By Randolph Ice PT, CCS
As athletes, it’s easy to believe that we are immune to heart disease because of how much we exercise and our resulting physical fitness. But recent studies have shown that even fit cyclists can have as much atherosclerosis (hardening of the arteries) as their less active peers.
In 1974 I founded the SCOR Cardiac Cyclists Club to assist with a research grant our hospital had received from the NIH to determine what were the factors that contributed to heart attacks in men between the ages of 40 and 50 years old, “premature” atherosclerosis as it was referred to. The SCOR (Specialized Centers of Research) grant to Rancho Los Amigos Hospital was for five years and recruited 100 men to be placed into a randomized low cholesterol, low saturated fat diet and a low or high intensity exercise program. Coronary angiography was performed on all men prior to entering the study and my role was to establish and keep these men complying with the exercise program.
I was a newly minted PT and this hospital was considered the “Mecca” for PT’s in the early 70s. There were only a total of three hospitals offering Cardiac Rehabilitation Services in all of Southern California at that time and I was lucky enough to go to work at Rancho in 1972.
The men in the “SCOR program” would exercise once/week in a group setting in our PT clinic at Rancho, attend lectures on various heart disease topics and were asked to exercise at home at least two to three times per week. I started the SCOR cycling club on Saturdays as a way of promoting compliance to the exercise portion of the research project while a PT partner of mine started a weekend SCOR Jogging Club for the same purpose for those who did not want to ride a bike (can’t imagine why!).
A complete risk factor analysis including lipids and a glucose tolerance test was done initially, at 18 months and five years into the study along with repeat angiography to examine whose arteries showed progression of disease and whose who did not. A statistical analysis of all their risk factors and blood chemistries was done to correlate what contributed to coronary artery disease progression.
To make a long story short only three factors determined progression of coronary atherosclerosis:
- Continued Smoking – This was huge
- Abnormal Glucose Tolerance Testing – What we would currently call pre-diabetes, insulin resistance or Type II diabetes
- Exercise compliance
Cholesterol, HDL and LDL were not correlated whatsoever. At that time I was a brainwashed PT who was told by all the cardiologists I trained with that “cholesterol” causes heart disease. I even (briefly) switched to drinking non-fat milk and gave up eggs for Egg Beaters in the 1970s. Ugh!! I gave that up after a few months.
The Lipid Theory of Atherosclerosis
By the early 1980s I had treated hundreds of coronary patients in different Cardiac Rehabilitation programs and could see the “Lipid Theory of Atherosclerosis” was not valid as other studies from around the world confirmed our findings at Rancho Los Amigos Hospital where I worked for nine years. That was the beginning of my cholesterol skepticism, which has only been confirmed many times over in the ensuing 40 years.
I am a devotee of the Weston Price Foundation’s Wise Traditions way of eating, which is how I was raised by my farm born and raised parents. If you have never heard of Weston Price DDS, here is his website. This eating program is pretty much just the opposite of the American Heart Associations recommendations, which in my opinion have been a disaster to the American public’s health. Despite 60 years of low cholesterol, low saturated fat propaganda put out by the AHA, Big Pharma and Academia heart disease remains the number one cause of death for the last 60 years! Gee, maybe it’s time for a different approach to prevention.
Unfortunately, by the mid-1980s the first statin drug studies emerged claiming lowering LDL cholesterol reduced cardiovascular death rates in those who previously had a heart attack by “20 to 25 percent.” Well, that is a relative risk reduction. When I read the Scandinavian Simvastatin Survival Study (4S Study) in detail which was published in 1984, the actual absolute risk reduction between the statin and placebo groups was “0.8 percent per year” over a five year period.
Really? That’s it??
Buried in the details was the fact that this miniscule change was evenly spread out amongst all levels of initial blood cholesterol levels. Also not reported too loudly was that there was no difference in subsequent second heart attacks nor strokes in either group. What? How can that be??
Heart attacks are caused by progression of atherosclerosis with a coronary thrombosis being the precipitating factor in most (but not all). Clearly Simvastatin did not affect the progression of the disease in those who already had documented atherosclerosis. Heart attacks and strokes occurred equally in both groups.
In fact many studies now show statins accelerate calcification of the arteries via their vitamin K blocking effects. I personally believe based on my experience and observations that statins cause an acceleration of atherosclerosis with more heart attacks. Research clearly shows this, but is ignored.
There are over 300 documented unwanted direct effects of statin drugs. I never recommend them and do everything I can to convince people to get off them before they come down with a statin-induced disease like congestive heart failure or Type II diabetes — or have another heart attack or sudden death.
