Tag Archives: heart disease

What you need to know about heart disease

February is American Heart Month, a time to raise awareness about heart disease, the leading cause of death among adults in the United States. Heart disease, sometimes called coronary heart disease or coronary artery disease, is responsible for nearly 375,000 deaths each year, mostly from heart attacks. Over 13 million adults have been diagnosed with heart disease and, if other cardiovascular diseases like high blood pressure, heart failure, and stroke are included, that number jumps to 80 million. (more statistics are available from the American Heart Association)

The process that leads to heart disease is called atherosclerosis and is characterized by the accumulation of cholesterol-containing plaques in the coronary arteries, the vessels that supply blood to the heart. These plaques narrow the vessels and reduce the amount blood delivered to the heart. The heart requires a constant supply of oxygen to beat and any narrowing in the vessels reduces blood flow and interferes with normal heart function. A decrease in oxygen delivery can cause chest pain (angina pectoris), especially during activity or exertion. It is usually relieved with rest, but can limit normal activities. A complete blockage in blood flow causes a heart attack, also called a myocardial infarction or MI, in which the heart muscle is damaged, sometimes permanently. Many MIs lead to death because dangerous arrhythmias—abnormal heart rhythms—develop that lead to cardiac arrest.

The traditional view of heart disease holds that the cholesterol plaques progressively narrow the arteries until they close completely, a process similar to a blockage in a pipe in your house. It turns out that the process of atherosclerosis is more complex. In fact, most heart attacks occur because of vessels that are around 50% blocked.

Current evidence shows that inflammation plays an important role in the accumulation of plaque in the vessel walls. Additionally, inflammation plays a role in making the plaques unstable and prone to rupture, resulting in a blood clot in the artery which completely blocks the flow of blood leading to a heart attack. This makes more sense if you think of the inside of a blood vessel like your skin. A cut on your finger results in inflammation and the formation of a blood clot which stops blood flow. A similar process occurs inside the coronary arteries to lead to an MI.

The process that occurs in coronary arteries also takes place in other vessels. A blood clot that forms in a vessel in the brain can cause a stroke, sometimes called a “brain attack” because the process is similar to a heart attack. Narrowed vessels that reduce blood flow to the brain can cause a reversible condition called a transient ischemic attack (TIA) or mini-stroke. Narrowed arteries in the legs can cause muscle pain during exercise or activity.

Atherosclerosis is a process that starts when we are young and progresses as we age. It generally doesn’t cause symptoms like chest pain until the arteries are at least 70% narrowed, so most people are unaware that it is happening. The process is accelerated by conditions like obesity, diabetes, high cholesterol, and high blood pressure as well as risk factors like a high fat diet, lack of exercise, and smoking.

Genetics play a role, too, but since you can’t change your genes, the emphasis is placed on factors that you can control. It turns out that making lifestyle changes can greatly reduce your risk of heart attack, and may even reverse the process that causes heart disease.

I will continue to celebrate Heart Month with more information about how to assess your risk for heart disease and what you can do to prevent and treat heart disease.

 

When it comes to your health, don’t take the high road.

When faced with challenging moral or ethical situations we are advised to do what is right, even if it is more difficult. “Taking the high road” is often synonymous with living a better life. When it comes to your health, though, taking the high road may lead you on a path to chronic disease, disability, and early death.

The high road I am referring to in this case has nothing to do with ethical decisions. It has to do with test results, specifically measurements your doctor makes of your weight and blood pressure as well as blood tests of cholesterol and glucose. This is the topic of my Health & Fitness column in the Aiken Standard this week.

These tests are indicators of your current health as well as risks to your health in the future. The results of these measures are used to classify you as having “normal” or “high” blood pressure, blood glucose, and blood cholesterol. For example, a fasting blood glucose between 70–100 mg/dl is normal but you are considered to have diabetes if your result is 126 mg/dl or higher.

