Heart Health

The quick answer:  Don’t die of a broken heart—live a muscular lifestyle and eat a whole foods diet.

________________________________________________________________________________________________

The subject this week is heart health.  Have you been with someone during a heart attack, or held a friend’s hand before they entered the hospital cath lab for an angiogram, or visited someone after coronary artery bypass surgery?  It’s pretty scary, isn’t it?  In that moment, we would give anything to have lived better.  Our lives depend on us caring for our hearts.  In the last post we discussed five steps for doing this.   They’re worth repeating:

Based on #1 above, the Healthy Change for the week says: Resist laborsaving devices—incorporate muscular activities into your life.

TV Watching

What’s the exact opposite of muscular activity?   Watching TV—being a couch potato.  There are some terrible TV statistics: By the time the average child turns 18, I’m told, they’ve seen 40,000 murders.  In four hours of Saturday morning TV a child will see 200 commercials glorifying junk food, according to one study.  (Yes, the food corporations slip around the parents and go straight for the kids; they’re the #1 advertiser to children.  There ought to be a law.)  How’s a mom going to compete with that?  No surprise that there’s a correlation between TV watching and obesity. 

We had a wary relationship with the TV when our kids were growing up.  If our TV broke, it might be years before it was replaced.  For a few years we had a Laundromat coin meter attached to the TV and the kids had to earn quarters to watch.  Another time we had a key-controlled switch.  The kids were bright and figured a way around it but they were careful to only do it when we were out.  After a Friday night out with the beautiful wife I’d come home and touch the TV to see if it was warm.  It’s OK, you know, to let the kids think they’re getting away with something now and then. 

I never found time to implement my best idea:  An exercise bicycle with a generator attached that the kids would pump to make electricity to power the TV.   The idea was they should be outside playing and only get enough TV to stay culturally connected, so they wouldn’t grow up weird.  It worked I think, they’re good citizens and all look pretty healthy.  The little girl who drew the hearts above doesn’t have TV service in her home.  Good parents place strict controls on TV watching.

Sodium and Potassium

You read a lot that we eat too much sodium, or, sometimes, that we get too little potassium.  Together they’re medically important so scientists look at our ratio of sodium to potassium.  A recent study looked at 12,267 adults, comparing their sodium-to-potassium dietary intake to the chance of dying.  Turns out that mortality is 46% higher for those with the highest vs. lowest ratio.  Worse, the risk of dying by heart attack is more than doubled.

So how can we eat less salt and more potassium?  Here’s where you mainly get sodium: eating food someone else cooks for you.  Table salt is 40% sodium but we get it from processed foods—fast foods, commercial snacks, and restaurant meals.  If you mainly cook at home using real food, you likely don’t have a sodium problem. 

Where do we get potassium?  From plants, especially nuts, seeds, and legumes, but potassium is found in all fruits and vegetables.  So if you eat a whole foods diet, you get plenty of potassium.  What we discover here is that the sodium to potassium ratio is a marker for processed food vs. plant foods in your diet.  Eat whole foods and you shouldn’t have a worry.

Single Adults

I spoke to some single adults the other night, about nutrition.  They have a tough problem, I think.  They mostly live alone, they work hard all day, and it’s hard to prepare a good meal when you’re the only one eating.  One explained how it’s a lot cheaper to pick something up than buy groceries for just one person.  I don’t think that’s true, but it’s been a long time since I lived alone.  You’d laugh if I told you what I ate during the college years.  Does any group eats worse than college kids?

Lots of kids today weren’t taught to cook when they were growing up.  The group I spoke to seemed like really good people, but they didn’t look healthy.  Driving home I wondered how this blog could be more helpful to single people.  Couldn’t we do something more—to inform, or inspire?

Please comment:  Please share your ideas.  How do you control the TV in your home?  Or, how can people living alone eat healthy?  Thank you for your comments—they make this blog work. 

Healthy Hearts

The quick answer:  Better to learn how to care for your heart then have the doctors “repair” it.  See the seven steps below.

