The heart - the body's pump. How do you avoid heart disease or how to avoid a heart attack? No certain guarantees about any answers to these two questions, but let's be very clear about how it can literally affect anyone, for example, James Hunt, having survived all of the many hazards of Formula One car racing, collapsed and died of a heart attack at the early age of 46, while the Labour leader, John Smith, suffered the same fate at 55 years. Cabinet Minister Michael Heseltine, close contender in the past for the premiership of the Conservative Party, laid in a Venetian hospital in intensive care, one of the lucky 50 per cent who would recover. Having reached 60 years, he was in the high-risk age group.
British people have the unhealthiest hearts in the world, with the Scottish and Irish the top scorers in cardiac failure. It's the commonest cause of premature death in the UK, accounting for 31 per cent of men under 65 and 14 per cent of women. Contrary to popular opinion, it is three times more likely to strike down the manual labourer than the executive. The financial burden to the National Health Service is estimated at around £500 million every year, yet, only one-fiftieth of this amount is spent in efforts to prevent it. Heart disease costs the UK about £2 billion per annum in lost earnings calculated on the staggering total of 40 million working days.
Before the Industrial Revolution, with its attendant changes in eating habits and lifestyles, heart disease was a rarity. Much of the blame, therefore, has to be attributed to the appalling UK diet. A switch from high-fat, high-sodium, over-refined junk food to an intake of whole grains, plenty of fresh fruit and vegetables without added salt, makes a noticeable difference to premature death rates, as has been proved in recent years in America and Australia, where emphasis has been laid on these simple preventive measures, combined with regular exercise and no smoking.
Considering that there are some 40,000 miles (96,500 km) of blood vessels in each human being, it is quite astounding that the circulatory system keeps going as well as it does. Part of its work is to transport oxygen and nutrients to the cells and to remove their waste products. Indeed, the network of capillaries is so dense that all 60 trillion cells have access to nourishment. Some capillaries are exceedingly fine, measuring only 0.001mm in diameter.
After collecting the digested food from the tiny villi in the intestine, the blood carries the nutrients in solution to the liver, following which the glucose, salts, vitamins and some proteins are transported to every part of the body. Eventually, they seep through the walls of the capillaries into the tissue fluid. The cells, being soaked in this fluid, can now absorb the nutrients and use them for the chemical reactions that maintain life.
Meanwhile, in the lungs, oxygen has combined with haemoglobin in the red blood cells. The newly oxygenated blood, now bright red, travels down the arteries, through the smaller arterioles and finally to the capillaries. Here, the oxyhaemoglobin breaks down and so the oxygen becomes available for use by the tissues. Equally, the blood carries away the carbon dioxide from the respiring cells, through the venules and then the veins and back to the lungs, from which it is breathed out.
The blood also transports hormones, made in the body by various glands, to the parts that need them. Additionally, it is important for the maintenance of correct temperature, keeping the extremities warm.
The liver and kidneys ensure that the cells are bathed in a liquid that stays the same in its composition (homoeostasis). All the tissue fluid is derived from blood plasma and it is the job of the circulation system to replenish this fluid.
The organ that keeps the blood on the move is of course the heart. It is amazingly efficient, sending a red cell round the entire circulation in as little as 45 seconds. The pumping action, caused by the contraction and relaxation of the heart muscles, creates blood pressure, which you can feel at particular points, for example on the wrist below the thumb joint. The number of beats per minute varies from individual to individual, this can be between 50 and 110 when resting, and as much as 200 during excessive exertion. Special muscle cells at the top right of the heart initiate the beat, which is regulated by two sets of nerves from the brain, according to the needs of the body. Yet if these nerves are severed, the heart will still continue to beat.
Basically three main things can go wrong with the circulatory system: the pressure can increase unhealthily (hypertension) or become weak or irregular; the vessels can become hardened and liable to burst (arteriosclerosis); fatty deposits or clots can block the vessels up (atherosclerosis and thrombosis).
Hypertension - When taking blood pressure, doctors note two
measurements in the arteries, the one caused by the heart contracting and the
other when it relaxes, producing a reading such as 120/80. If you show a reading
above 140/95 you are suffering from high blood pressure or hypertension and
could be heading for trouble.
