*Addendum at bottom of article*
“Former athlete in great shape has shocking heart attack at age 30.” We often see headlining stories of people who have unfortunate heart attacks despite doing all the right things. Or were they?… If we are finding so many exceptions, I think it’s time to question the conventional thinking on the matter.
This is the same phenomenon that allows your friend to stay thin while you gain weight with the same food and exercise regiments. When the diet is poor (although one might not be putting on weight) I would argue that that person is doing as much damage if not more to their body than the person putting on weight.
Heart Disease (CVD) belongs to a family of diseases that are thought to be caused by (or at least greatly increased risk of occurring when) having something called Metabolic Syndrome. The other major disease related to Metabolic Syndrome is Type 2 Diabetes. A small group of MDs around the world are ushering in a new and better approach to managing Type 2 Diabetes and CVD. Studies are showing that these 2 diseases are something we can almost eliminate entirely by just focusing on preventing Metabolic Syndrome. The CVD referenced in this post will be the type where damage to our arteries has been caused by eating and exercise habits. We will be ignoring other branches caused by birth abnormalities in the vascular system.
[DISCLAIMER: I’m not a doctor, nor do I play one on the Internet. Speak with a medical professional before doing anything medical-related, m’kay?] 
Type 2 Diabetes
Definition – “With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn’t produce enough insulin to maintain a normal glucose level.”  http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/basics/definition/con-20031902
Glucose is a fuel source for cells in the body, but the cells only need, and can only store so much. The liver and skeletal muscle are the two main storage areas for glucose in the body. If you are regularly having meals that create more glucose than your body currently needs, you can get two different reactions:
- Your body has had it’s fill of glucose in both the liver and skeletal muscle and starts to create subcutaneous fat (fat beneath the skin) with the excess energy. This can be seen in the diagram below and is arguably a healthy response to excess glucose in the blood. Subcutaneous fat is the body’s way of storing energy for later.
- Your body could be predisposed to preventing subcutaneous fat from being created. In this case the cells might push back on the extra glucose by developing insulin resistance. In this case the body is not relieving the stress of extra glucose through converting it into fat. Instead the cells are refusing the insulin signalling to take in the glucose.
Insulin resistance can result in too much glucose in the bloodstream. This is a condition known as hyperglycemia and is actually toxic for us. Long term hyperglycemia leads to damaging of the eyes, kidneys, nerves, and the arteries. The damaging of the arteries specifically is what leads to Heart Disease (CVD).
Normally when we develop insulin resistance (Type 2 Diabetes), we supplement with insulin injections, which effectively forces the glucose into the cells. These are the same cells that were pushing back the glucose supply because there was too much. You might already see the flaw in this approach. We are back to putting excess energy into the cells, the problem that developed the insulin resistance in the first place. If there is no dietary or exercise intervention, the cells will become more resistant and the injected insulin dose will need to be increased. Without dietary intervention or exercise intervention, this story does not end well.
In the American population in 2012 “8.1 million were undiagnosed” with Type 2 Diabetes. – American Diabetes Association
In the second reaction type listed above, insulin resistance can carry on undiagnosed due to no physical change in healthy appearance. Heart Disease may be fast tracked in development under these conditions. The person may be active enough and showing no signs of weight gain, however insulin resistance can, and in certain people does start before the weight gain occurs. This means that long term hyperglycemia is occurring undetected and therefore untreated with insulin, leading to CVD, Stroke, and other diseases.
Heart Disease (CVD)
Definition – “ Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.” – http://www.mayoclinic.org/diseases-conditions/heart-disease/basics/definition/con-20034056
At this point you might be thinking, “Hey, I thought fat is what causes clogging of the arteries?” And you would not be wrong for thinking that way, because that is what many physicians and the media have been saying for years. This is also a partial truth in that bad fats (triglycerides) accumulating in the blood are correlated with CVD. The incorrectness is how this bad fat accumulates in the blood. It’s not by eating fatty acids.
“Eight studies have shown that people with stroke have eaten less saturated fat than healthy people,” he says. “And no dietary study has succeeded in lowering heart disease deaths by reducing intake of saturated fat.” – Swedish researcher Uffe Ravnskov, MD, PhD.
To give a brief summary; bad cholesterol in the blood (triglycerides) has been correlated with carbohydrate consumption and not saturated fat. No study has shown any statistically significant increase to CVD caused by saturated fat consumption. Many studies have proven that high fat, low carb diets increases good cholesterol (HDL) while lowering bad cholesterol (triglycerides), effectively lowering the risk of CVD.
