The Problem

According to the American Heart Association, more than 910,000 Americans still die of heart disease annually.  And more than 70 million Americans live every day with some form of heart disease which can include high blood pressure, cardiovascular disease, stroke, angina (chest pain), heart attack and congenital heart defects.

The Myth

“Being overweight or obese increases your risk of developing a heart attack.”

Pop Quiz

What are the major risk factors for developing a heart attack?

  • Tobacco Use?  –  Yes
  • High Blood Pressure?  –  Yes
  • Diabetes Mellitus?  –  Yes
  • Obesity?  –  NO

Yes that’s correct, obesity is not a risk factor for developing heart disease.  Studies consistently DO NOT show an association of obesity with an increased risk of heart attacks.

An example can be found in a recent analysis of over 220,000 individuals.  This study, like many others, failed to find an association between increased heart disease risk and weight as measured by BMI (body mass index).  Unlike obesity, smoking history, blood pressure and blood sugar levels are the most important markers in determining the risk of heart disease.

Risk Factors for Heart Disease

A risk factor for a disease is a condition that if improved, decreases the severity of the disease or the likelihood the disease will occur.  If improving the condition does not change the disease, it’s not a risk factor for getting the disease. 

As I have discussed before, heart disease is triggered by the inflammation caused from insulin resistance.  Furthermore, insulin resistance is caused in most Americans by the quantity of carbohydrates (processed and non-processed sugars and starches) they consume.

carbs -> insulin resist. -> inflammation -> heart disease and attacks

Since carbohydrates are the driving force of heart disease and heart attacks, how come conditions such as tobacco, diabetes and high blood pressure seem to make things worse? 

Tobacco is easy to explain because many studies have demonstrated that the chemical ingredients in tobacco also worsen the inflammation in blood vessels that leads to heart attacks.  Smoking increases the risk of heart disease and not smoking lessens the risk of heart disease.  This process is independent of carbohydrate intake and insulin resistance.

tobacco -> inflammation -> heart disease and attacks

Diabetes and high blood pressure are both caused by insulin resistance thus making them a symptom of the underlying disease process. If there were no insulin resistance, there would be no diabetes or high blood pressure (at least most high blood pressure, some is caused by kidney disease independent of insulin resistance).

carbs -> insulin resist. -> diabetes

carbs -> insulin resist. -> high blood pressure

On the other hand, diabetes and high blood pressure seem to increase the risk of heart disease when they are uncontrolled.  The elevation of blood sugar/insulin levels and blood pressure have a direct, damaging effect on blood vessels that directly increases the likelihood of having a heart attack. 

carbs -> insulin resist -> incr. blood pressure -> blood vessel damage ->heart disease

carbs -> insulin resist -> incr. sugar/insulin levels -> blood vessel damage ->heart disease

The direct metabolic effects of elevated blood pressure and elevated blood sugar/insulin levels on the outcome of heart disease is what qualifies high blood pressure and diabetes as risk factors.

Obesity is Not a Risk Factor for Heart Disease

As I said earlier, a risk factor for a disease is a condition that if improved, decreases the severity of the disease or the likelihood the disease will occur.  If avoiding or improving the condition does not change the disease, it’s not a risk factor.

On the other hand, if the condition is just statistically associated with the disease but doesn’t influence the likelihood of getting the disease; it may just be a symptom of an underlying process that causes the disease in question.

For example, lighting matches (to light one’s cigarette) may be associated with heart attacks but if one switches from matches to butane lighters, the incidence of heart attacks will not change.  The acting of frequently lighting cigarettes with anything is just a symptom of people who smoke cigarettes.  The risk factor is the tobacco in the cigarette.

As I have written about before, obesity occurs from excessively high insulin levels, and these high insulin levels are a consequence of the consumption of carbohydrates beyond an individual’s metabolic tolerance.  

If someone is obese, they simply are demonstrating that their genetic make-up causes them to store excess fat when their insulin levels are too high.  This doesn’t mean anything in regard to increasing their risk for heart disease.

carbs -> elevated insulin levels -> increase fat mass (in the genetically prone)

Many people can consume carbohydrates beyond their metabolic tolerance but don’t store it as fat.  These people are genetically different.  Instead of creating fat, their excessive carbohydrate intake results in a more rapid onset of insulin resistance, diabetes, high blood pressure ultimately heart disease without the development of obesity.

In other words, obesity is just a visible symptom of excessive carbohydrate intake.  It’s not the cause of heart disease or diabetes or high blood pressure; it’s a symptom of elevated insulin levels arising from carbohydrate excess.  Since it does not make heart disease more or less likely, it is not a risk factor.

Both diabetes and high blood pressure are invisible symptoms of excessive carbohydrate intake but if left uncontrolled they can also contribute to the process that results in a heart attack.  Since they both can contribute to the disease process they are considered risk factors.

The Protective Effect of Obesity

Storing excess carbohydrate energy (in the form of triglycerides) in fat tissue delays the onset of insulin resistance.  This protective effect of obesity has been shown in studies looking at Pima Indians and Hispanic populations.  Women in these populations often become obese before their husbands but the husbands often develop diabetes and high blood pressure before the women.

Several studies of patients with known heart disease (here is an example) have shown the obesity seems to even lessen the risk of death when compared to normal weight individuals with known heart disease.

Additional studies show that being obese or overweight actually lessens the chance of having a heart attack if you have other serious illnesses such as kidney failure .

The major point here is that although many people who have heart attacks are overweight or obese, their weight was not the cause of the heart attack.  It is just a symptom of their genetic propensity to store fat when eating too many carbohydrtaes.

I’m Not Saying Obesity Is Harmless

Obesity may not associated with heart disease but it is still associated with an increased risk of gallbladder disease, certain cancers and arthritis.

Although these are important in their own right, if we are concerned about reducing the death and disability from heart disease, the single greatest killer of all Americans, we should be focused on reducing our carbohydrate intake, not trying to lose weight.

The Target Is Carbohydrate Reduction, Not Weight Reduction

If you have heart disease, high blood pressure, diabetes or a family history of early heart disease and you want to minimize your chances of having a heart attack, you need to focus on reducing the carbohydrates in your diet.  This is very different than focusing on losing weight.

Reduced carbs -> decr.insulin resist. -> decr. inflammation -> lessens risk of heart disease

Placing the focus on carbohydrate reduction eliminates the problem of wrestling with the sensation of hunger when trying to reduce your heart attack risk. 

If you feel hungry then eat, just don’t reach for a high carbohydrate food when you do.  Feed your hunger with meat, cheese, eggs and low carbohydrate vegetables.

Focusing on eating fewer carbs is much less daunting than trying not to simply eat less when hungry and will result in a significant reduction in your risk of heart disease.

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Patrick Nemechek, D.O.

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