Several factors can contribute to this disorder including smoking, chronic
stress, some oral contraceptives, certain anti-inflammatory drugs, lead
poisoning, obesity and a fatty diet. Hardening of the arteries will raise blood
pressure, as will an imbalance among the chemicals that regulate the
circulation, the hormone-like prostaglandin and steroids. Too much salt leads to
fluid retention which can result in hypertension, as can other mineral imbalances.
The main problem with this condition is that a blood vessel may burst due to the extra pressure. If this happens in the brain, a stroke will occur, damaging the nervous tissue, with death the very possible outcome.
(Fictitious names are used below, to give illustrations of typical examples)
Margery had a history of hypertension and circulatory disorders in her family.
She herself was overweight and chocolate biscuits and alcohol were her
consolations whenever she felt a bit depressed or lonely. She had recently
retired and was missing the companionship of her work colleagues. She went to
her doctor for a check up. After taking her blood pressure he warned her that
she was a possible stroke candidate and that she must lose weight. He also
recommended that she reduce her salt intake by not having it on the table and
that she give up alcohol. However, Margery found these therapeutic measures
extremely difficult to follow. She disliked preparing food, especially just for
herself; snacking seemed so much easier. After a month of struggling with the
new regime, she finally gave in again to her craving for chocolate biscuits, and
the glass of wine soon became supplemented with a few straight Scotches. She was
vaguely aware of tingling sensations in her right arm, but thought nothing of
it.
The inevitable happened. She was pottering about in her back garden when she collapsed. Luckily her neighbour happened to look over the fence and, seeing her crumpled up on the lawn, quickly rushed to her aid and called an ambulance. When she finally came out of the coma in hospital she felt very disorientated, especially on discovering that her right arm and leg refused to move and that she had trouble in coordinating her speech.
Margery needed almost two months of regular physiotherapy before she was mobile enough to leave the hospital. Having come into a small inheritance she was able to afford further rehabilitation at a private centre in the country, where the care was of a high standard. The dietary regime was strict, but this time she took it seriously; the effects of the stroke had been so frightening that she was now well motivated to look after herself properly. She lost some weight and her staggered lurches gradually began to resemble proper steps. She learnt from the excellent resident nutritionist that by following some simple measures her high blood pressure could be substantially reduced, which in turn would greatly lessen the risk of another stroke. At the same time she could take particular nutrients to increase the flexibility of the blood vessels, making them less prone to bursting.
She was astonished to learn that her intake of sodium was probably as much as 40 times the amount her body needed, bearing in mind her sedentary lifestyle, and that not only must she cut out added table salt, she must also avoid all processed and convenience foods (all high in sodium), canned foods preserved in brine and all obviously salty fare such as bacon and cheese. She was also fascinated to hear that humans have evolved from hunter-gatherer African tribes, who naturally sweated out considerable amounts of sodium as they looked for their daily supplies under the hot sun. They instinctively searched for salty flavours to replenish those losses. Our liking for sodium has been ruthlessly exploited by food companies to the detriment of our health. It also has useful preservative qualities that contribute to shelf life and therefore profits. This mineral is widely present in virtually all natural foodstuffs in sufficient quantities to maintain health and there is no need to add more. It took Margery a while to adjust to meals prepared without salt, but after a few weeks, her taste buds began to appreciate the subtleties of natural flavours. In August 1982 a study by T. C. Beard et al. was reported in The Lancet showing that 80 per cent of hypertensive patients put on a low-sodium diet were able to reduce or stop their drugs within three months. This knowledge encouraged Margery.
However, it is not just a question of low sodium, but of the crucial balance between this mineral and potassium. Potassium deficiency greatly increases the risk of hypertension and the more salt you take, the less your body can use the available potassium. Primitive hunter-gatherer humans consumed about 16 times more potassium than sodium, whereas modem Westerners eat four times more sodium than potassium. This imbalance creates serious health problems and needs to be reversed if we are to avoid premature deterioration of cell function. Although potassium is widely available in foods, especially in green leafy vegetables, about half is lost by boiling; a switch to light steaming means that all but about 6 per cent of this mineral is retained.