Metabolic Syndrome – “is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.” and many other diseases 
The American Heart Association defines Metabolic Syndrome for clinical diagnosis by having 3 out of 5 of the following criteria: 
- Elevated waist circumference:
- Men — greater than 40 inches (102 cm)
- Women — greater than 35 inches (88 cm)
- Elevated triglycerides: Equal to or greater than 150 mg/dL (1.7 mmol/L)
- Reduced HDL (“good”) cholesterol:
- Men — Less than 40 mg/dL (1.03 mmol/L)
- Women — Less than 50 mg/dL (1.29 mmol/L)
- Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension
- Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia
As the diagram above shows, waist circumference is sometimes thrown off by someone’s predisposition to putting on subcutaneous fat. This diagnostic measurement is used only because the more accurate measurement of a DXA, MRI, or CT scan for visceral fat is not clinically feasible currently. 
We can still take action however, to prevent Metabolic Syndrome while almost entirely avoiding, Type 2 Diabetes, Heart Disease (CVD), Stroke, and many other metabolic related diseases. Anyone interested in preventing any of these diseases should focus on dietary changes to prevent Metabolic Syndrome. It is the lead domino that will get you the most significant changes in disease prevention. If you only do one thing for your health, this should be it. If that does not motivate you, it is also the best way to lose unwanted fat.
Obesity Risk Factor
“Obesity. Carrying too much weight increases your risk of metabolic syndrome — particularly if you have an apple shape rather than a pear shape.” – Mayo Clinic
As mentioned earlier, lean people might be at a higher risk due to no visual warning signs of their predisposition to metabolic diseases. People are constantly surprised that fit and “healthy” people are having heart attacks. This is not a surprise to me because I know what leads to heart attacks.
“You can’t out train a poor diet.”
We need to change the conversation. We need to stop using body fat as a single visual indicator of whether we are healthy or not. It ultimately comes down to the actual reason you are skinny and not that being so equates to good health. If you eat like a carbohydrate devouring glutton, because you stay skinny no matter what, chances are you have a false sense of your personal health risks.
The only way to be sure is to measure our tolerances when it comes to fueling our bodies. Dealing with personal carbohydrate tolerance levels on an individual basis and ensuring we are not straining ourselves in excess.
“Are you skinny because you are healthy or are you unhealthy because you are skinny?”
If unsure, to find out the difference you should get checked for the above mentioned criteria for Metabolic Syndrome. Stay informed, and stay healthy.
Since reviewing an article (When does heart disease begin) written by Dr Peter Attia, I have since slightly changed views on the cause of heart disease in a small way that is worth noting. I still believe we cause Type 2 Diabetes but when it comes to Heart Disease, the title of this post is disingenuous as I now believe Heart Disease is a degenerative condition heavily correlated with old age. That being said I believe we can slow it down or speed it up greatly based on dietary and lifestyle decisions and that metabolic health should still be the main focus of nutrition.
Click for References:
- The Lean Gene – http://www.diabetes.co.uk/news/2011/Jun/gene-could-mean-thin-people-are-less-healthy,-says-study-94667050.html
- The A TO Z Weight Loss Study: A Randomized Trial –http://jama.jamanetwork.com/article.aspx?articleid=205916
- Study comparing Low Carb (High fat) diet to Low Fat Diet. – http://press.endocrine.org/doi/10.1210/jc.2002-021480?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
- A Randomized Trial of a Low-Carbohydrate Diet for Obesity – http://www.nejm.org/doi/full/10.1056/NEJMoa022207
- NHLBI/AHA Conference Proceedings – Definition of Metabolic Syndrome – http://circ.ahajournals.org/content/109/3/433.full.pdf
- Mayo Clinic’s Metabolic Syndrome Page – http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/basics/risk-factors/con-20027243
- A Big Fat Mistake – https://experiencelife.com/article/a-big-fat-mistake/
- Practical and Technical Advantages of DXA Visceral Fat Assessment Compared with Computed Tomography –http://www.hologic.com/sites/default/files/white-papers/WP_00062_Visceral_Fat_06-12.pdf
- Tim Ferriss Blog
Note: If you read something in this article that you whole heartily disagree with based on scientific empirical evidence, please share it with me here. I’m always interested in appending and updating my information to be as accurate as possible for my readers.
Also contact me if there is anything you would like me to expand on or write about as it applies to your personal situations.