Last weeks post by PrimalRD discussed the Elephant in the Room so why not be consistent and throw in another zoological analogy? Today, we move from the world of pachyderms to that of ornithology and discuss The Canary in the Coal Mine. This allusion refers to the caged canaries that miners of yore would carry down into the mine tunnels to see if high levels of dangerous carbon monoxide or methane gas were present. The gas would kill the canaries before the miners and serve as a valuable warning of coming danger. Good for the miners. Not so good for the poor canaries.
So on that note, let’s continue our journey and discuss metabolic health today through the lens of a radiologist. This post may be a bit more geeky than the previous posts. Give it a shot, or at least scroll down to listen to the musical selection at the end.
I was reading CT scans this past week and many of those scans were a Coronary Artery Calcium Score (or CAC-CT for short). This is a chest CT that takes a rapid view or snapshot image of your heart and specifically uses these images and a computer program to first measure the volume of calcium, or calcified plaque in your coronary arteries, and then calculate a score. The CAC score then places you in a risk category for future cardiac events (heart attack). See that CT image above? The arrow points to a moderate deposit of calcium in the Left Anterior Descending coronary artery. You don’t want that.
OK, so now what? What does this mean? What does this have to do with canaries?
When we talk about metabolic health, there are of course the previously discussed big pillars such as focusing on a non-processed nutrient dense real food diet, and engaging in sensible exercise, stress mitigation, and optimal sleep patterns etc. Then there are objective data points and labs, that you and your doctor can use to assess your health. The labs that best define your metabolic health and risk for cardiovascular disease include your waist circumference, fasting blood sugar, fasting HDL and Triglycerides, and blood pressure. (Deeper dive on metabolic markers and metabolic syndrome in the future, I promise). A recent study published in July 2022 https://www.jacc.org/doi/epdf/10.1016/j.jacc.2022.04.046 showed that only about 7% of Americans today can claim they are metabolically fit based on those criteria. Yikes. Think about how many adults over the age of 50 are on at least 2 or 3 meds such as blood pressure pills, statins, diabetes meds such as metformin or GI meds such as PPI acid-reducers etc. Double yikes.
The CAC score is a valuable test because it can indirectly help YOU and your doctor or cardiologist assess your RISK for FUTURE events. It gives you a risk score of your chance of having a future cardiac event. It is not a perfect test. It is, however, one set of data that you and your doctor can use. What IS valuable, in my opinion, is that the test can detect PRIOR injury or a prior inflammatory insult to your coronary arteries. It can alert you that some injury happened in the past and the calcified plaque represents the repair process to that insult. In that way, the presence of a large volume of calcified plaque can serve as a warning sign or at the very least, a powerful tool for behavior modification in select patients. It is the proverbial canary in the coal mine!
CAC score of 0? Great. No calcified plaque detected. Some investigators liken this to a 10-15 year warrantee of no future cardiac events. Congratulations I suppose, BUT it does not give you permission to go off the rails and gorge yourself on a bacchanalian smorgasbord of donuts and excess alcohol, added sugar, processed flour and carbs and fake foods and inflammatory vegetable oils. This will only create problems in the future, by creating inflammation in the lining of your coronary arteries and setting you up for plaque formation. Many physicians would recommend to retest in 10 years and keep a tab on your metabolic health markers.
CAC score not 0 but less that 100? The canary has value. It is a call to action for you and your doctor to look for underlying causes such as crazy amounts of chronic stress, and chronic inflammation due to excessive sugar and processed foods in your diet. Are your inflammatory markers like CRP high? Are you running high blood sugars? Time to talk with your doctor about insulin resistance, which can be associated with obesity and compromised cardiometabolic health. What’s your blood pressure? How are your Triglycerides? Are you an excessive chronic over-exerciser? Behavior modification helps here and many physicians will recommend a retest in 3-4 years.
CAC score over 100 or even up to 1000? That is a bigger canary. This calls for a real look ‘under the hood’ and assessment of your lifestyle and metabolic and medical health. Your doctor may want to do serial CAC tests to look for rate of change or rate of increase in plaque formation. Remember, the CAC does not detect soft or non-calcified plaque, which is the plaque that could break off and in fact cause an acute coronary event. Therefore, your doctor may want to do a more invasive test such as a nuclear stress test or coronary CT angiogram to look for soft plaque (that comes from chronically elevated glucose or frequent spikes in blood sugar, inflammation, irritants from smoking or the presence of genetic factors such as blood markers called LP(a) and ApoE4).
This post is for informational purposes only. Not every doctor thinks the test has value. But they should. More do today than 10 years ago. Many cardiologists I speak with do think the CAC score has value, especially in those with positive risk factors and markers such as obesity, diabetes, high triglycerides, family history of cardiac disease etc. If you fall into this category, speak to your doctor about your metabolic health and the utility of this test.
The PrimalMed opinion? The test has predictive value, but it is only one piece of the pie. It probably has more predictive and clinical value in the metabolically unfit rather than the ‘worried well’ population. The test tells YOU what damage has been done in the past and is a tool to help guide you forward and to make the necessary changes to optimize your metabolic health. If you have a high score, don’t fret. Thank that canary!
Remember that calcified plaque is not a direct cause of a future cardiac event. It is a healed response. It represents a predictor of future potential cardiac events unless changes are made. It is a call to action!
Look at the pillars of YOUR PrimalMed prescription and make the necessary changes to diet, and lifestyle. Work with your dietitian and doctor to address the underlying nutritional and medical issues. See what your follow up CAC exam shows to ensure that you are moving in the right direction.
The PrimalMed TL;DR? We advocate understanding and combining ancestral tenets and current science to ward off and delay the onset of modern chronic disease such as cancer, cognitive impairment and Alzheimer’s disease, AND cardiovascular disease so that we may enjoy an optimal healthspan.
HEED the warning of the canary !!!
And for now, enjoy the ska rhythms and rhymes of Sting and the Police and take a trip back in time to 1980.
Thank you Tom. I am glad you are enjoying the wide range of topics and styles. You never know what you’re gonna get when you open up Today’s PrimalMed Prescription !!! Best to you and Michelle.
So I’m confused, who is this Dr. Ted? A radiologist? A modern day primalmed caveman? Certainly he’s a humorist, and an essayist, or whatever the best words to describe someone with a gift of the pen. Bordering on comic, and wildly informative and entertaining. I’m not sure he’s a rockstar in the true sense of the word, I do believe he’s wanna be rockstar, and I lover of all things 70s and 80s rock. I’ll offer he’s a rockstar in all those early things I mention. But I’ve seen him sing as Elvis to his bride at a birthday party 20+ years ago. He ain’t no rockstar.