Heart Disease

Heart Disease

Famed cardiologist Dr. Caldwell Esselstyn once called heart disease a “toothless paper tiger that need never ever exist.  And if it does exist, it need never, ever progress.”  Yet heart disease kills more Americans every few years than ALL of our previous wars combined.  Most alarming, people who die from a heart attack get no warning sign whatsoever.  In fact, in his book “How Not To Die,” Dr. Michael Greger says of sudden cardiac deaths, “you may not even realize you’re at risk until it’s too late.” And for some, “their very first symptom may be their last.” Here one minute…and gone the next.  It’s scary, and unnecessary.  Yet a heart attack is also the number one reason that most of us, and those we love, will die.  In fact, every 40 seconds an American will die of a heart attack, which equals 610,000 annual deaths from heart disease in the United States every year–that’s 1 in every 4 deaths.  So what is coronary heart disease, or CHD? Is it preventable? And if so, how?

Heart disease is a catchall phrase for a variety of conditions that affect the heart’s structure and function.  It falls under the umbrella of a disease referred to as Cardiovascular Disease, or CVD.  According to the National Heart, Lung and Blood Institute, “CVD is the term for all types of diseases that affect the heart or blood vessels, including coronary heart disease (clogged arteries), which can cause heart attacks, stroke, congenital heart defects and peripheral artery disease.”  Thanks to our Standard American Diet, or SAD (diet high in fat, low in fiber), fatty deposits build-up in the wall of our arteries and create what are called atherosclerotic plaques.  According to Greger, “the majority of people with this cholesterol-rich gunk” develop atherosclerosis (athere-meaning “gruel”) and (sclerosis—meaning “hardening”).  The build-up of these plaques, accumulate in the coronary arteries (arteries crowning the heart) and narrow the path for blood to flow to the heart.   Greger cites William C. Roberts, the editor in chief of the American Journal of Cardiology, “there are only two ways to achieve low cholesterol, put 200 million Americans on a lifetime of medications or recommend they all eat a diet centered around whole plant foods.”

To illustrate this point, Greger describes how western doctors in 1930’s and 40’s, working in African missionary hospitals, found that most of the diseases of the western world were virtually non-existent there.   Thinking they might be on to something, the doctors decided to compare the autopsies of Africans to those of Americans.  Amazingly, out of 632 Ugandans autopsied in Africa, there was evidence of only one single heart attack.   But out of 632 patients autopsied in Saint Louis, MO, doctors found evidence of 136 heart attacks…holy pork steaks!   Baffled by the results they opted to study another 800 Ugandans.  Out more than 1,400 bodies autopsied, there was still only that one person with a small “healed”lesion of the heart, meaning, that’s not even what caused their death.”  So it’s got to be about their genetics, right?  No. In fact, large-scale immigrant studies in China and Africa both showed how rates of certain diseases like heart disease, characteristically coincided with where one lives.  In other words, if you move to an area where there are high rates of disease your risk goes up.  But if you move to an area where there are low levels of disease your risk of disease goes down.   These are what they called lifestyle diseases. So what can we do to prevent heart disease?   Just focus on treating the cause and the symptoms will go away?  No, not when there is money to be made.  In 2017, Pfizer’s Lipitor generated 1.8 billion dollars in annual sales.  Greger jokes (or is he?) that because Lipitor, a cholesterol reducing drug, and the best selling drug of all time, “garnered so much enthusiasm some US health authorities reportedly advocated they be added to the public water supply like fluoride is.”   Statins like Lipitor are known to cause memory loss, increase the risk of diabetes, and may also double a woman’s risk of invasive breast cancer

Modern day Africans have extremely low cholesterol in their blood because their diets are comprised mainly of plant-derived foods, such as grains and vegetables.  That means a lot of fiber and very little animal fat.  Our western diet is mostly the opposite; comprised mainly of animal fat, and little or no plant fiber. Most of the fiber we do consume is processed (yeast breads and rolls, flour and corn tortillas, bagels, English muffins, etc.).  And why is fiber so important, you ask? Found in plant foods, soluble fiber binds to the cholesterol particles in our digestive system and moves them out of the body before they’re absorbed.  Insoluble fiber, aka, “roughage,” is also found in plant foods and essentially cleans out our intestines and keeps us feeling fuller longer.    Yet the average American consumes about half of the recommended amount of fiber per day and more than double the recommended amount of fat.

So how come our doctors don’t give us nutritional prescription?  Maybe because they don’t know any better.  Or maybe they have no interest in knowing any better.  Nutrition is not a requirement in most medical schools across the country.   Physicians are taught to look for a set of existing symptoms (dis-ease) and write a prescription(s) for those symptoms… That’s it.  Even if those pills do nothing to correct the underlying cause.  And even if the drugs cause other health problems to occur.  Medical practitioners have their required continuing education subsidized, if not entirely paid for, by the pharmaceutical industry.  In a recent poll, Dr. Marcia Angell, a Senior Lecturer from Harvard Medical School, observed a “staggering 94% of physicians surveyed acknowledged receiving financial compensation of some form from pharmaceutical companies.”  It has also become entirely standard practice for pharmaceutical companies to have a direct hand in both the design and analysis of medical research, as well as conducting clinical trials, and in the publication of those results.  And finally, many doctors themselves are not healthy people.   Overweight and out of shape, many doctors today parallel their cigarette smoking predecessors of 50 years ago.  Dr. Neal Barnard of The Physicians Committee for Responsible Medicine, observed that doctors finally realized they were “more effective in counseling patients to quit smoking if they no longer had tobacco stains on their own fingers.”  Barnard also likened a plant-based diet as the nutritional equivalent to quitting smoking.

