The Big Ticker: Heart Disease

Clench your fist—that’s about the size of your heart. Located in the center of your chest, the heart beats about one hundred thousand times a day, pumping five to six quarts of blood per minute.

Once the blood receives oxygen from the lungs, the heart sends the blood from the aorta through the arteries and into the capillaries, which are smaller, thinner blood vessels. Then, once the capillaries have brought oxygen and nutrients to every cell in the body, the blood is redeposited into the veins, and from there it goes back to the heart for the cycle to begin again.

So what we have here is a plumbing system essentially, a smart pump with different connecting parts that circulates blood throughout the body. The heart itself is made up of four chambers—the two up top are called the atria, the two on the bottom are called the ventricles—connected by a set of valves. And the whole system is set in motion, or beats, thanks to the electrical impulses sent out by a small bundle of specialized cells in the right atrium that act as the heart’s natural pacemaker, causing the muscles of this organ to contract and relax.

Any malfunction of this blood pump is known as heart disease, of which one of the most common types is coronary artery disease. It is the number-one killer of both men and women in the United States. Half a million people die of it each year, and more than 12 million people have the disease.

Coronary artery disease, also known as coronary heart disease, is a narrowing and obstruction of the coronary arteries, which are responsible for bringing oxygen and nutrients to the heart itself. As early as your teen years, fat deposits begin to develop in some of these arteries, and as time goes by, the fat deposits build up, ultimately creating an obstruction that begins to decrease the amount of blood to the heart and cause an inflammation as the artery tries to heal itself.

Over time the fat deposits in the arteries begin to harden, and you begin to get deposits of small platelets that compound the obstruction. All of this can lead not only to a significant narrowing of the arteries, but to blood clots that may either obstruct the artery or get dislodged and create further obstructions elsewhere in the plumbing system.

One of the consequences of this narrowing or total obstruction of the coronary artery is ischemia, which occurs when there is an insufficient supply of oxygenated blood for the heart muscle. Any activity—eating, excitement, or changes in temperature—can make the problem worse.

One of the most common symptoms of ischemia is angina, which is a discomfort, heaviness, pressure, numbness, or squeezing feeling in the chest. Sometimes it is mistaken for indigestion or heartburn. It is usually felt in the chest, but it can also migrate to the arms, especially the left shoulder. Other symptoms include shortness of breath, irregular heartbeats or palpitation, a very fast heartbeat, nausea, and sweating. If this ischemia is not corrected, if it lasts more than 30 minutes and does not get better, a heart attack may result.

In a heart attack, the heart muscle begins to fail, either through a very erratic electrical stimulation called an arrhythmia or by stopping altogether. It is important to recognize these symptoms because early intervention could save your life.

A doctor can tell you if you have coronary artery disease by discussing your symptoms, especially shortness of breath, taking your medical history, and looking at your risk factors, in particular, smoking, cholesterol, blood pressure, and sugar control. There are a host of diagnostic tests your doctor can do, such as an electrocardiogram (ECG or EKG); an exercise stress test; an ultrafast CAT scan, which looks for calcium deposits in your coronary artery; and cardiocatheterization, which can help determine the degree of obstruction of the artery.

If you are diagnosed with coronary artery disease, treatment is threefold. The first has to do with lifestyle changes, like quitting smoking, starting to exercise, and keeping to a low-fat, low-sodium, low-cholesterol diet.

The second aspect of treatment is medication, which may be needed to get your heart working more effectively. Other medication will be prescribed to reduce the cholesterol.

The third aspect of treatment has to do with procedures to help improve the blood flow through the coronaries. One possibility is a balloon angioplasty, in which a small balloon-tipped catheter is inserted into the coronary arteries and then inflated to open up the clogged artery. Another possibility is placing a small, metal stent inside the artery to keep it open and improve blood flow.

A heart bypass operation takes place when total replacement of the piece of the coronary that is obstructed becomes necessary.

