Never suffer a heart attack!

Dr. Frank Shallenberger, MD

October 26, 2020



You probably already know that heart disease is the number one killer in the U.S. Over 600,000 men and women die of it every year.

If you were to ask any doctor in the world what causes heart disease, they would all say atherosclerosis, or plaquing of the arteries. And if you were to then ask them how the plaque gets there, the answer would be from the cholesterol in the blood. Both these answers are right.

So stopping heart disease should be pretty easy. All you have to do is to have a very low level of cholesterol in your blood. A level so low that plaque just couldn’t happen. Seems simple, but there’s one big problem with this. It doesn’t work.

One of the most amazing statistics in medicine is that the number of people who die from heart disease with high cholesterol levels is the same as the number of those dying with low cholesterol levels. If cholesterol were all there was to it, the numbers should be dramatically different.

There Must Be Something Else Driving the Disease

Perhaps that something else is the so-called “bad” cholesterol called LDL cholesterol? That seems to be the mantra of Big Pharma these days, “You have to lower your LDL cholesterol if you want to avoid heart disease.”

But there’s a problem with that too. Suppose you take 200 people with high LDL cholesterol and divide them into two groups of 100. One group you just leave alone with their high levels. In the other group, you lower the LDL to supposedly safe levels using statin drugs. If LDL was the cause of heart disease surely there would be a big difference between the two groups. But that’s not what the studies show. In fact, there is very little difference.

After five years, two people will die from heart disease in the low LDL group. Only one more will die in the high LDL group. So lowering the LDL cholesterol in 100 people saves only one of them from heart disease. Saving one out of a hundred is just about as unimpressive as it gets. Surely there must be something missing. And here’s where it really gets interesting.

The Real Culprit

It’s true that LDL cholesterol causes plaque. But before it does, it has to change into something called oxidized LDL. LDL cannot cause plaque unless it becomes oxidized. You probably have heard about oxidized molecules before. Molecules oxidize when they have electrons taken away from them by other molecules called oxidants. Antioxidants are molecules that help prevent this from happening.

Once LDL is oxidized, it starts the initial series of events that ultimately results in plaque, atherosclerosis, and heart disease. In other words, it doesn’t really matter how much cholesterol you have or even how much LDL you have. When it comes to your risk of heart disease from cholesterol, it’s entirely dependent on how much oxidized LDL you have. And this simple observation is why measuring cholesterol and LDL and lowering them when they are high is often so ineffective at preventing heart disease.

A few years ago, researchers looked at the oxidized LDL levels of 600 patients with heart disease. Then they compared them to the levels in 260 men and women without heart disease. The levels in the heart disease patients were 50% higher on average.

In another study of patients with heart disease, the researchers compared measuring oxidized LDL, total LDL, and HDL cholesterol. They were looking to see what measurement was the best predictor of who had heart disease. You won’t hear their results on TV.

That’s because they found that the levels of oxidized LDL were higher in heart disease patients, but the levels of HDL and total LDL were the same. The authors of that study stated, “These results strongly suggest an important role for oxidized LDL in the genesis of plaque instability in human coronary atherosclerotic lesions.”

Please notice that the term “plaque instability” is very important. Some patients with heart disease have angina as the first sign of the problem. This is fortunate for them because it alerts them to the problem. They can then do something before their condition gets lethal. But other patients have no warning at all. They just fall over dead.

In these patients, the cause of death is unstable plaque. Unstable plaque means that the plaque is soft and can break off the coronary artery causing a sudden and usually deadly heart attack.

So what the study above points out is that not only is oxidized LDL a marker of plaque in general, it is also an indicator of unstable plaque. This makes it even more important.

Another study entitled, “Oxidized LDL in carotid plaques and plasma associates with plaque instability” again showed this important relationship. These researchers also found that higher levels of oxidized LDL were the best indicator of plaque instability.

So, how long have we known that oxidized LDL cholesterol is the ultimate cause of plaque? Researchers discovered it 20 years ago. They found that oxidized LDL in the blood enters the lining of the arteries called the endothelium.

Since our immune system doesn’t recognize oxidized LDL, our immune cells (macrophages) attack it once it gets into this lining. The result is the first step that ultimately creates plaque. The higher the levels are of oxidized LDL, the more plaque you will have. In fact, the people with the highest levels of oxidized LDL have about 60% more plaque than those with the lower levels.

The good news is, as your levels come down, so does the plaque. A safe level is less than 60 u/L. That’s your goal. But that’s not all you need to do. You also need to look at the ratio of oxidized LDL to HDL cholesterol. This is important. That ratio is huge in the general population going all the way from 2 to 162.7 mU/mg. Ideally the ratio should be less than 30.

So why haven’t you heard about oxidized LDL before? It’s because it has taken 20 years to come up with a commercially available laboratory test that is able to accurately measure oxidized LDL. After all, if you can’t measure it, you can’t know if it’s a problem for you or not. And that’s the groundbreaking news I have to tell you about. All that has changed. Recently there have been several commercial laboratories offering oxidized LDL measurements.

These labs use the same lab methods as those that were first developed in Sweden and is now the standard for oxidized LDL testing. It is an FDA-approved testing process. And this test is likely the new gold standard for determining who is most at risk for developing heart disease. Not only that, but if the test says that your levels are high, there are many natural ways to lower them.

