bad" cholesterol.

This is a simplification that is only partially illuminating; in fact, under normal circumstances, both forms of cholesterol are essential for normal functioning of our bodies (and minds) and thus are not "good" or "bad. However, it is true that the ratio of total cholesterol to HDL says something about the risk of cardiovascular disease and that under certain circumstances LDL can cause plaque in the blood vessels (= cause clogged veins).

Overproduction of LDL (=oxidized LDL cholesterol) can trigger an inflammatory reaction. It is this inflammatory reaction (and not the cholesterol itself) that we could call "bad" because it is associated with cardiovascular disease. Prolonged stress causes oxidation of LDL and is thus an example of this.

Functions HDL and LDL

HDL and LDL are lipoproteins that transport cholesterol and triglycerides through the blood.

LDL is high in cholesterol and low in protein and transports cholesterol from the liver to the tissues.

The protein-rich HDL actually returns cholesterol to the liver.

In the liver, the remaining cholesterol is used to produce bile acid salts. The body controls cholesterol levels itself through biological feedback mechanisms.

"If a lot of cholesterol comes in through the diet, the body's own production goes down. If little comes in, production goes up again."

Excess cholesterol is excreted under normal conditions (=under physiological conditions) because it cannot be converted into energy.

Thus, cholesterol levels have a homeostatic balance; production goes down or up under normal conditions until the body can meet its needs as economically as possible. In this way, the body can put the released energy into other important processes.

When is elevated LDL value?

There may be elevated LDL levels because the cells and tissues need extra cholesterol. An example is because there is a situation with (a lot of) stress and/or endotoxemia in the bloodstream.

Increased LDL is then a physiological response of our body, to produce more cortisol, or address the endotoxemia.

LDL contains a relatively large amount of fat and therefore easily sticks to the edge of blood vessels. In principle, if blood vessels are smooth (comparable to the inside of a garden hose), LDL cannot stick.

When do problems arise, especially atherosclerosis?

Damage to the vessel wall can occur, for example, from increased homocysteine levels in the blood, as well as from low-grade inflammation. To these ragged blood vessels, LDL can easily stick and then oxidize. This leads to an inflammatory reaction in which monocytes produce foam cells. In this way, the vessel wall thickens, eventually leading to atherosclerosis.

Association with cardiovascular disease

Especially since 1985, consumption of saturated fat, cholesterol and of "dietary fat" in general has been associated with cardiovascular disease (Keys, 1953). This is still the predominant view.

For example, the Nutrition Center indicates on its website that saturated fat increases the "bad" LDL cholesterol in the blood and that this is not good for blood vessels. They therefore recommend replacing saturated fat with polyunsaturated fatty acids as much as possible (Nutrition Center).

Of course: polyunsaturated fatty acids have a beneficial effect on the heart and blood vessels. However, the question is whether saturated fat and elevated cholesterol levels lead to cardiovascular disease.

For example, a large-scale review shows that elevated LDL cholesterol levels do not shorten lifespan in the elderly. On the contrary, elevated LDL is often associated with a longer lifespan (Ravnskov, 2016).

In doing so, much research shows that dietary cholesterol has little effect on cholesterol levels in the body. For example, population studies show that there is no association between dietary cholesterol and heart disease in the population (Lecerf et al., 2011).

In fact, two-thirds of those surveyed saw little to no increase in cholesterol levels after consuming cholesterol-rich foods, even at very large amounts (Blesso et al., 2018).

In fact, there is research showing that dietary cholesterol actually has a beneficial effect on the LDL-HDL ratio in the blood. This ratio is considered the best indicator of cardiovascular disease risk (Ali et al., 2012).

Also, research from Kuopio University in Finland, among 1,000 men and with a study duration of 21 years, showed that consuming large amounts of cholesterol is not related to the risk of cardiovascular disease (Virtanen et al., 2016). This outcome holds true at least up to an intake of 520 mg of cholesterol per day.

Eggs then?

Even when looking specifically at egg consumption, it did not appear to carry an increased risk of cardiovascular disease. This outcome holds true at least up to an intake of seven eggs per week, the highest number eaten on average within the group.

Also, there appeared to be no association between dietary cholesterol and thickening of the carotid artery. Wall thickness in this vein is a marker for subclinical atherosclerosis. Thus, eggs also do not increase the risk of arteriosclerosis.

Statins or red yeast rice?