Vegetarians have lower blood pressure on average than omnivores and this may have something to do with their higher intake of potassium from fresh vegetables. At any rate, Margery was strongly advised to boost her consumption of plant foods and cut down on meat. Anyone who has great difficulty in cooking without salt can switch to a substitute such as Biosalt or Ruthmol which have the correct potassium content. It is a disgrace that doctors often put hypertensive patients on diuretics which cause potassium loss without also giving supplements of this mineral; such drugs are probably doing more harm than good.
Potassium has a direct benefit on the circulatory system by dilating blood vessels and relaxing the muscles that surround them. It also counteracts the effects of stress hormones that push up blood pressure. Margery was given a daily supplement of 2.5g.
Magnesium is another mineral that relaxes muscles, including those around blood vessels. A study by T. Dyckner et al. reported in volume 286 of the British Medical Journal in 1983 proved that this mineral helps to reduce blood pressure in hypertensive patients. Excessive alcohol causes a deficiency by acting as a diuretic and thereby promoting its loss in the urine - another incentive for Margery to give up those double Scotches.
Calcium also helps to lower blood pressure in about half of patients, although it is not fully understood why. It makes good sense, however, to take a combined calcium and magnesium supplement in the form of dolomite; Margery was prescribed 2g daily. Zinc has a similar effect at about 30mg daily balanced with 3mg of copper.
Another protective food is fish oil which contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) from the omega 3 family of polyunsaturated fatty adds. Patients who take regular doses of cod-liver oil (3 to 4 tablespoons daily) note a significant lowering of blood pressure within a month, after which the amount needs to be reduced in case of vitamin A toxicity. Fish became an important part of Margery's diet. Anyone who cannot tolerate the fish oil will benefit from 3g daily of evening primrose oil, which contains another important fatty acid, GLA (gammalinolenic acid), of the omega 6 family. While raising the level of polyunsaturated fats in the diet, saturated fats and hydrogenated oils must be reduced for maximum benefit.
Of the vitamins, C helps to build strong walls to blood vessels, and the bioflavonoids, especially rutin, toughen up the fragile capillaries. Clearly these are vital nutrients for stroke candidates. The recommended supplement here is 2g per day of ascorbic acid with 200mg of rutin.
Luckily Margery was fond of garlic, a truly magical ingredient for a healthy circulation, reducing blood pressure and lowering cholesterol and triglyceride levels. Garlic pearls are perhaps a more sociable alternative, although the chlorophyll in green vegetables and parsley help to freshen the breath. Another age-old remedy, ginseng, is known to improve the flexibility of blood vessels as well as counteracting hypertension.
The switch to a wholefood diet meant that Margery's intake of dietary fibre had increased significantly. Hair analysis had shown that her lead levels were too high - another source of hypertension. This could be remedied by the phytate in the wheat fibre, which attaches itself to body lead and helps to extract it from the system.
By the time Margery returned home, she was almost back to normal and her blood pressure was on the way down. Understanding fully how nutritional therapy would keep her well, involved her in preparing healing foods for herself (see recipes in the health-giving diet - link below). She was even able to give up the chocolate biscuits, knowing that sugar can increase hypertension.
At the same time she bought herself a dog and the regular walking provided much-needed exercise. To reduce tension she joined a relaxation class. Here she learnt how deep breathing can slow the heart rate. As an added bonus she made some good friends there which kept her loneliness at bay. When Margery went for her check-up a few weeks later, her doctor was astonished at her improvement.
Coronary heart disease - Colin is a self-employed builder, physically strong, but a life-long forty-fags-a-day man and overweight with a 'beer belly'. Despite the smoking, he had always considered himself to be reasonably fit until at the age of 53 he began to suffer from chest pains. He was repairing a roof early one morning when he experienced the first symptoms: a gripping pain behind his breastbone, which spread up into his neck, causing a feeling of suffocation, and then down his left arm and over the upper part of his abdomen. He climbed down his ladder with great difficulty and lay on the ground until the pain gradually subsided.
His doctor suspected angina pectoris and this was later confirmed by an electrocardiogram and blood tests. The pain was the result of the heart muscle being deprived of the blood supply needed to keep it working properly, due to clogged-up arteries. He was instructed to give up smoking which was damaging his blood vessels, and to avoid fatty foods and lose weight. Yet Colin was nicotine-addicted and, try as he might, he just could not cut out cigarettes. His angina attacks became more frequent, although somewhat alleviated by the drugs prescribed, which helped to dilate the blood vessels.