_____________________________________________________________________________________________

The motto of this blog, that we all "eat smarter, look better, and live longer" requires us to squarely face the greatest threat to longevity: the chronic diseases.

Chronic disease is a natural and preventable consequence of the mismatch between our biology and the modern lifestyle, especially our diet.  The good news is that while we can’t change our biology, we can change lifestyle.  “Chronic” suggests that symptoms develop slowly over years, even decades.  Dental cavities are an early warning of a diet gone awry.  Our sugary intake leads to other symptoms: high insulin levels, inflammation, insulin resistance, atherosclerosis, high blood pressure, and metabolic syndrome (discussed here). The end result may be an autoimmune disease, cancer, diabetes, or heart disease, this week's topic.

What Causes Heart Disease?

If there were a single cause for heart disease, we would have fixed it by now.  Sadly, a generation of time was wasted on the now-discredited “saturated fat-dietary cholesterol theory.”  The simplest answer is that heart disease has multiple causes, including the following lifestyle factors:

•  Smoking is a significant risk factor.

•  Excessive sugar intake leading to elevated insulin and triglyceride levels is an important cause.  See Gary Taubes’ book, Good Calories, Bad Calories. 

•  Chronic infection is a risk as shown by the link heart disease and gingivitis.

•  Central obesity (fat around the liver and other internal organs) is a special risk, even in people of relatively normal weight.

•  The Stress Theory posits that cortisol, the stress hormone, contributes to heart disease during chronic stress.

•  Lack of exercise is a significant risk; a 1996 study found that even 15 minutes a day reduced risk by almost half.

•  High homocysteine level, a result of vitamin B deficiency, is also a risk factor.  For more on homocysteine, see the N.Y. Times article, “The Fall and Rise of Kilmer McCully.”

•  Trans fats, from hydrogenated vegetable oils, are another cause.

Heart Disease Treatments

The intent of this blog is to provide fresh insight into the power of diet to prevent disease, and not to repeat what you’ve already heard.  You likely know that heart disease is the #1 killer of women as well as men, that women display different warning signs, and that women are slower to seek emergency help.  For more on women and heart disease, go here.   

Though the incidence remains high, deaths from coronary heart disease (CHD) have declined since 1980.  Reasons include better emergency and secondary care, more attention to high blood pressure, and the cutback in smoking.  The result is that people are living longer with heart disease and treatment has become an enormous business for drug and device companies, doctors, and hospitals.  Good business doesn't mean good medicine; the following therapies are getting a second look:

• The campaign against dietary cholesterol has not had a significant benefit, and Dr. Uffe Ravnskov, MD, PhD, questions the evidence for cholesterol-lowering drugs, in books like Fat and Cholesterol are GOOD for You.

•  The survival benefit of coronary artery replacement, is now questioned.  See also, “Is Heart Surgery Worth It?”

•  The use of catheterization to expand or stent coronary arteries, except to reduce persistent angina, may not be the best treatment. 

Preventing Heart Disease

Pioneering doctors have demonstrated that lifestyle improvement, including diet, and appropriate pharmaceutical support may be the best way to treat heart disease.  Dr. Caldwell Esselstyn of the prestigious Cleveland Clinic was among the first to demonstrate that lives could be saved through diet and other changes.  His book Prevent and Reverse Heart Disease, tells the remarkable survival story of 17 patients who followed his protocol.  On the West Coast, Dr. Dean Ornish has a similar program and also a book.  Other doctors have followed these pioneers.  If you Google “preventive cardiology” you get a million hits, a sign of progress.

Here is a short list of preventive measures against heart disease:

1. Develop a muscular lifestyle.  Forget laborsaving devices.  Walk everywhere you can.  Care for your own yard.  Exercise at least 30 minutes most days.

2. If you smoke, stop.

3. Eat a healthy diet of vegetables, whole grains, fruit, nuts, fish, dairy, eggs, and a little meat.  Avoid highly processed foods, especially trans fats.  Keep intake of added sugar below the AHA level.