Since oxidized LDL is the culprit in plaque formation, finding the best treatment for it is easy – antioxidant therapies. I have found that the single best antioxidant therapy is ozone therapy. Ozone therapy, unlike any other treatment out there, stimulates the antioxidant enzymes that prevent excessive oxidation.

Many studies have shown that ozone therapy is very effective for heart disease. In almost every case, my patients can avoid the dangers of angioplasty, stents, and bypass surgery with a course of ozone therapy.

Ozone Works

In our clinic, we have seen decreases in carotid artery plaque after a series of ozone treatments. Ozone therapy is a very effective way to decrease oxidized LDL levels.

However, there’s a study that shows that it may work in other ways. When you treat blood with ozone, the ozone interacts with the LDL in the blood to form ozonated LDL. This newly formed ozonated LDL competes with oxidized LDL and decreases its plaque-forming effect. And ozonated LDL also inhibits the way oxidized LDL stimulates the NF-kappaB enzyme in the macrophages. It is by stimulating this enzyme that oxidized LDL starts plaque formation. By blocking that enzyme, ozonated LDL stops the process. So it seems to work in several ways.

Besides ozone therapy, there are a few other things you can use to decrease oxidized LDL levels.

Get your diet right. You want to eat a nutrient-dense diet.

Make sure that your glutathione levels are adequate. Glutathione is a critical antioxidant enzyme system. You can ask your integrative physician to test your glutathione levels. If the test indicates it, your doctor can treat you with glutathione therapy.

Have your total cholesterol, HDL, LDL, and oxidized LDL levels measured. I am convinced that knowing your oxidized LDL level is the single most important way to evaluate the risk of heart disease from elevated cholesterol. If your LDL levels are high, but your oxidized LDL is low, you are not at risk. You are one of the many people out there with high LDL cholesterol that will never get heart disease. But if your oxidized LDL is elevated, even if your total level is low, there is work to be done. You need to get it down into the safe range.

Next check your CRP and homocysteine levels. Since inflammation plays such an important role, make sure that your CRP (C-reactive protein) and your homocysteine levels are normal. As you may know, these are good markers of inflammation in your arteries. If they are high, start working with a nutritionally trained doctor to get your oxidized LDL, CRP, and homocysteine levels in a healthy range. Specific treatments you can use include antioxidant vitamins, especially vitamin E.

Researchers just last year looked at the effect of vitamin E on the way oxidized LDL caused plaque to form. Remember that plaque starts when the macrophage cells in the arteries take up oxidized LDL. That’s the trigger. These researchers found out that vitamin E inhibits this. But the way that it inhibits it is important. It does it by blocking the NF-kappaB enzyme in the macrophages. You can recall that this is exactly one of the ways that ozone therapy works to get rid of plaque.

Other researchers looked at the effect of giving vitamin E, vitamin C, and beta-carotene supplements to 181 men who were at high risk for heart disease. They divided the men into groups. One group took 400 units of vitamin E each day. The second group took 500 mg of vitamin C per day. The third took 15 mg of beta carotene. And a fourth group took a placebo pill.

The vitamin C and beta carotene group had a reduction in oxidized LDL by 18%. The vitamin E group did 25% better with a 23% reduction. Another study showed even better results with higher doses of vitamin E. In that study, three months of vitamin E at a dose of 1,600 mg per day (about 2,400 units per day) lowered the oxidized LDL levels by 30-40%!

Studies also show that CoQ10 and ginkgo biloba extract also can stop oxidized LDL from causing plaque.

And don’t forget the incredible effects of stress reduction, exercise, fish oil supplements, and a vegetarian diet on plaque formation. I also recommend pomegranate juice (1/2 pomegranate per day), as it can help lower your oxidized LDL all by itself. You can read all about it at


Cappello, C., B. Saugel, K.C. Huth, et al. “Ozonized low density lipoprotein (ozLDL) inhibits NF-kappaB and IRAK-1-associated signaling.” Arterioscler Thromb Vasc Biol, 2007 January;27(1):226-32.

Huang, H., R. Ma, D. Liu, et al. “Oxidized low-density lipoprotein cholesterol and the ratio in the diagnosis and evaluation of therapeutic effect in patients with coronary artery disease.” Dis Markers. 2012;33(6):295-302.

Huang, Z.G., C. Liang, S.F. Han, et al. “Vitamin E ameliorates ox-LDL-induced foam cells formation through modulating the activities of oxidative stress-induced NF-κB pathway.” Mol Cell Biochem, 2012 April;363(1-2):11-9.

Najafpour Boushehri, S., R.M. Yusof, et al. “Effect of vitamin supplementation on serum oxidized low-density lipoprotein levels in male subjects with cardiovascular disease risk factors.” Iran J Basic Med Sci, 2012 July;15(4):958-64.

Nishi, K., H. Itabe, M. Uno, K.T. Kitazato, H. Horiguchi, K. Shinno, and S. Nagahiro. “Oxidized LDL in carotid plaques and plasma associates with plaque instability.” Arterioscler Thromb Vasc Biol, 2002; 22: 1649–1654.

Tsimikas, S. and J. Witztum. “Measuring Circulating Oxidized Low-Density Lipoprotein to Evaluate Coronary Risk.” Circulation. 2001; 103: 1930-32.

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