Plumbing Vs. Electrical Problems

Other types of cardiac disease have nothing to do with obstruction of the coronaries but with the way the electrical system of the heart works. Sometimes the specialized cells that electrically stimulate the heart become dysfunctional, and you can develop an arrhythmia, where the heart beats either too slowly, too quickly, or out of sync. These conditions can be diagnosed with an electrocardiogram, and sometimes medications alone can help to regulate the rhythm.

Another common problem is heart failure. This occurs when the heart can no longer effectively pump all the blood that it receives. Heart failure affects about five million Americans, and it’s the leading cause of hospitalization of people older than 65. Many times, heart failure is due to prior damage caused by coronary artery disease, or by arrhythmias that have weakened the function of the heart. Ultimately, heart failure creates a backlog of pressure into the lungs, and people with heart failure tend to have difficulty breathing. Depending on the cause of the heart failure, different medications are available for treating it.

The valves of the heart are another source of heart problems. The valves can be damaged at birth or through infection. Abnormal or infected valves can interfere with normal blood flow and heart function and can lead to major cardiac disease. Surgery may be needed to replace the valves.

Sometimes the lining of the heart may be infected, a condition called pericarditis. If this membrane is inflamed, the heart may not beat properly. Valve abnormalities, arrhythmias, and heart failure all have a common symptom—shortness of breath or difficulty catching your breath. If you have this problem, see a cardiologist to get the correct diagnosis and treatment.

The heart is a remarkable organ. It is the core of life, and its beat is central to your survival. Keeping it in prime working order is of paramount concern.

All for One and One for All

When we talk about heart attacks, we tend to describe them in a way that suggests there are different kinds of heart attacks. But those are just words to describe our experience of the same underlying disease.

Number one is the silent heart attack. Here you don’t have major chest pain, you don’t have shoulder pains, you may have a little palpitation, but you’re not tired, you’re not fatigued, and you’re not dizzy. However, when you go in for a physical, the doctor finds that you have had a silent heart attack.

Number two is typical angina. This is the chest pressure that doesn’t go away, and you have thirty minutes to get yourself to an emergency room.

Number three is the sudden heart attack. This occurs when you have a major, catastrophic obstruction in a main branch of the coronary artery, and a very large area of your heart is instantly void of any blood.

Even though the three heart attacks described here evolve differently, the underlying theme is the same—they all involve chronic coronary artery disease. In other words, you don’t go around with a normal coronary artery one day and the next day develop a major clot. That’s just not the way it works. The heart attack may present itself differently in different people, but the cause is the same no matter how we experience the critical moment.

A Heart Test for Venusians

What works for men, doesn’t always work for women. We all know that, but medicine is just catching up to the fact.

The standard test for heart disease is known as an angiogram. In this test a dye is injected into the coronary arteries, which are then X-rayed to look for blockages. The test is very effective in detecting heart disease in men, but a new study has discovered that this test often misses the symptoms of heart disease in women. When the tests turn up nothing, women are given a clean bill of health, even though as many as 3 million women could be at risk with a buildup of fatty deposits that could ultimately interfere with blood flow to the heart and cause a heart attack.

Hidden heart disease may be a significant problem in women. It appears that one cause may be due to a phenomenon called arterial remodeling. This means that the artery dilates as plaque is deposited in the blood vessel so that, in the early stages of atherosclerosis or coronary artery disease, very little overall narrowing is seen on an angiogram. But late in the disease, the deposits may overwhelm the body’s ability to compensate by remodeling, and severe narrowing or complete blockage can occur. If this happens, a sudden heart attack can result.

To diagnose heart disease in women, physicians will now have to use the new generation of CT scanners and magnetic resonance scanners, which can visualize the heart’s blood vessels with ever-greater detail. In many cases, these tests can detect problems before a stress test or a conventional angiogram. Physicians should test for the presence of coronary artery disease in women who have risk factors for heart disease such as diabetes, hypertension, high cholesterol, a family history of heart disease or stroke, or nicotine use.

The moral of this story is: paying closer attention to the vast differences between men and women could save lives—in this case, women’s lives.

Which Fruit Are You?