4. Avoid protracted stress.  Pick your battles wisely.

5. Get plenty of sleep.

6. Have fun—smell the roses, laugh a lot, enjoy friends and family.

7. Get regular physicals but take ownership of your health in partnership with your doctor.  Keep a health log with regular checks of waist circumference, blood pressure, and fasting blood glucose, etc.  

You could add, “maintain a trim waist,” to the list, but this should naturally result from following the seven lifestyle steps.

Budget wisdom:  I have always thought it wasteful to pay for both an exercise club and a gardener.  Cancel the gym membership and buy a hand mower, or plant a garden.  Rediscover the pleasure of long walks.  Without endangering your safety, save a little gas by riding a bike.  (Read about four women who rode across the US to promote preventive cardiology here.)  Try grinding wheat by hand, it’s a good workout (though it does take time).  Wash your own car, and your neighbor’s too.  Take up swimming.  Give your spouse a backrub, and a little loving.  It’s all good—the best things in life really are free.

Please comment:  How is life made more enjoyable by using your muscles?

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

The Chemical Fire Within

Short Answer: There is a chemical fire that burns within us all, managed by our immune system.  If our lifestyle forces it to burn without rest, chronic disease will eventually result.  You have been warned!
______________________________________________________________________________________________

Saturday morning I worked on this post, seeking a simple explanation for a complex and dangerous healthy problem common to the modern lifestyle—chronic inflammation.  Inflammation is the chemical firestorm driven by our immune system to respond to various threats and to heal injury.  When we mistreat our body the immune system must work without rest, and the resulting chronic inflammation sets the stage for the chronic diseases that will surely follow: metabolic syndrome (more on this in the next post), autoimmune diseases (a special risk for women of childbearing age), diabetes, heart disease, and cancer.  By the end of the morning I had made little progress on the post, which I had started the day before.

After lunch I went down to the beach to greet some guests, a pediatrician and his family.  There was a benefit at the beach for a big group of kids with type 1 diabetes.   As the kids walked by, our guest pointed out the patches and catheters for their insulin pumps.  I wanted to applaud the kids—T1D is a tragic autoimmune disease that strikes without warning, but from what I could see the kids were handling it well.  After they passed our conversation turned to nutrition and the protection of health.  I soaked up some rays—vitamin D protects against inflammation.  The 124 steps to get down to the beach are part of my exercise regime, another protection from inflammation.

In the evening we were guests of dear friends at a concert.  Orange County has a beautiful concert hall with superb acoustics, and an excellent symphonic orchestra.  The program included Gershwin’s Rhapsody in Blue, and a Rachmaninoff symphony.  It was very soothing; I held my beautiful wife’s hand and was grateful for the friendship of our hosts.  I’m no expert on classical music, but the excellence demonstrated by the orchestra planted the idea that I should reach higher in writing this blog.  It’s a worthy and meaningful goal.

Before the concert we dined at a new restaurant called the True Food Kitchen.  The menu—based on Dr. Weil’s anti-inflammatory diet—offers “simple, fresh, pure ingredients”, including vegetables, whole grains, and protein.  Anti-inflammatory diet?  I had struggled to write about it yet here it was in front of me and it tasted great.  I had the chicken chop salad.  The waitress did give me a copy of Weil’s Anti-inflammatory Food Pyramid; you can see it here.

People are becoming aware of inflammation and how it rages within us for years before the symptoms of chronic disease present.  How can you tell if chronic inflammation is a problem?  There are several tests; one increasingly used is the high sensitivity C Reactive Protein (hsCRP) test.  I had it done in a physical exam a couple of years ago and had an average score; not bad but not super good either. 