If LDL cholesterol was “bad” then it would be expected the most benefit would be seen in those with the highest cholesterol and LDL levels. That was not the case in the 4S study and years later, it turns out this tiny survival benefit amongst a cherry picked healthier cardiac population was due to statin drug’s ability to block the pro-inflammatory Nuclear Factor Kappa Beta pathway. LDL lowering was a “side effect,” one which has many detrimental effects as time goes on. This includes reduced immune function with increase susceptibility to pneumonia, cognitive dysfunction, peripheral neuropathy, ALS, Parkinson’s Disease and even dementia.
Stopping the Progression of Atherosclerosis
So what does cause atherosclerosis, what determines whether it gets worse or not and how do you stop it? I am always asked can it be reversed? Well, yes, if you look at those living under starvation conditions, there doesn’t seem to be any heart attacks, but that’s not exactly a desirable lifestyle. In our studies at Rancho we observed coronary atherosclerosis reversal in some coronary arteries in about two percent of our patients, so it is possible, but probably not a realistic goal.
In my mind, if the disease can be arrested in its tracks, then it’s game over. After 49 years of treating thousands of heart disease patients, I think I have discovered through a lot of research and essentially trial and error on my patients what works and what does not.
The Role of Vitamin C
Baby boomers remember the 1972 book Dr. Linus Pauling published entitled “Vitamin C the Common Cold and the Flu.” In this book Dr. Pauling presented extensive research showing mega-doses of oral Vitamin C taken at the onset of cold or flu symptoms could ameliorate these illnesses very quickly. Much research since then has confirmed this therapy works.
What most people don’t know is that Linus Pauling turned his attention to atherosclerosis and cancer and their relationship to vitamin
C after writing this book. This was his work for the next 19 years until his death at age 93. The result of this research along with Mathias Rath MD was the publication of the Unified Theory of Atherosclerosis in 1990 that posited that atherosclerosis is a vitamin C deficiency disease. In essence atherosclerosis is a one manifestation of scurvy created by a low grade chronic deficiency of it.
For example, virtually all mammals are able to manufacture vitamin C in their liver except for humans, guinea pigs, some primates and fruit bats. The latter four do have heart attacks while none of the other mammal species who eat their normal diet do. Did you know the average adult goat will manufacture 13,000 mg of vitamin C every day? Can you now see why people who tell me they take “500 mg of vitamin C every day” are actually extremely deficient? That the government recommends “75 – 90 mg/day from the diet is preposterous!
This topic was extensively documented in Dr. Rath’s 2003 book entitled Why People Get Heart Attacks But Animals Do Not. Dr. Pauling essentially passed the “vitamin C / atherosclerosis” ball on to Dr. Rath at the time of his death in 1994. I began to recommend vitamin C to my patients in the early 1990s, but was probably not recommending enough based on what I have learned since then. Dr. Pauling reportedly took 20 grams of oral Vitamin C for the last 15 plus years of his life once he discovered how much a typical animal makes on a daily basis.
The problem is that oral vitamin C is poorly absorbed and only about 20 percent of a 1,000 mg pill will actually reach the bloodstream (200 mg). That’s enough to meet the RDI of “60 mg” but is nowhere near what is needed to prevent and arrest atherosclerosis IMHO.
That problem was solved a few years ago with the invention of fat soluble vitamin C. Ascorbyl palmitate is a version of that, but lypospheric vitamin C seems to be a much better mousetrap. A 1,000 mg gel packet will have an 80 percent absorption rate (800 mg). My current advice to anyone trying to prevent a heart attack or stroke or progression of peripheral / carotid artery disease is to start with two packets per day at a minimum. Some higher risk people will need more, especially if they have an elevated blood Lipoprotein(a) level. Or take 2000 mg of any fat soluble form of vitamin C. You can have your doctor order a blood vitamin C level to see if you are getting therapeutic amounts absorbed.
Now you may be asking yourself, “How come my cardiologist hasn’t recommended this?” Well, that is a complicated answer, but let us just say vitamin C does not fit into the allopathic pharmaceutical model of treating any disease and is actually competition to statins, ACE inhibitors, diuretics, aspirin, Plavix, beta blockers, etc. The reality is that atherosclerosis in not caused by a deficiency of any drug! It is caused primarily by a deficiency of several nutrients and hormones with vitamin C being the most critical.
One cardiologist who has studied and written about the many therapeutic benefits of vitamin C is Thomas Levy MD, JD. His book Primal Panacea covers the overwhelming documentation proving that in high enough doses, vitamin C prevents and cures cancer, coronary artery disease, infectious and degenerative diseases. I encourage all my patients to purchase and read this book. Chapter four deals specifically with the effects of vitamin C and the mechanism behind how a lack of it leads to arterial wall thickening and how vitamin C protects the coronary arteries. (See attached figure).
Dr. Levy says, “If humans still had the capacity to synthesize vitamin C in quantities commensurate with their need, this disease might be totally non-existent.”