Finally, as feared, Colin suffered a heart attack. Fortunately he was at home at the time. The pain in the left side of his chest was intense and he turned deathly pale, cold and sweaty. His pulse became so weak and his breath so gasping that his wife thought he would die, but the ambulance managed to rush him into intensive care in time to save his life.
If only Colin had been able to quit smoking and follow proper nutritional advice in the early stages of angina, the heart attack would most probably not have occurred. In this disease, the arteries become increasingly blocked by fatty deposits consisting mainly of cholesterol and triglycerides. Yet there are nutrients that can actually reverse this process and thin the blood out. Another factor is the stickiness of the little pieces of blood cells called platelets, normally available to aid the healing of wounds through causing the blood to congeal. Here again, nutrients can correct stickiness so that clots do not form in the wrong places.
EPA (eicosapentaenoic acid), an active ingredient of omega 3, found in fish oil, is especially beneficial to heart disease patients. This both thins the blood out and reduces its stickiness. Studies have shown that it lessens by more than half the manufacture of TXA2, a thromboxane produced by blood platelets that promotes clotting. Equally, EPA stimulates the blood vessel walls to put out more PGI (prostacylins) that discourage the clotting action. If patients eat plenty of oily fish, especially herring, mackerel and salmon, then blood cholesterol levels will drop to a healthy level - even if eggs are consumed (although this is not recommended) - as will the triglycerides. Salmon oil in particular, reduces the VLDLs (very low-density lipoproteins), forerunners of LDLs (low-density lipoproteins), which are high in the 'bad' cholesterol that gets deposited in blood vessel walls.
If Colin had taken fish oils, he would have noticed his angina pains lessen considerably. Not all cholesterol is bad by any means. Indeed, the body generally makes more than twice as much as we consume in food because it is needed for making steroid hormones, the manufacture of bile and for the structure of cell membranes. High-density lipoproteins (HDLs) pick up cholesterol from the tissues for transportation to the liver and then excretion. This sort of cholesterol is popularly referred to as 'good' because it is being removed from the body.
A couple of portions of fish per week is very protective against heart disease. If EPA is taken in capsules, then the antioxidant vitamins C and E should also be included to counteract potential ill effects of any rancidity. Patients with heart disease will profit from doses of EPA ranging from 300 to 3,000mg daily, depending on severity. An alternative is a teaspoon each day of cod-liver oil; this can be bought with a pleasant mint or orange flavour. A word of caution, though: it is easy to overdo a good thing. Do not exceed recommended 'doses or you may bleed more than usual if you cut yourself. In any case, all heart disease patients should consult their doctors before taking supplements.
Vegetarians are not likely to suffer from heart disease, especially if they do not smoke, but protective factors similar to those in fish oils are found in linseed oil and the herb purslane. Linseed oil actually encourages the cells to make EPA. Evening primrose oil at 2 to 3g per day can also reduce blood cholesterol.
Calcium has cholesterol-lowering effects too, especially if combined with a low-fat diet. Patients improved in only six weeks with 400mg of elemental calcium taken three times daily. This is particularly beneficial if combined with 200mg of magnesium.
Vitamin C is not only a useful antioxidant, it can actually break up clots at a dosage of at least 2g daily, it lowers the amount of fats in the blood and increases the ratio of the 'good' HDLs. It's even more effective if taken with bioflavonoids, especially rutin.
Multiple benefits are also provided by vitamin E at between 200 and 800IUs daily, especially if taken along with selenium at a dosage of 70mcg up to 1,000mcg. Do check with your doctor first, however, as such supplementation can conflict with anticoagulants. A natural way to take selenium is in the form of wholemeal bread or brazil nuts - just two will provide you with your daily needs, or soya beans are another good source. It's well known that the lower the level of selenium in the blood the greater the risk of heart disease. Studies have shown that selenium and vitamin E have natural anticoagulant properties by promoting prostacyclin levels, the prostaglandin that discourages clotting. These nutrients offer marked relief from the pain of angina and vitamin E is better at thinning blood than aspirin.
Angina sufferers will gain from another nutrient, vitamin B6, which at about 40mg per day diminishes the stickiness of platelets and hinders the formation of an enzyme in the blood called thrombin; this converts the plasma protein fibrinogen into fibrin, insoluble strands of fibres in which red cells become trapped, thus making a clot. Remember to take B complex also, as this group of vitamins needs to be balanced.
