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UNIT 1
Picture
The Heart
​The Top Killer Disease
What is Atherosclerosis?
Heart Disease Begins in Childhood
Is it Really Cholesterol?
Reversing Heart Disease
The Endotoxins
Consider Brazil Nuts
Article Review
Video Review
OBJECTIVES:
  • To understand how heart disease sustain the position of being the Top killer Disease in the world
  • Describe atherosclerosis
  • Discuss how atherosclerosis begins in childhood
  •  Understand the role of cholesterol in heart disease
  • Discuss the potential reversal of heart disease
REFERENCES:
  • Michael Greger, MD, Nutrition Facts
  • Nathan Brown, Learn More, Complete Health Improvement Program
  • Caldwell Esselstyn, MD, Cleveland Clinic
  • Dean Ornish, MD, UCLA Lifestyle Medicine

The Heart

The human heart is a miraculous organ.  In an average lifetime, it will faithfully beat around 3 billion times, transporting blood, with the oxygen and nutrients it contains to where they are needed around the body.  In simple terms, the heart is a pump, pumping blood through the tens of thousands of miles of our circulatory system.

In some ways, this system is like a water feature or fountain.  While everything is working properly, it's a wonder to behold, but if one of any number of things goes wrong with the plumbing, it can slowly lose effectiveness or even suddenly shut off.
When this happens with a fountain, a plumber will check a number of things.  The first thing they'll check is if the pump is still working.  If it is, the next thing they check is if something is blocking the pipes.  Perhaps dirt or leaves have gotten into the plumbing or maybe the water has left mineral deposits that need to be cleaned out.

As complex as the human heart and circulatory system are, they can fall victim of these same simple problems of plumbing.  Something can happen to our pump - the heart - or, more commonly, our blood vessels - the pipes - can become clogged or completely blocked.

Cardiovascular disease (CVD) is the term used to describe a range of conditions, including heart attack, stroke and blood vessel diseases.  The main cause of CVD is atherosclerosis.  As we have seen, this occurs when cholesterol, fat and other substances build up inside the blood vessel walls.  The vessels become narrow or even completely block up, so little or no blood can travel through to the brain, heart and other organs.

When the arteries that supply the heart become clogged, this is known as coronary heart disease (CHD), where the heart stops getting all the oxygen it wants to keep functioning efficiently, and this can result in angina or heart attack.  When blood supply to the brain is reduced or blocked, this can cause a stroke.

​According to the World Health Organization, cardiovascular disease is the world's leading cause of death.  When you talk about heart disease, you may remember a family member or friends who suffered for years with chest pain and shortness of breath and chest pain before they finally succumbed. However, for the majority of patients who die suddenly from heart disease, the very first symptom may be their last. It's called "sudden cardiac death."
*CHIP

THE TOP KILLER DISEASE

The world's number-one killer is simply caused by fatty deposits in the walls of arteries called atherosclerotic plaque. For most Americans raised on a conventional diet, and other countries who adopted the Western diet, plaque accumulates inside the coronary arteries, the blood vessels that crown the heart (hence "coronary") and supply it with oxygen-rich blood. 
​This is when death occurs within an hour of symptom onset. In other words, you may not even realize you're at risk until it's too late. You could be feeling perfectly fine one moment, and then an hour later, you're gone forever. That's why it's critical to prevent heart disease in the first place, before you even necessarily know you have it. Patients would often ask, "Isn't heart disease just a consequence of getting old?" This is a common misconception. After all, your heart pumps literally billions of times during the average life span. Does your ticker just fall out after a while? Simply No.

A large body of evidence shows there were once enormous swaths of the world where the epidemic of coronary heart disease simply didn't exist. For instance, In the famous China-Cornell-Oxford Project (known as the China study), researchers investigated the eating habits and incidence of chronic disease among hundreds of thousands of rural Chinese. In Guizhou province, for example, a region comprising half a million people, over the course or three years, not a single death could be attributed to coronary artery disease among men under sixty-five.
During the 1930s and 1940s, Western-trained doctors working throughout an extensive network of missionary hospitals in sub-Saharan Africa noticed that many of the chronic diseases laying waste to populations in the so-called developed world were largely absent across most of the continent.  In Uganda, a country of millions in eastern Africa, coronary heart disease was described as almost non-existent. 