Researchers have long noted the importance of body shape in determining a person’s risk factors for heart disease. They talk about the apples versus the pears. The apples tend to store their access fat in their stomach and chest. The pears store it below the hips, in their thighs and buttocks. A recent study found that a person’s waist-to-hip ratio is an even better predictor of cardiovascular risk than their body mass index, or BMI, the commonly used ratio of weight to height. It appears that a large waist size, which generally indicates large amounts of abdominal fat, is more harmful than a larger hip size.

Determine your body shape and risk for cardiovascular disease by calculating your waist-to-hip ratio. First, measure your waist at its smallest circumference; then, measure your hips at their widest. Next, divide your waist measurement by your hip measurement. For example, a person with a thirty-six-inch waist and forty-inch hips would have a waist-to-hip ratio of 0.9. Waist-to-hip ratios over 0.85 in women and over 0.9 in men are strongly associated with an increased risk for heart disease.

You Are What You Eat

I think Americans generally pay more attention to the gasoline they put in their cars than to the food they put in their mouths. We are a society of excess, and one of our more impressive excesses is the way in which we eat and what we choose to put in our mouths.

We are the leading country in the world in almost everything, yet our mortality rates, our cancer rates, and our neonatal death rates don’t rank among the best in the world. We lead in research, we lead in academic training, we lead in freedom of information, yet we don’t lead in taking care of our health.

We have all the knowledge in the world about everything in life, but that has made no impact on our health. Why? I think nutrition is part of the reason, and I think I know why.

No one is ever taught about nutrition. We certainly don’t teach the subject in grammar school, and it’s rarely taught in high school. Some colleges may offer it as an elective. But our parents certainly don’t talk to us about carbohydrates and proteins the way they do about the birds and the bees. If you combine this lack of knowledge with our appetite for diversity, taste, and presentation, what you have is a lot of people who know nothing about the food on their plate.

It’s never too late to learn about nutrition. The fundamental issue with nutrition is learning how to balance your caloric intake with the number of calories you burn. Everything we eat has a caloric value. If you take in more nutrients that contain a lot of calories and you don’t burn them up, the excess caloric energy is going to be stored as fat, and you’re going to gain weight. That weight and that fat will then interfere with all the normal functions of your body.

On the other hand, if you consume too few calories, say fewer than 1,200 calories a day, then your body doesn’t have sufficient energy to maintain adequate functioning. The caloric intake for a normal adult should range between 1,500 and 2,000 calories a day.

The body requires certain nutrients in order to work properly. Nutrients are the chemicals our body gets from food. These nutrients are used to build muscles, improve cell-to-cell transmission, and manufacture hormones. In describing nutrients, the word “essential” means that the body must consume them; it cannot produce them on its own. The nutrients we need include:

Essential amino acids.
The body requires amino acids to produce new body proteins and replace damaged proteins to build and maintain the body.

Vitamins and minerals.
These are recognized as essential nutrients that are specifically linked to the functionality of cells. If we’re deficient in vitamins and minerals, we develop a weak immune system, cell metabolism disorders, premature aging, scurvy, goiters, and bone loss.

Fatty acids.
Also essential, fatty acids are crucial for maintaining the body’s normal health. They are responsible for the normal formation of hormones and creation of some of the biological pathways responsible for dealing with inflammation and cell repair.

Sugars.
They are essential because they provide the fuel our cells need to function adequately, which allows the other nutrients to be utilized properly. If cells don’t have the sugar molecule necessary to generate the energy required for repairing, functioning, transmitting, and utilizing nutrients, then cellular damage and disease will result.

Each nutrient carries out one or more unique tasks your body needs to function. And because you need many nutrients to stay healthy—protein, fat, carbohydrates, vitamins, minerals—you have to eat a wide variety of foods to get them all.

It’s when we don’t recognize the necessity of all those elements that we begin getting into trouble. It’s like filling your gas tank with gasoline and forgetting to change the oil every 3,500 miles, or forgetting to put water in the radiator. The car needs the gasoline, the oil and the water, all in the proper proportions, in order to function properly. The same is true of the human body.

The problem, as I’ve mentioned before, is that about one-third of all American meals are prepared foods. And the problem with prepared foods is that their contents are not nutritionally balanced.