Even if your blood glucose is above normal (100–125 mg/dl) but isn’t high enough for you to be classified as diabetic, it may still be too high. This condition is called prediabetes because without intervention most people in this category will eventually develop diabetes.

Considering that diabetes is a leading cause of heart attacks, blindness, and amputations, preventing your blood glucose from increasing should be a high priority.

The same is true for other measurements including blood pressure and body mass index (BMI), the most common assessment of obesity. Even if you aren’t considered obese or don’t have hypertension, the higher your BMI or blood pressure becomes puts you at increased risk of the condition getting worse over time or leading to other more serious health problems.

In fact, even within the normal range, a higher value is associated with increased health risks. Take blood cholesterol for example, where the risk of heart disease increases at total cholesterol levels above 150 mg/dl, well within the “normal” range of less than 200 mg/dl. At even higher levels, total cholesterol is associated with a much greater risk.

Clearly, having a high BMI, blood pressure, blood glucose, or cholesterol is concerning. But it is important not to be fooled into thinking that a value that is technically below the diagnostic criteria for “abnormal” is necessarily “normal.” For many, even slightly elevated levels of these variables now are likely to get worse over time.

The good news is that modest lifestyle changes including weight loss, regular moderate physical activity, and changes to what you eat can prevent conditions like prediabetes and prehypertension from getting worse. This can be achieved through losing as little as 10 pounds, walking or doing other activity for 30 minutes per day, and adding more fruits and vegetables to your diet.

To be sure, taking the “high road” with BMI, blood pressure, cholesterol, and glucose, even if your test results are within the normal range, can put you at increased health risk. For these conditions, you are far better off taking the low road and making the necessary lifestyle changes to stay there.

“Heart” your heart.

Today is World Heart Day, with a focus on encouraging all of us to make heart-healthy choices to reduce cardiovascular disease risk. I thought that sharing some information about the heart, how it works, and how to keep it healthy would be an appropriate way to celebrate. This is also the topic of my Health & Fitness column in the Aiken Standard this week.

Your heart started beating months before you were born and will continue to beat every second or so…until it stops, signaling the end of your life. During your lifetime, your heart will probably beat more than two billion times, or about 100,000 times per day. (more interesting heart facts here)

The major function of the heart is to pump blood to all of your tissues through the arteries and back again through the veins. The heart has four chambers: the left and right atria that receive blood from the veins and the left and right ventricles that pump blood into the arteries. The right ventricle pumps blood to the lungs to pick up oxygen and the left ventricle pumps oxygenated blood out to the rest of the body.

The activity of your heart will vary throughout the day. At rest your heart rate is low, typically around 70 beats per minute. Some athletes have resting heart rates that are much lower, owing to their bigger, stronger hearts.

But when you are active your heart beats faster and more forcefully to eject more blood to the working muscles. During intense exercise, a young person’s heart rate can go above 200 beats per minute and the amount of blood pumped can be five times higher than at rest!

The heart is made up mostly of muscle that functions similarly to the skeletal muscles you use to move your body. But cardiac muscle is different in that it can spontaneously contract when stimulated by a specialized area of the heart called the SA node or pacemaker. And unlike skeletal muscle, the heart is remarkably fatigue-resistant, meaning that it can contract repeatedly without needing a break.

In order to beat continuously, the heart needs a steady supply of oxygen which is delivered through coronary arteries, not from the blood inside the chambers of the heart. Normally, plenty of oxygenated blood gets through. But if the coronary arteries become narrowed through atherosclerosis, the accumulation of plaque in the vessels, blood supply can be limited.

This can lead to reversible symptoms like angina pectoris (chest pain), especially during exertion. If a clot forms in the narrowed vessel, blood flow can be blocked completely causing a myocardial infarction (heart attack). Heart disease can be managed using medications, angioplasty, or bypass surgery, but the best approach is to prevent the problem from occurring in the first place.

