American Heart Association
Hal Higdon's 7-7-70 Quest
How to Prevent
Heart Disease
By
Hal Higdon
Sitting
in the crowded waiting room, I saw people around me who seemed old, infirm,
obese: not the sort you'd expect to encounter at a 5-K starting line. One
individual needed the help of a walker. Moving tediously, he joked to the
nurse, "If I have to take a treadmill test, we're in trouble."
I
wondered: What am I doing here among all these unhealthy people?
I
wasn't old, I wasn't ill, and I certainly wasn't overweight. Yet, despite
my background as a runner, the truth remained: I had coronary heart disease!
Maybe we all do to a point, but mine now had been properly diagnosed. Kenneth
H. Cooper, M.D. made the initial assessment at his Aerobics Clinic in Dallas,
Texas. Using an ultrafast CT scan, he detected calcification around my main
coronary artery. A follow-up exam several months later at Rush-Presbyterian
Hospital in Chicago confirmed Dr. Cooper's diagnosis and revealed a calcium
score of 480 and a homocystene level of 16, putting me in the 95th percentile
of high risk. Later, I had a surgical catheterization under the supervision
of Franklin Wefald, MD, a cardiologist at Elkhart General Hospital in Indiana.
Dr. Wefald said that I "passed," that my blood circulation remained good,
but he prescribed medication to arrest, if not reduce, the buildup of plaque
that had reached 40 percent in one of my arteries.
How
could this happen to a well-conditioned athlete? Isn't running supposed to
prevent heart disease? I've run continuously since high school. I never
smoked. I follow a low-fat diet. Until recent tests, my cholesterol count
consistently had been 180 or lower. I have a low-stress job, one I enjoy.
Every second or third year I visit Dr. Cooper for a physical examination and
have always been placed in the 95th percentile of low risk. To shift
suddenly from low to high risk didn't make sense to me.
Yet
dare I deny the evidence? The calcification of my arteries did not happen
overnight. The plaque must have been building up for years, if not decades.
Most likely it was genetic, inherited from my parents who died of heart attacks.
My high level of fitness may even have disguised the problem. The increasing
availability of highly sophisticated machines, however, now makes diagnosis
easier and more precise. My experience should motivate all of us to look in
the mirror. Nobody is immune. But you don't have to wait to be diagnosed with
coronary heart disease to modify your lifestyle. Even young people can change
habits so as to modify their risk factors. It's never too early and never
too late. Here's how to keep your heart healthy:
The Case for Exercise
The
case for exercise as a means of preventing coronary heart disease is overwhelming,
insists Paul D. Thompson, MD, director of preventive cardiology for Hartford
Hospital in Connecticut. "There are a multitude of epidemiological studies
that have looked at people who are active in occupations and at leisure,"
states Dr. Thompson. "In all those studies, the more active you are, the less
likely you will suffer from a heart attack."
Research
into cause-and-effect goes back to 1802 and to a physician named William Heberden
who first described angina, the chest discomfort that is symptomatic of inadequate
blood flow to the heart. In his Commentaires on the History and Cure of
Diseases, Dr. Heberden admitted that he wasn't certain how to treat angina,
but described a patient who "set himself the task of sawing wood for half
an hour every day and was nearly cured."
But
few people saw wood any more. It's easier to drive to the Garden Center in
your S.U.V. and pick up a cord for your fireplace. Twentieth Century Man (and
Woman) sit in front of computers rather than labor in the fields. If you want
to prevent heart disease, you need to program time for exercise. Physical
Exercise--and specifically running--can have a positive effect on several
risk factors:
-
Body weight: Exercise more and weigh less. Run or walk a mile, and
you burn 100 calories. Burn 3,600 calories and you lose 1 pound. Overweight
people are more likely to have heart disease. "Body weight is not a major
risk factor," admits Larry Gibbons, MD, medical director of the Cooper Clinic,
"but it contributes to many of the other risk factors, particularly diabetes."
-
Diabetes: Control your weight and you're less likely to get adult-onset
diabetes. One complication of diabetes is heart disease. Exercise not only
burns excess glucose in the blood stream, but apparently improves insulin
function. Many diabetics who exercise can decrease their insulin shots.
"Fewer people who exercise develop diabetes as they age," says Dr. Thompson."
-
Blood
Lipids: The most significant risk factor is cholesterol, since this
compound causes plaque to block arteries. Exercise somewhat lowers the bad
LDL cholesterol, but more important: it raises the level of the good HDL
cholesterol, a proven artery-cleanser. Exercise also lowers triglycerides.