But were the people of these nations simply dying early of other diseases, never living long enough to come down with heart disease No. The doctors compared autopsies of Ugandans to autopsies of Americans who had died at the same age. The researchers found that out of 632 people autopsied in Saint Louis, Missouri, there had been 136 heart attacks. But in 632 age-matched Ugandans? A single heart attack. The Ugandans experienced more than one hundred times fewer heart attacks than the Americans. The doctors were so blown away that they examined another 800 deaths in Uganda. Out of more than 1,400 Ugandans autopsied, researchers found just one body with a small, healed lesion of the heart, meaning the attack wasn't even fatal. Then and now, in the industrialized world, heart disease is a leading killer.

In central Africa, heart disease was so rare it killed fewer than one in a thousand.  Immigration studies show that this resistance to heart disease is not just something in the Africans genes. When people move from low-risk to high-risk areas, their disease rates skyrocket as they adopt the diet and lifestyle habits of their new homes. The extraordinarily low rates of heart disease in rural China and Africa have been attributed to the extraordinarily low cholesterol levels among these populations. Though Chinese and African diets are very different, they share commonalities: They are both centered on plant-derived foods, such as grains and vegetables. By eating so much fiber and so little animal fat, their total cholesterol levels averaged under 150mg/dL, similar to people who eat contemporary plant-based diets.  So what does all of this mean?
It means heart disease may be a choice.  If you looked at the teeth of people who lived more than ten thousand years before the invention of the toothbrush, you'd notice they had almost no cavities. They never flossed a day in their lives, yet no cavities. That's because candy bars hadn't been invented yet. The reason people get cavities now is that the pleasure they derive from sugary treats may outweigh the cost and discomfort of the dentist's chair. 

But what if instead of the dental plaque on our teeth, we're talking about the atherosclerotic plaque building up in our arteries? We're not just talking about scraping tartar anymore. We're talking about life and death. Heart disease is the number-one reason we and most of our loved ones will die. Of course, it's up to each of us to make our own decisions as to what to eat and how to live, but shouldn't we try to make these choices consciously by educating ourselves about the predictable consequences of our actions? Just as we could avoid sugary foods that rot our teeth, we can avoid the trans fat, saturated fat, and cholesterol-laden foods that clog up our arteries.

Let's take a look at the progression of coronary heart disease throughout life and learn how simple dietary choices at any stage may prevent, stop, and even reverse heart disease before it's too late.
*HNTD

What is Atherosclerosis?

The main contributor to poor circulation is atherosclerosis, commonly known as narrowing and hardening of the arteries.  Typically by the time many of us are 45 years of age, plaque can have grown to the point that it narrow our arterial lumen by about 50 percent.  And by 70 years of age, many live with 90 percent narrowing of their arteries, leaving only 10 percent opening for blood to flow through.
While we often talk about heart attacks and heart disease, there is usually nothing wrong with the heart muscle, the myocardium.  Instead, the problem usually resides inside the coronary arteries - arteries supplying blood to the heart muscle - that deliver oxygen - an nutrient-rich blood to the heart muscle to keep it nourished and in good running order.  

As the coronary arteries progressively narrow and harden, the evolving disease is free of symptoms for a long time.  The first common symptom, such as chest pain (angina pectoris), often appears only after some 70 percent narrowing of the coronary arteries has made it difficult to deliver the oxygen needed by the heart muscle, especially during exercise or other exertion.

In this way, angina is an early warning sign of the larger and serious health problem.  When a coronary artery becomes fully blocked, this prevents the flow of blood to part of the heart muscle, which begins to starve of oxygen and then to die.  The narrower the artery, the greater the risk of it being blocked by a rupture in the plaque-lined artery wall or a blood clot, which is also a greater risk when circulation is impaired.