Taking care of your heart is one of the most important things you can do for your health. Like other muscles, regular exercise can make your heart larger and stronger to pump blood more effectively. Exercise also lowers your blood pressure and can help reduce your blood cholesterol, further reducing the risk of heart disease.

A diet that is low in salt and unhealthy fats, like trans fats, can help lower blood pressure and cholesterol, slowing the process of atherosclerosis and preventing heart failure, a condition in which the heart muscle becomes weak. Maintaining a healthy body weight and controlling blood glucose are also keys to a healthy heart.

More than anything, though, your heart likes to be active. So celebrate World Heart Day by taking your heart for a walk!

 

The diet wars continue

If you are confused or frustrated by the conflicting claims about whether a low-fat or low-carbohydrate diet is the best, you are forgiven. First we were told that eating a low-fat diet was the best way to lose weight and improve heart health. Then, research suggested that low-carbohydrate diets were better. And back and forth it has gone for years.

During this time, the prevailing recommendations have suggested that a diet low in fat and high in carbohydrates was best. But more and more research has supported the notion that cutting carbohydrates, not fat, would lead to greater weight loss. Although this has been supported by some research, critics pointed out that eating more fat would raise blood cholesterol and other risks for heart disease.

According to a recent study, though, low-carbohydrate diets seem to have benefits for promoting weight loss and improving some indicators of heart health over low-fat diets. But you should hold off on shunning fruits and vegetables in favor of cheeseburgers! Here is a practical interpretation of the research and some common sense recommendations, taken from my Health & Fitness column in the Aiken Standard this week.

The study, published last week in the Annals of Internal Medicine, reported on 150 men and women who either restricted the amount of carbohydrates or fat they ate. After one year, the group that ate a low carbohydrate diet lost over 7 pounds more than the subjects on the low-fat diet. Additionally, the low-carbohydrate diet promoted greater improvements in blood lipids than the low-fat diet.

This is important for two reasons. First, this wasn’t a weight loss study; the researchers were simply following the subjects to see what would happen as they followed either diet. The fact that the low-carbohydrate group lost more weight suggests that it is relatively easier to cut calories following this type of diet.

This is consistent with other research showing that eating more carbohydrates, especially refined carbohydrates and sugar, can actually make people feel hungrier and eat more. Indeed, other studies have shown low-carbohydrate diets to be more effective for weight loss than low-fat diets (although a more recent study suggests there isn’t such a difference).

Second, the greater decrease in triglycerides and “bad” LDL cholesterol and increase in “good” HDL cholesterol in the low-carbohydrate group were different from what might be expected. Conventional wisdom holds that a low-fat diet should have a greater effect on blood lipids. Since weight loss can have a big effect on blood lipids, the improvement in the low-carbohydrate group may be due to losing more weight, not a direct effect of the diet.

It is important to note that the low-fat diet also led to weight loss in this and numerous other studies. The critical component of any weight loss diet is that it is relatively low in calories, regardless of what nutrients supply those calories. Really, almost any diet will lead to weight loss as long as it contains less energy than what is expended, but a low-carbohydrate diet may be more effective for weight loss than the traditional low-fat diet.

The bottom line is that the best diet is one that emphasizes eating wholesome foods, not on cutting carbohydrates or fat. That said, limiting carbohydrates in the form of refined grains and added sugar is an excellent way to reduce calorie intake and improve the overall nutritional value of what you eat. And shifting toward more monounsaturated fats (think olive oil and nuts) rather than worrying about the total amount of fat you eat is also a good idea.

To make your diet healthier, add exercise.

The American diet is frequently blamed for the poor health of Americans and, increasingly, other countries. The quest for the healthiest way to eat can literally take people around the world to find the right foods eat.

Unfortunately, diets and supplements that include these “super foods” are rarely the answer to good health on their own. It turns out that the key getting the optimal health benefits from your diet isn’t the food itself—it’s exercise!