-
Blood Pressure and Stress: Exercise not only lowers systolic and diastolic
pressure, but it prevents the development of high blood pressure. Another
related risk factor is stress, including anger, hostility and depression.
"Exercise is a proven stress eliminator," says Dr. Gibbons.
-
Smoking: It's difficult to smoke while you exercise. Many individuals
discover that by embracing a positive addiction like running, they can more
easily eliminate their negative addiction of cigarettes.
All
of the benefits of exercise on the cardiovascular system are not entirely
understood by heart scientists. Dr. Thompson speculates that exercise helps
to relax the coronary arteries so they open up. Exercise also increases the
amount of blood pumped with each heartbeat. This lowers the workload, so the
heart muscle uses less oxygen. Increased blood flow also promotes the development
of collateral routes: bypasses around semi-blocked arteries that can help
you survive a heart attack if one occurs.
How
far do you need to run? There's no easy formula, says Dr. Thompson: "To a
point, the more you run, the more protection you get. While a 1-mile walk
is good; 3 miles jogging seems to be better. At higher mileages, you reach
a point of diminishing returns, but the exact mileage is hard to pinpoint,
and it certainly varies with individuals." Research at the Cooper Clinic,
however, suggests that most benefits occur by 3 miles, but you need to be
regular--at least five days a week (thus, 15 miles a week). Running some of
those 3-mile workouts at a faster pace (85% of maximum heart rate) seems to
offer more benefits, but may create additional risk for those with arteries
already partially blocked.
"The
major risk is for people who have hidden heart disease, or who develop symptoms
and ignore them," cautions Dr. Thompson. Exercise, however, is not a panacea.
As I discovered when tested at the Cooper Clinic, all the running I did failed
to immunize me from coronary heart disease. For maximum benefits, you need
to combine exercise with a healthy diet:
The Case for Diet
While
exercise is essential if you want to prevent coronary heart disease, diet
and nutrition rank equal in importance. It's the other edge of the preventive
sword. Why place so much emphasis on diet? In Eat Your Way to a Healthy
Heart, Liz Applegate, Ph.D. explains: "More than half the deaths that
occur every year in the U.S. are a direct result of clogged arteries that
cause heart attacks and strokes. Twice as many people die of heart and other
vascular diseases than cancer. Food is your best weapon against heart disease."
The
first rule of managing heart health with nutrition is getting the fat content
of your meals into the 20 to 30 percent range. For most people, this means
lowering fat content, but some individuals already on very low-fat diets may
actually need to increase fat intake. The best fats are the monounsaturated
fats found in olive oil, canola oil and nuts. Also ranking high among nutritionists
are the Omega-3 fats found in fish, as well as in flaxseed meal and oil. The
worst are the saturated fats found in animal products and processed foods,
which also contain artery-clogging hydrogenated fats, or trans-fats.
"You
need to know your blood lipid profile to make effective food choices," explains
Joanne Milkereit, R.D. at the Medical University of South Carolina. "Individuals
who choose low-fat diets may have low levels of LDL cholesterol, but, surprisingly,
they sometimes have high triglycerides and not enough of the (good) HDL cholesterol."
Milkereit cites a National Institutes of Health recommendation that cholesterol
should be measured in all adults 20 years of age and over at least once every
five years. HDL cholesterol can be measured at the same time. Consult a physician
to determine whether you should change your diet to improve your lipid profile;
consult a dietitian for advice on how to do it.
Heart
strategy is also important. It's not only what you eat, but when
you eat it, claims Nancy Clark, RD, director of nutrition services at Sportsmedicine
Brookline in Massachusetts and the author of Nancy Clark's Sports Nutrition
Guidebook. Clark identifies breakfast as the key meal of the day. "Fortify
yourself for a high-energy day by eating a hearty breakfast featuring a fiber-rich
cereal covered with lots of fruit, and you won't get as hungry later in the
day," she says. "Add a good lunch, and you'll be less likely to snack on fatty
foods that are bad for your heart."
Current
research identifies fiber as important for heart health. Dr. Applegate recommends
that in addition to choosing that high-fiber cereal (she prefers oats), keep
peels on fruits and select whole versions of other grain products. She also
likes beans, particularly kidney beans and lentils. "The amount of fiber in
beans is staggering," says Dr. Applegate. "Everybody should be eating beans
four or five times a week." While you are getting the fat out, get into your
diet the vitamins that research suggest promote a healthy heart. These would
include the antioxidant vitamins C and E along with carotines. And although
many cardiologists prescribe supplemental vitamins such as B6, B12 and Folic
Acid to help keep homocysteine levels low, nutritionists such as Milkereit,
Applegate and Clark prefer that individuals first seek those vitamins in the
refrigerator rather than in the medicine cabinet.