About 10 percent of heart attacks result from blockages directly related to the accumulated hard plaques.  The greater risks - and those to as many as 90 percent of heart attacks - are those of softer plaques, deposits of which are linked to higher cholesterol and are more unstable, so more likely to rupture and block blood flow to the heart muscle.  These dangerous soft plaques often go unnoticed, even in angiograms.

The conventional medical treatment for these medical emergencies are the extremely invasive open-heart bypass surgery - using replacement vessels to "by-pass" the blocked or nearly blocked coronary arteries - or arterial stents to reopen blocked arteries, and ongoing medication to manage and reduce risk factors.
*CHIP

Heart Disease Begins in Childhood

In 1953, a study published in the Journal of the American Medical Association radically changed our understanding of the development of heart disease. Researchers conducted a series of three hundred autopsies on American casualties of the Korean War, with an average age of around twenty-two. Shockingly, 77 Percent of soldiers already had visible evidence of coronary atherosclerosis. Some even had arteries that were blocked off 90 percent or more. The study "dramatically showed that atherosclerotic changes appear in the coronary arteries years and decades before the age at which coronary heart disease (CHD) becomes a clinically recognized problem.

Later studies of accidental death victims between the ages of three and twenty-six found that fatty streaks - the first stage of atherosclerosis - were found in nearly all American children by age ten.  By the time we reach our twenties and thirties, these tatty streaks can turn into full-blown plaques like those seen in the young American GIs of the Korean War.  And by the time we're forty or fifty, they can start killing us off.  If there's anyone reading this over the age of ten, the question isn't whether or not you want to eat healthier to prevent heart disease but whether or not you want to reverse the heart disease you very likely already have.
​Just how early do these fatty streaks start to appear? Atherosclerosis may start even before birth. Italian researchers looked inside arteries taken from miscarriages and premature newborns who died shortly after birth. It turns out that the arteries of fetuses whose mothers had high LDL cholesterol levels were more likely to contain arterial lesions. This finding suggests that atherosclerosis may not just start as a nutritional disease of childhood but one during pregnancy.  It's become commonplace for pregnant women to avoid smoking and drinking alcohol. It's also never too early to start eating healthier for the next generation. 

According to William C. Roberts, the editor in chief of the American Journal of Cardiology, the only critical risk factor for atherosclerotic plaque buildup is cholesterol, specifically elevated LDL cholesterol in your blood. Indeed, LDL is called "bad" cholesterol, because it's the vehicle by which cholesterol is deposited into your arteries. Autopsies of thousands of young accident victims have shown that the level of cholesterol in the blood was closely correlated with the amount of atherosclerosis in their arteries.  To drastically reduce LDL cholesterol levels, you need to drastically reduce your intake of three things: trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and to a lesser extent dietary cholesterol, found exclusively in animal-derived foods, especially eggs. 
Notice a pattern here? The three boosters of bad cholesterol-the number-one risk factor killer-all stem from eating animal products and processed junk. This likely explains why populations living on traditional diets revolving around whole plant foods have largely remained free from the epidemic of heart disease.
*HNTD

Is it Really the Cholesterol?

Dr. Roberts hasn't only been editor in chief of the American Journal of Cardiology for more than thirty years; he's the executive director of the Baylor Heart and Vascular Institute and has authored more than a thousand scientific publications and written more than a dozen textbooks on cardiology. He knows his stuff.  In his editorial "It's the Cholesterol, Stupid!," Dr. Roberts argued (as noted earlier) that there is only one true risk factor for coronary heart disease: cholesterol. You could be an obese, diabetic, smoking couch potato and still not develop atherosclerosis, he argues, as long as the cholesterol level in your blood is low enough.
The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That's where you start out at birth, that's the level seen in populations largely free of heart disease, and that's the level at which the progression or atherosclerosis appears to stop in cholesterol-lowering trials.  An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study, a generations-long project to identify risk factors for heart disease. The population target should therefore be a total cholesterol level under 150 mg/dL. "If such a goal was created," Dr. Roberts wrote, "the great scourge of the Western world would be essentially eliminated." 
​The average cholesterol for people living in the United States is much higher than 150 mg/dL; it hovers around 200 mg/dL. If your blood test results came back with a total cholesterol of 200g/dL, your physician might reassure you that your cholesterol is normal. But in a society where it's normal to die of heart disease, having a "normal" cholesterol level is probably not a good thing.  To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL. Dr. Roberts noted that there are only two ways to achieve this for our population: to put more than a hundred million Americans on a lifetime of medications or to recommend they all eat a diet centered around whole plant foods.