Other Cardiovascular “Risk Factors”
One of the interesting things about atheroscerlosis is the massive age range of heart attacks I have seen. My youngest patient was a female who had a heart attack at age 29 and my oldest was a gentleman with an “MI” at age 92. Why such a huge range? Pretty much everyone in the USA is vitamin C deficient unless they are mega-dosing vitamin C everyday (which is probably less than 0.001% of the population) so there must be other factors that drive this disease. You might be familiar with the American Heart Association cardiovascular disease risk factor list of advancing age, male sex (post-menopausal women finally catch up to men by age 65), smoking, Type II diabetes, obesity, hypertension, family history, inactive lifestyle, etc. What you may not be familiar with is the newer list of risk factors I consider to be as if not more important and can be easily measured.
- Highly sensitive C Reactive Protein
- 25HyroxyVitamin D3
- Fasting Insulin, Hemoglobin A1C, Fasting Glucose
- Thyroid Stimulating Hormone (TSH)
- Oxidized LDL
- Low Free Testosterone Levels (men)
- Low Estradiol and Progesterone Levels (Women)
- Fasting Triglycerides
My experience has been that the more of these biochemical abnormalities one has on top of a vitamin C deficiency, the earlier atherosclerosis will develop and a heart attack or stroke will occur. People with heart attacks under age 50 tend to have several of these, while those over age 80 tend to have just a few. Each of these risk factors could be a topic of separate discussion however that can be deferred until later should there be an interest.
Another huge contributing to heart attacks is root canaled teeth, first identified by Dr. Price in the 1940s as a major causative agent of many diseases. He wrote two books totaling 1,100 pages on the dangers of this procedure. Dr. Levy agrees and has written another book called The Toxic Tooth, illustrating how these dead teeth become infected and leak endotoxins into the circulation from anaerobic bacteria. Periodontal gum disease is also a contributing factor to heart attacks via the same mechanism. I do my best to discourage these in my patients and encourage them to see an endodontist to determine if the root canaled tooth/teeth are infected and consider having them extracted.
Here is a Youtube video where Dr. Levy discusses how root canaled teeth can contribute to heart attacks via inflammation.
Keep in mind atherosclerosis is an arterial wall (endothelial) injury / repair process gone haywire. Vitamin C is critical to the repair process and all the other factors listed above just accelerate the injury to a greater or faster extent. Eliminate as many as possible and speed up the endothelial healing and heart attacks will cease. At least that has been my experience since the early 1990s.
My approach is to measure all of these and develop a nutritional supplement plan combined with aerobic and strength training exercise and a bio-identical hormone replacement program to negate as many as possible.
Notice I do not measure total cholesterol, HDL nor LDL. After 49 years, I see no value in trying to change them, so why measure them? They have no predictive value. In fact one will live longer if they are left alone. It has been shown that centenarians have an average blood total cholesterol level of 250 ng/ml. Why fight success? Your liver makes as much LDL and HDL as it needs to on a daily basis and trying to lower LDL or raise HDL by dieting or with drugs is a recipe for more illness.
Finally, even though I did not know any of this information back in the 1970s and 1980s, many of my SCOR CCC heart disease patients who rode every Saturday year-after-year survived into their late 80s and early 90s. My oldest was 92 when he passed away from dementia and had no progression of atherosclerosis since his bypass surgery at age 54. That’s 38 years with no cardiac event — pretty much unheard of.
Certainly we can say regular exercise of any kind has protective effects on the coronary arteries. However one still hears about the “Jim Fixx Story” so it is necessary to keep in mind atherosclerosis is a multi-factorial process and one cannot count on just exercise to keep you heart attack free.
Jim Fixx was a runner who died of a coronary at age 52 after changing his lifestyle and popularizing running as a positive health behavior. His sudden death / MI was blamed on “genetics,” yet none of what I have written about here was known in 1977 when he died, so I think it is better to say we don’t really know how this happened.
My SCOR club members usually passed away from “old age” or cancer, the number two cause of death in this country. Interestingly since I have implemented more aggressive nutritional supplement and hormone replacement therapies, only a few of my heart disease patients have succumbed to cancer and none have had any heart attacks in the last 20 years.
Yes it’s anecdotal but trends are trends!
Randolph Ice PT, CCS
USC Graduate – 1971
Founder SCOR Cardiac Cyclists Club – 1974
Inventor/Manufacturer of Ultra Energy – 1986, SPIZ meal replacement/energy drink – 1995 (www.SPIZ.net)
Clinical Coordinator – Vintage Medical Hormone Replacement Group – 2000 to present
Director of Cardiopulmonary Rehabilitation at Rancho PT, Murrieta California 1991 – 2020
Director of Physical Therapy and Cardiopulmonary Rehabilitation – Metroflex Gym – 2020