Greger finishes the chapter on heart disease by further explaining why more doctors don’t counsel their high cholesterol patients about nutrition as an option for treatment.  Aside from not having enough time to counsel their patients on diet (this was the case as explained by my own physician), most of them said they didn’t want their patients to feel “deprived” of eating the foods they loved.

 

 

 

 


 

“How Can You Mend A Broken Heart?”

“How Can You Mend A Broken Heart?”

When my Grandma Francine died at 72 of cardiovascular disease (CVD) I was devastated. Like a second mom to me, she was one of my closest confidants, my comfort, and I loved her (and still do) like crazy.  My husband and I had just gotten married, and we were still processing the loss of his grandfather who had died of liver cancer the month before. Bedridden and unable to attend my wedding, her health had been failing for a few years. Several strokes had stripped her of a job she enjoyed, and the ability to drive a car.  In fact, the last time she drove she suffered a mini stroke and ended up parked in front of a random strip mall.  The only thing she could remember was the sound of horns honking and cars coming toward her.  By the grace of God, no one was injured.  Eventually, she was rendered speechless and robbed her of most prized possession, her mind.  So much so, she didn’t even realize she was playing in her own excrement when my aunt was driving her home from a doctor’s visit.  It’s like the old saying, “Once an adult, and twice a child.”

Her father had also died young, but from a massive heart attack.  He was 59 years old, a mere 13 years older than I am now.  My grandmother was heartbroken and sad, for many, many years after his death.  So what is the take away from all this?  Heart disease runs in my family, and takes away people who are dearly loved, far too early. Furthermore, it begs the question, since my grandma and great-grandpa died from cardiovascular disease, does that mean my children and grandchildren will lose me the same way?

“Your Bad Habits Are As Inherited As Your Bad Genes.”

The other day I was listening to Dr. Neal Barnard, MD on a podcast.  A very articulate and tremendously intelligent man, Dr. Barnard is a trailblazer in the areas of preventive medicine, good nutrition, and higher ethical standards in research.  In the segment, Rich Roll (one of the best interviewers, ever…) and Dr. Barnard were talking about something called epigenetics.  “Epi”-whaaa?  Yep.  Epigenetics.  Here is a quick analogy that might help understand epigenetics. “Think of the human life span as a very long movie. The cells would be the actors and actresses, essential units that make up the movie. DNA, in turn, would be the script —the DNA sequence would be the words of the script, and certain blocks of these words that instruct key actions or events to take place would be the genes(1)

We all have two types of genes.  Some genes are “Dictator” genes.  “You, Stephanie will have blonde hair and blue eyes.”  These genes give you orders and you can’t argue with them. But then there are the other guys, the “Committee” genes.  They make suggestions and if you don’t like them, you can refuse.  “Hey Steph, how about some clogged arteries?”  Nah, I think I’ll pass.  There are certain circumstances in life that can cause genes to either be “silenced” or “expressed” over time.  They can be turned off (becoming dormant) or turned on (becoming active).  What you eat, where you live, who you interact with, when you sleep, how you exercise, even aging – all of these can eventually cause chemical modifications around the genes that will turn those genes on or off over time. (2)

Still with me?

So this made me wonder if there was a relationship between epigenetics and cardiovascular disease.  Is CVD really a familial death sentence?  In his book “How Not To Die,” Dr. Michael Greger explains,  “For most of our leading killers (heart disease being number one), non-genetic factors like diet can account for 80-90% of cases.”   Migration studies and twin studies show us this is not just a case of bad genes.  When a person moves from a place where there is a high incidence of heart disease to a place where heart disease is virtually non-existent, their rates of disease decrease. Conversely, when a person moves from a place where there is a low incidence of disease, their risk raises when they move to a place where there are higher incidents of disease.   In a twin study funded by the American Heart Association, 500 twin pairs were examined for CVD.  Some were non-identical (only share 50% of the same genes) and some were identical twins (they share the exact same genes).  The results of the identical twins showed that one twin can die early of a heart attack, and the other can live a long, healthy life with clean arteries depending on what they ate and how they lived.”

So even if I have the genetic predisposition to heart disease, it doesn’t mean that I have to die from it.

Whew.

“Your genes are the gun, but it’s your lifestyle that pulls the trigger.”

Bad habits also run in families.  Families that grow up together and eat together, end up “inheriting” bad eating habits from mom and dad.  That is what explains why entire families are obese; suffer from CVD, diabetes, and other chronic diseases.  Overeating, consuming foods high in fat and cholesterol, eating fast food for breakfast and dinner, and a sedentary lifestyle are all significant factors that lead to early death from Cardiovascular Disease.