Our lack of knowledge of nutrition, combined with our obsession with processed foods, is really damaging our health. So we have to get back to fundamentals, a good example of which is the diet of people who live in the Mediterranean. Their diet is well balanced with vegetables and fruit, fish and lean meat, and the good unsaturated fats like olive oil.

Today, many people think that if they stick to low-fat or nonfat foods, they won’t gain weight. That’s a myth, because gaining weight has to do with calorie intake. If you take a salad and you add cheese and eggs and everything else in the book, even if you select low-fat ingredients, you’re still consuming a tremendous load of calories. And size matters, too; the size of your portions does make a difference in terms of the total amount of calories consumed. It’s just a plain mathematical calculation.

There are no magical foods that are going to help you burn calories or increase your cell metabolism either. There is no such a thing as a food that is more active in the body than others. People think that eating a grapefruit each day or having cabbage soup for lunch is going to burn off their fat. But that’s a myth. There is only one way to burn off those extra calories: exercise, any exercise at all.

How to Eat
It’s not just what or how much we are eating that’s the problem these days, it’s the way most of us eat. Many people skip breakfast, gulp down a quick lunch at noon, and then consume a large meal at seven o’clock at night.

Trouble is, they don’t need all that fuel at night. They need a little bit throughout the day when they are active—either moving, thinking, or both.

So what happens in the middle of the day if this is the way we eat? Without a supply of energy, our metabolism gets altered. Our blood sugar level is erratic. Our hormones go haywire trying to figure out where to obtain the fuel we need. People are always telling me, “I don’t eat, so how come I’m not losing weight?”

That’s the answer. Their metabolism is out of whack, and they need to get it back in order.

Supplements
If you eat a balanced diet with fruits, vegetables, grains, fish, and all the rest, you don’t need to take supplements. But how many of us really eat such a balanced diet?

And even if we do, because we are all predisposed for certain diseases and the aging processes, being proactive and adding certain supplements to our diet may be a good idea. But before popping supplements like candies from a bag of M&M’s, check with your doctor about what’s best for you. Some supplements can be toxic. Others may cause allergies or cross reactions with medications you may be taking. But there is no doubt that certain supplements can have specific health benefits and can lower the cost of health care at the same time.

An Important Word About Supplements
Many supplements contain active ingredients that can have strong effects on your body, and some supplements can interfere with prescription medicines. Always consult with your doctor or pharmacist before taking supplements.

I am particularly bullish on five supplements that have been well studied and are proven to support optimal health.

Omega-3 Fatty Acids
I love the omega-3 fatty acids. They are an important contributor to the improvement of human health. Some studies have shown that omega 3s are good for the prevention of heart disease, as well as for depression, rheumatoid arthritis, and asthma. You can get omega 3s by eating leafy greens and fish or by taking a fish oil tablet. Omega 3s assist with fat metabolism and help maintain a balance of good and bad cholesterol.

Calcium
Calcium is another very good supplement, specifically calcium with vitamin D. Calcium intake is an important factor in bone health and may play a role in the prevention of colon cancer, though it doesn’t appear to be the silver bullet that everyone hoped it would be. Research has shown that calcium supplements can significantly lower the occurrence of hip fractures among those aged 65 and older.

Folic Acid
Folic acid and folate are forms of a water-soluble vitamin B that occur naturally in leafy vegetables such as spinach and turnip greens, dry beans and peas, fortified cereal products, and some other fruits and vegetables. Folic acid supplements have been a lifesaver in the prevention of neural tube defects in children. They are also very beneficial for cell function and the prevention of heart disease.

Glucosamine
I also like glucosamine. It has good anti-inflammatory effects, especially for individuals with arthritis. It doesn’t prevent arthritis, and it doesn’t repair or rejuvenate cartilage, but I think it’s a very good supplement because it helps promote joint function and relieves the symptoms of inflammation and pain.

Other supplements that are thought to make a positive contribution to health include saw palmetto, the fruit of the fan palm, for men. Native Americans consumed it as food and used it to treat urinary and genital problems. Some research has shown that it could be effective for the treatment of an enlarged prostate in men. It increases urinary flow and has no known safety hazards.