Episode 5: The Untold Power of Diet and Lifestyle (Cardiovascular Disease: Part 5) 

 
In this episode, we uncover why real-world interventions—whole-food diets, metabolic health markers, and the simplest “medicine” of all—walking—outperform any pill in preventing and reversing heart disease. 

Topics include 

• Ancestral lessons from the Mediterranean, Panama, Japan, and the Nordic countries
• Key RCTs: Lyon Diet Heart, PREDIMED, CORDIOPREV
• Mechanisms: refined carbs & seed oils driving insulin resistance and endocannabinoid activation
• Visceral fat & hormones: aromatization of testosterone, GLUT4 dysfunction
• Atherogenic cascade: ↑VLDL → CETP exchange → small dense, oxidized LDL → plaque formation
• Dysfunctional HDL and breakdown of reverse cholesterol transport
• Triglyceride-to-HDL ratio as a powerful, under-used marker of metabolic risk
• Reversing metabolic syndrome: 28% reversal in PREDIMED’s lifestyle arm; DPP lifestyle success
• Walking as medicine: Blue Zones insights, DPP activity goals, and a 77% ↓ in CV mortality per 10,000+ steps
• Walking vs. Statins: 77% RRR vs. 13% RRR—no side effects, only benefits

📚 References & Resources

EUROLIVE Trial (Polyphenols in Olive Oil)

Investigated how high- vs. low-polyphenol extra-virgin olive oils affect HDL and oxidized LDL in healthy men.

https://pubmed.ncbi.nlm.nih.gov/12386254/

Japanese Diet Systematic Review

Pooled nearly 60 studies on Japanese-style eating patterns and reduced cardiovascular/cerebrovascular mortality.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10386285/

MDPI Diagnostics – Olive Oil Biomarkers

Examined biomarkers of extra-virgin olive oil intake and their clinical impact on lipid profiles.

https://www.mdpi.com/2075-4418/13/5/929

PMC 9248272 – Olive Oil & Lipid Oxidation

Demonstrated that polyphenol-rich olive oil lowers markers of lipid oxidation.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9248272/

PMC 3753679 – Olive Oil Meta-Analysis

Meta-analysis of 26 trials showing high-polyphenol olive oils reduce inflammation and modestly improve blood pressure.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3753679/

PLOS ONE – TG/HDL Ratio & IHD Risk

Case–control study: highest quartile of triglyceride/HDL ratio carried 16× greater ischemic heart disease risk.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052036

GeroScience – Benefits of Walking

Reviewed observational and interventional evidence for walking’s impact on healthy aging.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10643563/

PMC 7706282 – Daily Steps & Incident Diabetes

Prospective cohort of 3,055 seventy-year-olds linking step count to new-onset diabetes.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7706282/

PMC 2576026 – Habitual Exercise & Arterial Aging

Showed regular aerobic exercise preserves arterial compliance and endothelial function with age.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2576026/

Systematic Review: Physical Activity & Post-Op Recovery

Found higher post-operative activity levels predict shorter hospital stays across surgical types.

https://www.sciencedirect.com/science/article/pii/S1743919117305721

Dr. Kumar Discovery – Daily Steps & Mortality Risk

Meta-analysis of 17 cohorts (226,000 people) showing each +1,000 steps/day → 15% ↓ in all-cause mortality.

https://drkumardiscovery.com/posts/daily-steps-mortality-risk/

CORDIOPREV Trial

Seven-year RCT in CHD patients: Mediterranean diet vs. low-fat diet, 22% RR reduction in major CV events.

https://academic.oup.com/eurjpc/article/30/18/1975/7226309

CTT Collaboration – Statin Meta-Analysis (Lancet)

Showed each 1 mmol/L LDL reduction from statins yields a 13% relative risk reduction in CV death over 5 years.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00122-2/abstract

Circulation – Rosuvastatin & CRP (JUPITER Precursor)

Early evidence of statins’ anti-inflammatory effect by lowering C-reactive protein.

https://www.ahajournals.org/doi/10.1161/01.cir.99.6.779

PREDIMED Trial – NEJM

Mediterranean diet (plus olive oil or nuts) vs. low-fat diet in high-risk adults: ~30% RR reduction; NNT = 65.

https://www.nejm.org/doi/10.1056/NEJMoa1200303

Lyon Diet Heart Study – AJC

Secondary prevention RCT post-MI: 72% relative reduction in cardiac death/MI; NNT ≈ 9 over 4 years.

https://www.ajconline.org/article/S0002-9149(05)01825-4/fulltext

Circulation – TG, HDL & MI Risk

Landmark 1996 study linking triglycerides and HDL levels to myocardial infarction risk.

https://www.ahajournals.org/doi/10.1161/01.cir.96.8.2520

JAMA (2023) – TG/HDL Ratio & Acute MI

Case–control analysis confirming high TG/HDL ratio as a strong predictor of heart attacks.

https://jamanetwork.com/journals/jama/article-abstract/374290

Korean NHIS – TG/HDL & IHD Longitudinal Study

National Health Insurance data linking baseline TG/HDL ratio to future ischemic heart disease risk.

https://www.researchgate.net/publication/353953093_Triglyceride_to_HDL-Cholesterol_Ratio_and_the_Incident_Risk_of_Ischemic_Heart_Disease_Among_Koreans_Without_Diabetes_A_Longitudinal_Study_Using_National_Health_Insurance_Data

PubMed 35631146 – Nordic Diet Meta-Analysis

Meta-analysis of 15 cohorts & 6 RCTs showing 7–19% reduction in cardiovascular events with Nordic diet adherence.

https://pubmed.ncbi.nlm.nih.gov/35631146/

Blue Zones & Longevity Factors

Explored lifestyle elements—walking, community, diet—in regions with exceptional healthy lifespan.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9630197/

MOJ Public Health – ω-6/ω-3 & MetS in India

Door-to-door study of 2,000+ Indian adults: high omega-6/omega-3 ratio linked to 70% central obesity vs. 12%.

https://medcraveonline.com/MOJPH/association-of-higher-omega-6omega-3-fatty-acids-in-the-diet-with-higher-prevalence-of-metabolic-syndrome-in-north-india.html

PMC 9413490 – Western Diet & Metabolic Syndrome

Cross-sectional analysis of Western dietary patterns and prevalence of metabolic dysfunction.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9413490/

PMC 4808858 – Seed Oils & Inflammation

Investigated inflammatory pathways triggered by industrial seed oils rich in linoleic acid.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4808858/

PMC 4587992 – Endocannabinoids & Diet

Showed how dietary linoleic acid boosts endocannabinoid production, driving appetite and fat storage.

https://pm...