This is the topic of my Health & Fitness column in the Aiken Standard this week. It’s not to say that what you eat isn’t important (it is!). The point is that healthy eating will only get you part of the way to the goal of good health.

For decades scientists have tried to isolate the types of foods or individual nutrients that lead to good health by studying what healthy and unhealthy people eat around the world. In some studies eating more of a certain nutrient or food, like saturated fat or red meat, was associated with a higher risk of heart disease and people who ate more fish had better heart health.

This is how we arrived at the common guidelines that encourage us to eat more fish and less red meat. The assumption was that the saturated fat in red meat was the cause of more heart attacks in Americans while the beneficial oils in fish protected the Japanese from heart disease.

But these studies, or at least the interpretation of these studies, didn’t take into account the fact that the populations that had the higher heart attack risk were also less active than their healthier counterparts. Perhaps it was the physical activity that made the difference in health.

A good example of this is the popular Mediterranean diet, which is often touted as the healthiest diet in the world. It’s true that people in the Mediterranean region historically tended to have a lower risk of heart disease. This was thought to be due to their diet which emphasizes healthy fats from olive oil along with vegetables, whole grains, seafood instead of red meat, and red wine in moderation.

Unfortunately, eating more olive oil or drinking more red wine, both recommendations based on the Mediterranean diet, won’t necessarily make you any healthier. This is because health benefits are due to a complex interaction of what we eat and other lifestyle factors, including activity. And people in the Mediterranean region move a lot more than we do, a key to realizing the benefits of the local diet.

Another example is the Ornish diet, a low-fat, semi-vegetarian diet that has been credited with improving blood lipids and even reversing the process that clogs arteries in heart disease. This is part of the reason for the recommendation to avoid foods high in saturated fat and cholesterol and eat more vegetables. It’s true that this diet has been shown to improve heart health, but the subjects in the studies also exercised regularly. Achieving the full benefits of this diet requires exercise, too.

Even the typical American diet won’t necessarily be unhealthy when combined with enough exercise. The Olympic swimmer Michael Phelps famously revealed what he ate on a typically day. The amount and type of foods he consumed were not what you would expect from someone so fit and healthy! Without the hours of training he engaged in each day that diet would almost certainly have resulted in obesity and poor health.

So, as you work toward improving your diet, don’t forget about the importance of daily exercise or other activity in maximizing the health benefits. And when people ask your secret, you can tell them that the real key to a healthy diet is exercise.

Don’t go into (health) debt!

We are all aware of the hazards of being in debt. Too many individuals and families have gotten themselves in a poor financial situation by spending too much and not saving enough. For most, this debt has developed over several years and will have an impact lasting years into the future.

Unfortunately, this is not the only debt we face. Many of us are also in a health debt crisis. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Poor eating habits and increasingly sedentary lifestyles have led to an obesity epidemic. This is important since the three leading causes of death among adults (heart disease, stroke, and cancer) are directly linked to poor diet, inactivity, and obesity.

Obesity, diabetes, heart disease, and cancer are among the conditions that make up our health debt. Even if we have not been diagnosed with these or other health conditions, our lifestyle has put us on that path.

Whether our doctors have told us or not, many of us are in poor health. And our overall health and potential complications get worse each year, so the longer we are overweight and inactive, the worse our health is likely to be in the future. That is our health debt crisis.

Another example of a health debt is smoking, the cause of nearly 90% of lung cancer cases. Lung cancer doesn’t develop after the first cigarette; it takes years of smoking to cause cancer. One estimate suggests that there is a 20 year time lag between smoking and lung cancer diagnosis.

During this time smoking is causing damage to the lungs that leads to cancer, but it is usually undetectable. The cancer process is underway long before it causes symptoms, and since smokers are unaware of it, they continue to smoke. Quitting smoking begins to erase this debt but former smokers suffer poor health even after they quit. In some cases, the debt can’t be completely paid back.