Worse, the more behavioral risk factors people have—smoking and eating a high-fat diet and not exercising, for instance—the less likely they are to be interested in information about living healthier. (3)

So what do we do about it?

DIET:

Without question, diet is the single most important component of preventing, halting, and in many cases even reversing the effects of cardiovascular disease.  A high fiber diet made up of mostly whole, plant-based foods, similar to those diets followed by Asian and African populations (areas where heart disease is virtually non-existent) has been scientifically proven to lower cholesterol and dissolve plaque build-up in the arteries without the use of medications or surgery.   In fact, diet is so powerful that Dr. Barnard equates eating a plant-based diet as the nutritional equivalent to quitting smoking.   So does this mean a vegan or vegetarian diet?  According to Dr. Joel Fuhrman MD, by striving to eat at least 90% of your calories from the unrefined plant foods that comprise the base of the pyramid each day, you construct a health-promoting, disease-preventing diet. But what about the remaining 10%?  While I love the idea of every person eating a 100% whole food plant-based diet, I know it’s not a realistic option for everyone.

In a large scale study of the longest living people in the world, National Geographic researcher Dan Buettner examined five places in the world – dubbed “Blue Zones” – areas where people live the longest, and are healthiest.  The data showed the need to LIMIT MEAT.  “Think of meat as a celebratory food,” Buettner said.  “Portions should be no larger than a deck of cards, once or twice a week.  Avoid processed meats such as hot dogs, bacon and sausages.”  FISH IS FINE.  Enjoy fish up to three times weekly.  Wild-caught salmon or smaller fish like sardines, trout, snapper, cod, and anchovies are okay choices.  Limit portion sizes to 3 ounces (about the size of the palm of your hand.)” Although, you need to know there are other serious issues with fish, such as sustainability, and the health dangers of mercury consumption.

Quick Side Note: Epigenetics and Cancer.

Dr. Dean Ornish and his colleagues took biopsies from men with prostate cancer before and after three months of intensive lifestyle changes, including a diet rich in whole plant-based foods.  Without any chemo or radiation a positive change was noted in 500 different genes.  The expression of disease –preventing genes were boosted and those that promoted the cancer were suppressed. (4)

YOGA:

Performing a variety of yoga postures gently stretches and exercises muscles.  This helps them become more sensitive to insulin, which is important for controlling blood sugar. Deep breathing can help lower blood pressure.  Mind-calming meditation, another key part of yoga, quiets the nervous system and eases stress.  All of these improvements may help prevent heart disease, and can definitely help people with cardiovascular problems. (5)

PHYSICAL ACTIVITY:

It can be as simple as taking a walk.  While walking 60 minutes per week can reduce your overall mortality by 3%, walking 300 minutes a week, or 40 minutes a day, can reduce your mortality rate by 14%!  So in this case, more really is better.  And physical activity doesn’t mean just going to the gym.  It can mean anything from cycling and playing Frisbee, to practicing yoga.

BE HAPPY:

In a 2007 study that followed more than 6,000 men and women aged 25 to 74 for 20 years, researchers found that emotional vitality—a sense of enthusiasm, of hopefulness, of engagement in life, and the ability to face life’s stresses with emotional balance—appears to reduce the risk of coronary heart disease.  The protective effect was distinct and measurable, even when taking into account such wholesome behaviors as not smoking and regular exercise.   Optimism cuts the risk of coronary heart disease by half. (6)

**It has also been shown that being good at “self-regulation,” i.e. bouncing back from stressful challenges and knowing that things will eventually look up again; and choosing healthy behaviors can be a major factor in reducing heart disease.  The idea is that you are avoiding risky behaviors such as drinking alcohol to excess, and regular overeating.

How do you start a Plant-based diet?

How do I begin to make a change to a plant-based diet? What behaviors do I need to improve in order to stick with it? I am starting from scratch, and enjoy sugars, carbohydrates and meats. It is going to be a major life change for me, but I have arthritis, high blood pressure and high cholesterol (the latter two conditions are controlled with medications). The arthritis in my hands is painful and anti-inflammatory medications are not helping.

Think evolution rather than revolution.  Introduce one new, plant-based recipe per month, and in a year you have great ideas for eating for two weeks.  Identify one or two types of breakfast you can eat on most days.  I recommend a smoothie.  It’s a great way to get at least 3-4 servings of fruits and vegetables in one meal.  Replace all of the simple carbohydrates, breads and pastas with 100 percent whole grain product.  Add beans to your salads and eat more vegetables.

Any change requires some effort.  If you want a different result, i.e.  Better health, you have to be willing to introduce changes that may be uncomfortable at first.  Our taste buds do not like change.  So, essentially you have to educate your taste buds and do this with a mindfulness and a sense of purpose when you are changing your diet.  If you stay long enough, one month or two off of addictive sugars and fats (and salt as well), you will stop craving those altogether.  Just take the first step in your mind that you want to change to a plant-based diet if you have a sense that such changes will benefit you.