Statins lower LDL cholesterol and are therefore widely used for elevated cholesterol levels with the goal of treating cardiovascular disease.

Statins, however, have unpleasant side effects.

Our lecturer Remko Kuipers, a cardiologist at the OLVG, therefore advocated in the past for more independent research on statins. A possible short-term alternative is red yeast rice.

Red yeast rice alternative to statins?

Red yeast rice, thanks to monacolin K, contributes to the maintenance of normal cholesterol levels in the blood. It has similar effects to statins but is of natural origin.

In addition to regulation of LDL cholesterol, lowering homocysteine levels and reducing short-term oxidation of LDL are also indicated because they contribute to the development of inflammation and atherosclerosis. Vitamin B6, B12 and folic acid are beneficial for homocysteine metabolism. For the long term, however, lifestyle changes are always necessary.

Ultimate solution of cholesterol problems

Major causes of increased cholesterol production are stress and insulin resistance.

Insulin resistance results in less glucose being absorbed into cells and consequently more glucose being converted into fat. Fat is the building material of cholesterol.

More fat storage in the body means increased production of cholesterol.

Excessively growing adipose tissue is more easily damaged, and as a result of this damage, inflammation occurs in the adipose tissue.

As adipose tissue continues to grow, these inflammations increase and spread throughout the body. In response, cholesterol production goes up further; after all, one of the functions of cholesterol is to fight infections. Reducing insulin resistance has a beneficial effect on cholesterol production.

Eating fewer carbohydrates results in less glucose entering the blood, reducing the need to produce insulin and decreasing insulin resistance. In addition, less glucose is converted into fat, which can reduce fat tissue.

Eating unprocessed foods has the added benefit of reducing the amount of substances that are unfavorable to our bodies, which can reduce inflammation and reduce pressure on the liver's detoxification capacity. As a result, the liver can better perform its role in regulating cholesterol.

In addition to dietary modification, reduction of meal frequency and sober exercise also have beneficial effects on insulin resistance.

Stress leads to the release of the hormone cortisol. This is a steroid hormone: its basis is cholesterol.

With increased stress, there is an increased demand for cortisol and more cholesterol is needed to meet the production of cortisol. Thus, this leads to increased cholesterol levels.

Stress reduction by seeking more relaxation and applying relaxation techniques such as mindfulness or yoga reduces the production of cholesterol. The ultimate solution to stress problems is, of course, to remove or deal with the stressor differently. The text/context meta-model gives you guidance in this regard.

Thus, the ultimate solution to cholesterol problems lies in addressing the main causes of cholesterol elevation, insulin resistance and stress, using lifestyle interventions.

The quick win, employing red yeast rice (or statins if necessary), is an aid to achieving the ultimate solution. Thus, you have a total intervention that allows you to contribute to the health of yourself, or if you are a healthcare professional, your clients, and thus to a healthier world.

Sources
[1] (Ravnskov, 2003) U. Ravnskov, High cholesterol may protect against infections and atherosclerosis. QJM: An International Journal of Medicine, Volume 96, Issue 12, December 1, 2003, Pages 927-934.
[2] (Muskiet, 2011) F.A.J. Muskiet (2011). The evolutionary background, cause and consequences of chronic systemic low grade inflammation; significance for clinical chemistry. Ned Tijdschr Klin Chem Labgeneesk 2011, vol. 36, no. 4.
[3] (Keys, 1953) Keys A. Atherosclerosis: a problem in newer public health. J Mt Sinai Hosp N Y 1953; 20; 1: 18-39. More information: https://www.sevencountriesstudy.com
[4] (Nutrition Center, coconut fat) https://www.voedingscentrum.nl/encyclopedie/verzadigd-vet.aspx and https://www.voedingscentrum.nl/encyclopedie/kokos-en-kokosvet.aspx
[5] (Ravnskov, 2016) Uffe Ravnskov, David M Diamond, Rokura Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Aseem Malhotra, Luca Mascitelli, Kilmer S McCully, Yoichi Ogushi, Harumi Okuyama, Paul J Rosch, Tore Schersten, Sherif Sultan, Ralf Sundberg, 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
[6] (Lecerf et al., 2011) Lecerf JM, de Lorgeril M., Dietary cholesterol: from physiology to cardiovascular risk, Br J Nutr. 2011 Jul;106(1):6-14. doi: 10.1017/S0007114511000237. Epub 2011 Mar 9.