How do we reduce chronic inflammation?  Unwittingly, while struggling to write this post, the most important steps had found their way into my Saturday activities.  Healthy Changes have also taught them, with more to come.  In fact, the Healthy Changes constitute a handbook for avoiding chronic inflammation and protecting your health.  Here is a list of ten steps to reduce chronic inflammation (with links to those already presented):

1.     Reduce your sugar to below the AHA recommendation by cutting  back on sugary sodas,  avoiding sugary breakfasts, and slashing sugary snacks.

2.     Replace trans fats  and vegetable oils with traditional fats.

3.     Eat whole grains, especially fresh-ground.

4.     Eat anti-oxidant and nutrient rich fruits and vegetables.

5.     Be sparing in meat, eating more plant than animal protein. 

6.     Enjoy midday sunshine for vitamin D (but don’t get pink).

7.     Get regular exercise.

8.     Stress has a purpose, but don’t let the stress of life and work overwhelm you.  Organize your days enough to provide order, reduce chaos, and complete the tasks that make life meaningful.  The best guide to stress reduction?  The answer to this modern problem is in the Bible—take a fresh look at the Sermon On The Mount.

9.     Get adequate sleep, eight to nine hours daily, in the dark.

10.    Seek activities that build bonds with friends and loved ones, including dining together.

Budget wisdom:  The non-inflammatory lifestyle is the most affordable.  The person of modest means, who lives a simple but orderly life, enjoys friends and family, finds purpose within their faith, and takes their food as nature provided, has more chance of avoiding chronic inflammation than any billionaire surrounded by his possessions and served by his retinue.

Please comment on the lifestyle and diet choices that help you find harmony and health in daily living.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

fat city

In the last post—The Short And Sweet Of It?—we briefly discussed the health consequences of America’s love affair with sugar.  We know we eat too much sugar, it’s likely our biggest health problem, but the sugar habit is hard to break.  So this first step was proposed as Healthy Change #1:  If you consume sodas or other sugared drinks, limit yourself to one (12 oz.) serving per week.  We’re not done with sugar, we’ll return to reducing sugar intake in later posts.

This post gets after the next unhealthy food we persist in eating:  hydrogenated trans fat.  In the 20^th century we abandoned traditional fats like butter and lard in favor of modern factory-made fats, such as Crisco and margarine.  We now know this was a very big mistake.  As our consumption of traditional fats declined in favor of factory fats, there was a parallel increase in cardiovascular disease, cancer, and other chronic diseases. 

 In the last 30 years we went on a reduced-fat binge, which meant avoiding animal fats in favor of factory-processed vegetable oils.  Another big mistake; the result was we ate more trans fats and less of the healthy omega-3 fats.  By now, just about everyone knows that trans fats should be avoided.  So here is a good start on doing this (more to come):

This means no French fries, no onion rings, no corn dogs, no donuts, and especially, no deep-fried Twinkies.  The language of this Healthy Change does leave a door open:  you can cook these foods at home, using healthy oil.  Because this is difficult, in our home we replaced French fries with oven-roasted potatoes (recipe coming soon!).

How did trans fats become so entrenched in our diet?  It started with the invention of hydrogenation and the introduction of Procter & Gamble’s Crisco in 1911.  Crisco shortening was followed by the introduction of a butter substitute, margarine.  Both these products are full of trans fats and depleted of healthy omega-3 fats.  Because hydrogenated oils are cheap and have a long shelf life, they also found their way into a multitude of processed foods and fast foods. 

What was most remarkable about Crisco was how easily it replaced a product people had used for centuries—lard.  It happened practically overnight.  A 1921 book, The Story of Crisco, tells how the product was presented:  It seems strange to many that there can be anything better than butter for cooking, or of greater utility than lard, and the advent of Crisco has been a shock to the older generation, born in an age less progressive than our own, and prone to contend that the old fashioned things are good enough.  It was a clever pitch that disarmed the wisdom of tradition and it worked.

As it turns out, the “older generation” was quite wise in preferring olden ways.  The rest of us ate Crisco and margarine for a long time before we learned how harmful trans fats were to our health.  Today the merits of the old fats—butter, olive oil, and lard—are being rediscovered. 

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.