Start Helping Your Heart
By Michael F. Roizen, MD
I truly have an enjoyable medical practice—what I get to do is the most fun you can have with your clothes on. I get to help people chose to be healthier and live with less disability.
My typical patient is a 50-something guy (although I also see women and people ranging from those in their early 20s to those in their early 100s) who asks one of the following questions:
- Unfortunately, I was not as conscientious about heart health in my 20s and 30s, and now I have some pretty serious arterial blockages. What can I do before these get me?
- There is a big history of heart disease in my family. What can I do to make sure my bad genes do not get to me?
- I have had a heart attack. My doctor gave me three stents, put me on a blood thinner and a statin, and said I could do whatever. My spouse wanted me to see you about lifestyle things. I know I should exercise and cut down on red meat, but do these or anything else make a real difference if I am already on a statin?
Most patients do not realize that looking old (having wrinkles, etc.), stroke, impotence, most memory loss, and heart attacks are part of the same process: arterial aging. So no matter how motivated my typical patient seems by the phrasing of their questions, I review with each patient the five steps of arterial aging: injury, immediate repair with a fatty streak, chronic inflammation, acute inflammation and rupture, and clot formation. I assure that the individual can, to a large degree, have control over each step. Then the dialogue usually goes like this: “You get to control your genes—and you get a do-over.”
That answer is easy: The data are very solid that diet and other lifestyle choices—like physical activity (as in cardiac rehab), stress management, avoiding tobacco (that includes secondhand smoke), and even flu shots (they decrease inflammation)—add to optimal drug management to decrease heart attack and cardiac death rates after a first heart attack, and in preventing arterial aging.
Recently, an international study indicated that those individuals (more than 31,000 men and women of average age 66, in this study) who chose whole grains, fruits, veggies, nuts, and fish over meat, eggs, and simple carbs had a 35 percent reduction in cardiac death rates during a 5-year time period. That is a 35 percent reduction in addition to the decrease from surgery and optimal medical management.
Because four factors control more than 50 percent of heart disease, we’ll start with these lifestyle changes that can drastically reduce your risk for heart problems.
Kiss Your Butt Goodbye
No, we are not talking about weight, but about tobacco—which is still the leading cause of heart disease and strokes (not to mention cancer). Even if you do not smoke but live or work in a smoke-filled environment, you will likely still experience related complications, like disease and signs of aging. Did you know that spending just one hour in the presence of secondhand smoke is the equivalent of smoking four cigarettes?
Whether the smoke you are breathing is from your own cigarette or someone else’s, or even from someone else’s water pipe or e-cigarette, it ages your arteries, increases your risk of heart and lung disease, weakens your immune system, and promotes cancer.
Feed Your Heart
These days, you do not have to be a dietitian to know that certain foods will create some serious roadblocks on your arterial highways. Simple carbohydrates, added sugars and syrups, saturated fats, and trans fats are five choices that start, accelerate, and magnify the inflammatory process in your arteries. That doughnut, cola, or chili-drenched hot dog does not just add to your lousy LDL cholesterol; these types of foods also stimulate your genes to produce more inflammatory proteins to make the tissue irritation a whole lot worse.
Normalizing your five key numbers is doable with lifestyle or medications, and maintaining those numbers is important for reducing your risk of heart disease: blood pressure of 115/75 or less, LDL cholesterol of 100 or less, appropriate waist to height measurement, fasting blood sugar of 100 or less, and absence of cotinine (tobacco products) in your urine.
I could write an entire book about the fat around our waists, but we must also spend some time talking about the fat in our diet. Most of us know that dietary fats come in two general forms: either they are good for us, or they are bad for us. And most know that we should avoid the bad kinds (e.g., saturated fats, trans fats) the way we avoid telemarketers.
But if we dive a bit deeper into the story of good fats, we can also realize that it is more than just a “get-good/avoid-bad” argument. Research suggests that omega-6 fatty acids (found in cereals, some nuts, whole grains, and vegetable oils) can be harmful to us if we do not have the proper ratio of omega-3s (found in oily fish, walnuts, certain algae, and flax) to counterbalance those fats and provide a protective effect against heart disease. The ideal ratio? Omega-3 intake, especially DHA—as found in salmon, trout, and algae—should be 25 percent or more of total omega-6 intake.
Get Your Clothes Wet
We may not like to see sweat on treadmills or public speakers, but we want to see it on you. While we recommend different kinds of physical activity in different circumstances (including resistance exercise, walking, and stretching), the best way to improve heart function is to sweat more than a kid in the principal’s office. Why? Cardiovascular activity lowers both the top systolic (the pressure being exerted when your heart contracts) and the bottom diastolic (the pressure in the arteries when the heart is at rest) numbers of your blood pressure.
Cardiovascular exercise may also be helpful because it makes your blood vessels more elastic by forcing them to dilate. In addition to 30 minutes of daily walking, aim for a minimum of 60 minutes per week of cardiovascular or sweating activity—ideally in three 20-minute sessions—in which you raise your heart rate to 80 percent or more of its age-adjusted maximum (220 minus your age) for an extended period of time.
To do this, begin with a low-impact activity, like swimming, cycling, or using an elliptical trainer, to get your heart rate up without compromising the quality of your joints in the process. Remember to change activities from time-to-time so you do not get repetitive use injuries from always doing the same activity. Also incorporate interval training—that is, alternating periods of maximum effort with periods of recovery—to optimize heart benefits. You may want to check with your doctor beforehand; he or she may want to try interval training in the controlled setting of a stress test first. However, even doing one minute of maximum effort exercise at the end of every 10 minutes can be beneficial.