Another magic ingredient is the amino acid L-carnitine. Specific research in Italy has shown that patients who had died of heart attacks had a deficiency of this substance in the heart muscles. In a different study, chronic angina sufferers were prescribed 1g twice a day. After only four weeks they were able to exert themselves much more without incurring pain. Carnitine helps to keep the blood dear of fats by ensuring their efficient burning for energy. It is found only in animal products, but humans also manufacture their own. However, vitamins B6 and C, together with iron and the amino acid lysine, are essential for the production of carnitine, so that a deficiency in any of these nutrients could result in low levels of this important substance. Best sources of lysine are lean lamb and fish, another good reason to go in for seafood. In addition to lowering blood fats, carnitine raises those 'good' HDLs that help to keep the blood dear of cholesterol. Dosage can range from 500 to 3,000mg daily depending on need. Muscular weakness can be a sign of deficiency.
Coenzyme Q is also concerned with the release of energy from food, working in cooperation with vitamin E. It is the 'spark' that initiates the conversion of carbohydrates to energy in the presence of oxygen. More than 90 per cent of patients given this quasi vitamin showed improvement in the pumping action of the heart within a month. Angina patients were also significantly helped. It could be that some people are not able to make enough of this substance in their bodies to ward off heart disease, maybe due to a deficiency of the necessary complementary B vitamins, and a supplement of 30-60mg could be helpful. This coenzyme is also depleted by stress and ageing.
Wonder foods are garlic and ginger, both of which have passed with flying colours in scientific studies. When eaten daily, blood cholesterol decreases. Walnuts and avocado pears have a similar effect. Garlic also significantly lowers triglyceride levels while at the same time promoting those 'good' HDLs. In one experiment, patients ate up to ten cloves per day, with outstanding results . . . even if they did become unpopular with other members of the amity! Perhaps it is well worth being unsociable for the sake of a sound heart!!
Apart from smoking, Colin was also a coffee addict. It is now known that drinking more than two cups of coffee per day is connected with high blood cholesterol and low HDLs. On the other hand, chicory has the reverse effect and can be used as a coffee substitute. As for sugar, a high intake brings about a loss of chromium, another nutrient that helps to keep the blood clear of fatty blockages. Heart disease patients must therefore cut out sugar and increase their consumption of wholewheat bread and pasta. Refining flour removes nearly all of this vital mineral.
Frightened by the appalling experience of the heart attack and relieved to be alive, Colin this time, was sufficiently motivated to adopt a wholefood diet. While too weak to cook for himself, his wife was glad to support him in this by learning to select ingredients that would do him good. She substituted soya products for much of his meat, thereby providing him with a useful source of lecithin. This substance is a natural emulsifying agent, since it is partly soluble in water as well as in fat, and for this reason has been adopted by the food industry as an additive. In the body it can prevent and reverse atherosclerosis by causing blood fats to be broken down into such small particles that they can pass right through the walls of the arteries and then be used by the tissues. It can be bought in granules and sprinkled onto food.
Colin's new wholefood diet had the advantage of increased dietary fibre which binds to blood fats and escorts them out of the body. At the same time it effectively raises the 'good' HDLs and lowers the 'bad' LDLs. Oats and legumes were more or less new to him, but they were particularly recommended. Pectin from fruits such as apples and oranges is a healthy type of water-soluble fibre. Colin rarely ate fresh fruit prior to his heart attack, but it now features every day on his menu along with fresh vegetables. As he has lowered his intake of saturated fat by eating less meat and switching to skimmed milk, so his weight has dropped.
The hospital helped him with a gently graduated exercise programme by handing him a card every so often with a new goal written on it. At first, he could scarcely climb the stairs when he arrived home, but his strength returned as his vascular health improved, until he could walk several miles a day.
Giving up smoking was hardest of all, but he finally achieved this by joining a self-help group. The support of others in similar predicaments encouraged him to stay the course. As for the garlic, this has become a joke in the family. Recently Colin and his wife have learnt to introduce main courses made from beans and lentils, such as those described on the healthy diets page on this website, and sandwiches are now spread with non-hydrogenated margarine rather than butter.
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