Here
are some heart-healthy foods they suggest you add to your table:
-
Oil and Nuts: Researchers suspect that the olive oil present in the
diets of people living in Mediterranean countries is one reason people from
those countries have a lower rate of heart attacks than Northern Europeans.
Choose an olive oil-based salad dressing instead of the creamy kind. Almonds
and peanuts (including peanut butter) also are good sources of monounsaturated
fats. And don't add monounsaturated fats without subtracting
saturated fats. "If you are already getting 30 percent of your calories from
fats, adding olive oil and nuts will be too much," warns Milkereit.
-
Fish: Eskimos traditionally followed diets containing as much as
50 percent fats, yet rarely died of heart attacks. One reason is because
the fats they ate typically were Omega-3 fats found in cold-water fish.
(This is a liquid form of fat different from the hard fat found in butter
and diary products.) Rather than clog arteries, Omega-3 fats lower blood
cholesterol and triglycerides and decrease the likelihood of blood clots
by making platelets in the blood less "sticky," thus less likely to stick
to artery walls. Salmon, a fish found in the waters around Alaska, but also
in the Great Lakes, is a particularly good menu choice. "If you don't eat
fish at least once a week," suggests Dr. Applegate, "you aren't taking advantage
of a heart-healthy diet." Tuna, as well as salmon, is a particularly good
source of Vitamin B12.
-
Veggies: "Go for the (carotene-rich) dark green stuff, such as broccoli
and spinach" advises Clark. Spinach is a good source of Folic Acid, often
prescribed for heart patients. Clark recommends any vegetables with deep
color such as tomatoes and carrots. "No vegetables are bad," she says. "Some
are just nutritionally better than others." Milkereit's favorite vegetable
is the sweet potato, which she would rather see on the plates of carbo-loading
runners than pasta. "Pasta attracts a lot of attention, but it's made from
processed grain," she says. Beans are good heart protectors, particularly
soybeans.
-
Soy: Regardless of how it comes--tofu, miso, natto, tempeh, soymilk,
soyu flour, soybeans, soynuts, soy sauce--soy has leaped to the top of the
charts among nutritionists seeking to prevent heart disease. Soy contains
phytochemicals that prevent blood clots from forming. Dr. Applegate recommends
that runners get at least one serving of soy into their diets each day.
"When soy protein is substituted in the diet for other proteins such as
milk or beef, cholesterol levels fall off the chart," she says.
While
I always followed what I considered a well-balanced diet, because I ate a
wide variety of lightly processed foods and got sufficient carbohydrate to
fuel my long runs, the various scans and tests I took indicated that I still
had room for improvement. Fortunately, I have begun to take steps to assure
that I will continue to run into the millennium. I now watch my diet even
more closely and have begun to take supplements, including Folic Acid, Niacin,
Norvasc and baby aspirin under Dr. Wefald's supervision.
When
Dr. Wefald called with the results of my most recent blood test, he said all
the numbers looked good. My triglycerides were at 122, and my total cholesterol
had dropped from 212 to 184. My (bad) LDL cholesterol fell from 144 to 105;
my (good) HDL went from 50 to 54, resulting in an impressive LDL/HDL ratio
of 1.94. My homocysteines were now TK. I plan to make some additional dietary
changes to improve even those numbers
According
to Pamela Douglas, MD of Harvard Medical School: "The most powerful thing
you can do to prevent heart disease is to exercise and eat well. Fitness is
tremendously important in preventing heart disease, but you have to utilize
a nutritional diet as well. Do so, and you will reap the benefits for years
to come.
("How to Prevent Heart Disease" originally was published in a slightly
different version in the November 1999 issue of Runner's
World under the title "Take It To Heart." Copyright
1999 by Hal Higdon, all rights reserved.)
More information on Heart Disease:
What's
Your Heart Risk?
10
Favorite Foods
For
the Future
The
Hearts of Women
Hal
Higdon's 7-7-70 Schedule
To celebrate
his 70th birthday on June 17, 2001, Hal Higdon plans to run 7 marathons in
7 months and help raise $700,000 for 7 separate charities. Here is his schedule.
More information--including additional links--will be available later.
Please send your pledge to
roadrunnerpress@attbi.com,
or make out your check to a specific charity, and mail it to: Roadrunner
Press (7-7-70); PO Box 1034, Michigan City,
IN 46361-1034. (We are currently making plans to allow you to contribute online.)
