With high cholesterol rampant in my family and Asian Indians being at the highest risk of cardiovascular disease of any ethnic group in America, I’ve been adamant about protecting my heart over the last decade.
You might be able to relate to my story.
Despite being mindful of what I put in my body for the last twenty years, my labs would always show dyslipidemia—high LDL and high apoB.
So many experts would tell me to either take a statin or completely cut out saturated fat because I likely had familial hypercholesterolemia (a genetic condition that causes high cholesterol).
But actually, it was something quite different.
Today I want to share why my lipids were so wonky and some things I’ve been doing to protect my heart.
Let’s dive in…
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Genetic Testing
I met cardiologist Michael Twyman, MD, a few years ago when I heard about the advanced cardiovascular testing he does at his lab. I wanted to get to the bottom of my abnormal lab results and knew Dr. Twyman was exactly who I needed to work with.
One of the first things he did was run a genetic test called GBinsight. This test dissects the complex genetic differences that contribute to heart disease, Alzheimer’s, type 2 diabetes, and more. The biggest takeaway I got from this test is that I DO NOT have familial hypercholesterolemia. I am actually a hyper-absorber of cholesterol. What’s the difference? A hyper-absorber just continues to reabsorb the cholesterol that is circulating in their bloodstream. Their body is ineffective at eliminating excess cholesterol.
Knowing this difference matters when it comes to treatment.
A typical statin (the normal treatment for high cholesterol) would not work on my body the way it would for someone who has familial hypercholesterolemia. In fact, it might have done more harm than good. Knowing this information also helped me understand that even small amounts of fat could increase my lipids—but this might not necessarily be a bad thing. My body needs support when it comes to eliminating cholesterol, so Dr. Twyman took a few steps to support my body in this process and get the right testing to make sure my elevated cholesterol was not causing a bigger issue.
Cleerly Scan
Another test that Dr. Twyman ran for me was the Cleerly scan (CCTA). This scan is an AI-based coronary computed tomography angiography scan, which is a fancy way of saying that it can look at both hard plaque and soft plaque in the arteries.
Before the Cleerly scan came out, the best option for looking at heart health was a traditional CT Coronary Calcium scan (CAC), but that scan only looks at hard plaque. Soft plaque is also a huge issue; in fact, most heart attacks are caused by soft plaque!
The Cleerly scan, which Dr. Twyman has been putting a spotlight on, helps people find the earliest stages of endothelial damage and hopefully prevent heart attacks before they happen!
My Cleerly scan showed that my arteries are virtually free from hard plaque AND soft plaque! This gave me such peace of mind and also proved to me that all of the hard work I put in to eat well, exercise, sleep, and manage stress is paying off, despite my labs showing elevated lipids, especially apoB.
I want to share just a couple of quick notes about the Cleerly scan if anyone is considering it. First, it’s much more expensive than a traditional CT scan. It’s around $2,000 (vs $100 for a CT scan) and you need a provider to order it for you. Also, unlike an MRI scan, both CT and Cleerly scans are radiation based, but I don’t plan on getting them yearly, so I’m okay with that risk/reward trade-off.
Prescription Medication
Even though there is still so much that we don’t understand about lipids, evidence shows that long-term elevated lipids can be problematic. And although my Cleerly scan was pretty much perfect, who knows what it could look like when I’m 70, 80, and hopefully 100!
After reviewing all the evidence, Dr. Twyman and I discussed the pros and cons of a prescription intervention to support my body in lowering apoB. Based on my unique situation, he recommended ezetimibe, a cholesterol absorption inhibitor.
Multiple experts I consulted told me that this drug had an extremely low-risk profile, and it was best suited for someone like me who is a hyper-absorber of cholesterol.
When I first measured my apoB a few years ago, my levels were close to 150. After taking ezetimibe and following Dr. Twyman’s advice, my levels lowered to 86! My plan is to stay on this medication long-term while continuing to exercise, eat clean, prioritize sleep, and find ways to actively recover from stress daily.
Supplements
Dr. Twyman also had me start on three specific supplements to provide some extra support to my endothelium and potentially minimize future plaque buildup.
Arterosil: This supplement is designed to support the endothelial glycocalyx, which is the “fragile inner lining of the entire vascular system.” It’s been shown to protect and restore the endothelial glycocalyx. Dr. Twyman and I discuss the importance of the glycocalyx on this week’s episode of The Dhru Purohit Show.
Vascanox: This supplement is designed to support the natural production, storage, and release of nitric oxide. Nitric oxide regulates blood pressure, improves blood vessel health, and is a huge part of having a healthy endothelium.
Kyolic Aged Garlic: Aged garlic is one of the only supplements that has been shown to reduce and prevent soft plaque in the arteries, which is mind-blowing, so this supplement is really a no-brainer for me.
As always, work with a practitioner before you start any new supplements, especially if you’re taking other medication or dealing with an active health condition.
Doubling Down on Circadian Biology
Dr. Twyman and I talked extensively about the importance of honoring circadian biology, specifically for optimal cardiovascular health. This means getting 15 minutes of sunlight in the morning within 30 minutes of waking up (for me it’s while I drink my coffee out on my balcony or walk to the local coffee shop). At night I wear my blue-light blockers one hour before bed and turn off really bright lights. I’ve also been consistently using red-light therapy every single night before bed as a way to wind down.
I was pretty much doing all of these things, but since meeting Dr. Twyman I’ve become way more adherent.
The second part of honoring circadian biology is to eat with the sun and not eat too close to bed. I am definitely more consistent about wrapping up dinner three hours before I go to bed, but this is not always feasible, so I do my best 85 percent of the time. Dr. Twyman shared that when we eat is just as important as what we eat when it comes to optimal heart health and total body health.
Working with Dr. Twyman has been such a game-changer for me. I actually flew some of my family members, including my dad, to his clinic in St. Louis because I want everyone to take a preventative approach to heart health.
We ran a ton of tests on my dad, and I’m excited to share more about that in future newsletters.
If you or anyone you know is concerned about their cardiovascular health, I highly recommend checking out Dr. Twyman’s Clinic, Apollo Cardiology.
This week you can also catch our episode where Dr. Twyman shares the most important tests and lifestyle habits he recommends, and my brother-in-law, who is a cardiologist, also joins us for a robust discussion on all things heart health. Check it out here.
Here’s to your health,
Dhru Purohit