Create Your Backup Plan
Stress causes almost as many heart attacks as tobacco; that said, stress is not all bad. It is what gives you the concentration and ability to finish a project or meet a deadline. But stress can linger like week-old leftovers and create its own kind of stink, so during periods of high stress you need to have a plan that works for you. Exercise and meditation work for some people, and both of them will help you manage chronic stress through the release of feel-good substances like nitric oxide and brain chemicals called endorphins. But in the heat of the moment, at peak periods of high intensity, you should be able to pull a quick stress-busting behavior out of your biological bag of tricks. Whatever backup plan you have, practice it daily.
Create a plan you can commit to—for example, buy two pedometers, so you will always have one in case you misplace it, and wear it at all times; keep track of the steps you take for the first four days, then increase them by 500 steps every week until you are walking at least 10,000 steps each day, no excuses; and go through your kitchen cupboards and trash everything that has corn syrup or sugar listed in the first five ingredients.
There are other parts of the plan, and individual goals will vary, but these are the most important steps toward better health, in combination with conventional medications.
In addition to these four strategies, I recommend eight helper tips that will not only get you started, but also support you throughout your heart health journey.
Get a buddy
It can be difficult to stick to the plan, and to implement all parts consistently, without a little motivation and even competition—so the first helper is a buddy, be it a committed spouse or an exercise buddy. This person can help you monitor medications and supplements, plan and eat similar meals, and participate in exercise with you. Finding someone else with similar health goals creates an open forum for heart health dialogue, and you can both discuss your difficulties and successes.
The role of aspirin
Many studies of primary prevention have shown that two baby aspirin decrease the risk of heart attack by 30 percent or more for men and the risk of stroke by 30 percent in women, as well as nine cancers (including colon, rectal, esophageal, liver, breast, and prostate). Aspirin is thought to work by making platelets less sticky, which prevents clotting, and by decreasing arterial inflammation. You can reduce potential gastric discomfort by drinking half a glass of warm water before and after taking aspirin; the pills dissolve faster in warm water and are less likely to cause stomach irritation, ulcerations, and bleeding. If you do choose to take aspirin, limit intake to half a regular aspirin or two baby aspirin—about 162 milligrams total, daily—if you are a man older than 35 or a woman older than 40 and in typical health.
Mitochondria convert glucose into electric energy, and one of the molecules carrying electrons in this process is CoQ10. Taking CoQ10 as a supplement seems to protect against heart failure and other inflammatory processes by improving the efficiency of mitochondria. The usual dose is 200 milligrams per day (100 in the morning and 100 in the afternoon). Although no solid data exist to support it, I feel that CoQ10 can be especially helpful for people who take statin drugs; statins decrease levels of CoQ10, which may be the reason why statins can be associated with muscle cramps and pain.
Recent research suggests that vitamin D3 is good for not only your bones and immune system, but also for your heart and brain. Those younger than 60 can try 1000 IU daily; 1200 IU if age 60 or older. Your doctor can measure your vitamin D3 level, but you should aim for a level of 50 to 80 ng/mL.
DHA omega-3 is critically important for heart health, as well as the eyes and brain. Take 900 milligrams every day.
Another odd omega
You have already heard plenty about DHA, the great-for-you omega-3 fatty acid found in fatty fish- or algal oil capsules. You probably also know of the health benefits of olive oil, the odd omega-9. Now, research from Harvard Medical School, the Cleveland Clinic, the University of Hawaii, and Japan suggest that purified omega-7s (purified palmitoleic acid—a C16 monounsaturated fat) have amazing powers, too.
In several studies, omega-7s squelched heart-threatening LDL cholesterol and triglycerides, boosted ticker-friendly HDL levels, decreased fatty liver disease, decreased C-reactive protein, and improved cells’ ability to take in blood sugar. In one animal study, omega-7s blocked plaque formation by more than 90 percent. Although we need more conclusive human trials before recommending omega-7s unconditionally—more research has not been done because getting omega-7 purified is too expensive—my take is that the three studies are more than three times better than one. I have urged a company whose scientific advisory board I chair to start such research, but because I am intrigued by its benefits, I currently take 420 milligrams of purified omega-7, in capsules, along with 900 milligrams of DHA daily. Make sure to discuss with your doc if you choose to go this route.
Don’t underestimate the multivitamin
Take a multivitamin twice per day; this is your insurance policy against an imperfect diet. It is clear that the vast majority of people older than age 55—at least in my practice—have at least one vitamin or mineral deficiency if they do not routinely take a multivitamin. Also, multivitamins can decrease non-prostate cancers by 20 percent in healthy men older than 70.
Remember gut health
Much data indicate that your gut bacteria, and how they metabolize what you feed them, may make a substantial difference regarding inflammation in the body (and subsequent arterial aging). Take a daily probiotic to encourage and support a healthy gut and, in turn, whole-body health.
About the Author:
Michael F. Roizen, MD, is the chief wellness officer and chair for the Wellness Institute at Cleveland Clinic in Cleveland, Ohio. He is the coauthor of the RealAge and YOU series of books and the 2011 co-winner of the Paul G. Rodgers award from the National Library of Medicine for “Best Medical Communicator.”