Aside from poor health and reduced quality of life, health debt carries a financial cost. The medical costs attributed to obesity alone are estimated to be $147 billion per year, and a typical obese patient spends over $1,000 more per year on their own medical care than someone at a healthy body weight. The financial burden is both collective and individual, meaning we all pay for it.

Just as financial debt is due to an difference between the money we save and what we spend, much of our health debt is due to an imbalance between the energy (calories) we save and spend.

We have been spending too little energy through activity and saving too much of the energy we eat in the form of fat. Each day we consume more calories than we burn, we store that extra energy as fat. Even a small difference each day adds up over time.

Putting it in these terms, the pathway out of health debt is clear—spend more energy by being more active and cutting back on the calories we eat. Like a financial debt, even though the solution is easy to identify, putting it into place requires making some difficult choices.

But it doesn’t have to be a painful process. Even small changes in activity and diet can lead to weight loss and improved health over time. Make it a priority to be active every day and try to spend less time sitting. Pass on second servings at meals and skip desert once in a while.

Remember, the health debt wasn’t created overnight. It was the result of small changes over time, some of which we may not have noticed. Fixing it will take time, too.

Are fat-free and sugar-free foods healthy? Maybe not!

Have you ever felt confused by the health claims made about some foods? If so, you are not alone. Nutrition is isn’t always easy to understand and, unfortunately, misleading information on food labels only makes it worse.

There are a great many foods that seem as though they would be healthy choices for weight loss or good health in general. Surprisingly, some of these low-fat and low-sugar alternatives aren’t as healthy as you might think.

This is because, in many cases, the claims on the label only tell part of the story. This isn’t to say that the information is false, but it does require some interpretation to understand whether these foods are really a healthy choice.

My Health & Fitness column in the Aiken Standard this week includes two examples of label language that seems to indicate a healthier option, but may not necessarily be the case:

1. Fat-free

Cutting back on fat intake is a good way to reduce calories and is typically recommended for weight loss. It is also a major part of traditional recommendations to lower cholesterol and prevent heart disease, although recent research suggests this may not be so important.

In order to meet a demand for lower fat and lower calorie foods, manufacturers have long offered fat-free versions of popular items. Cookies, snack foods, and salad dressings are among the most popular fat-free foods, especially for people who are trying to lose weight.

However, the number of calories in the fat-free foods may be the same as the full-fat versions because manufacturers often add sugar to make these lower fat foods taste as good. This is often the case for cookies, cakes, and other fat-free baked goods.

In the end, these fat-free foods may not really be lower in calories. And common sense tells us that the best way to reduce calories is to eat fewer of these snack foods and dressings in the first place.

 2. Sugar-free

Reducing sugar intake is also a popular way to limit calories in many foods and beverages. Currently, sugar is viewed as a major contributor to obesity and poor health in general, so this also makes some foods appear to be healthier than they really are.

While it is true that sugar-free versions of desserts and snack foods do usually contain fewer calories, the alternative sweeteners used instead raise some concerns. While there is no good evidence that these sweeteners are harmful, they certainly don’t make these foods any healthier.

It is important to note that the concern is with foods that have added sugar, such as packaged or prepared desserts, baked goods, and snacks. Foods with naturally occurring sugars like fruits, fruit juices, milk, and some vegetables are not worth worrying about.

Again, the most reasonable approach to creating a healthy diet is to eat fewer foods with added sugar, not looking for foods that replace added sugar with artificial sweeteners.

The Bottom Line

The problem for most people isn’t that they are eating cookies with too much sugar or salad dressing with too much fat, it’s that they are eating too many cookies and using too much dressing in the first place. Lowering fat or sugar in these foods does little to make people healthier.

The only way to do that would be to limit the intake of these processed foods in favor of more “real” food. Indeed, fruits, vegetables, nuts, and natural oils (like olive oil) are widely thought to be healthful, certainly better than processed and modified alternatives.