So: drugs or diet. All health plans cover cholesterol-lowering statin drugs, so why change your diet if you can simply pop a pill every day for the rest of your life? Unfortunately, these drugs don't work nearly as well as people think, and they may cause undesirable side effects to boot.
*HNTD
Want Fries with That Lipitor
The cholesterol-lowering statin drug Lipitor has become the best-selling drug of all time, generating more than $140 billion in global sales. This class of ​drugs garnered so much enthusiasm in the medical community that some U.S. health authorities reportedly advocated they be added to the public water supply like fluoride is.
One cardiology journal even offered the tongue-in-cheek suggestion for fast-food restaurants to offer "Mcstatin" condiments along with ketchup packets to help neutralize the effects of unhealthy dietary choices.  For those at high risk for heart disease who are unwilling or unable to bring down their cholesterol levels naturally with dietary changes, the benefits of statins generally outweigh the risks. These drugs do have side effects, though, such as the potential for liver or muscle damage. The reason some doctors routinely order regular blood tests for patients on these drugs is to monitor for liver toxicity. We can also test the blood for the presence of muscle breakdown products, but biopsies reveal that people on statins can show evidence of muscle damage even if their blood work is normal and they exhibit no symptoms of muscle soreness or weakness. The decline in muscular ​strength and performance sometimes associated with these drugs may not be such a big deal for younger individuals, but they can place our seniors at increased risk for falls and injury.
​More recently, other concerns have been raised. In 2012, the U.S. Food and Drug Administration announced newly mandated safety labeling on statin drugs to warn doctors and patients about their potential for brain-related side effects, such as memory loss and confusion. Statin drugs also appeared to increase the risk of developing diabetes.  In 2013, a study of several thousand breast cancer patients reported that long-term use of statins may as much as double a woman's risk of invasive breast cancer. 

Plant-based diets have been shown to lower cholesterol just as effectively as first-line statin drugs, but without the muscle risks.  In fact, the "side effects" of healthy eating tend to be good - less cancer and diabetes risk and protection of the liver and brain.

Reversing Heart Disease

It's never too early to start eating healthfully, but is it ever too late? Such lifestyle medicine pioneers as Nathan Pritikin, Dean Ornish, and Caldwell Esselstyn Jr. took patients with advanced heart disease and put them on the kind of plant-based diet followed by Asian and African populations who didn't suffer from heart disease. Their hope was that a healthy enough diet would stop the disease process and keep it from progressing further.

But instead, something miraculous happened.  Their patients heart disease started to reverse. These patients were getting better. As soon as they stopped eating an artery-clogging diet, their bodies were able to start dissolving away some of the plaque that had built up. Arteries opened up without drugs or surgery, even in some cases of patients with severe triple-vessel heart disease. This suggests their bodies wanted to heal all along but were just never given the chance. 
​Let me share with you what has been called the "best kept secret in medicine". Given the right conditions, the body heals itself. It you whack your shin really hard on a coffee table, it can get red, swollen, and painful. But your shin will heal naturally if you just stand back and let your body work its magic. But what if you kept whacking it in the same place three times a day - say at breakfast, lunch, and dinner: It would never heal.

You could go to your doctor and complain that your shin hurts. No problem, he or she might say, whipping out a pad to write you a prescription for painkillers. You'd go back home, still whacking your shin three times a day, but the pain pills would make it feel so much better. That's what happens when people take nitroglycerin for chest pain. Medicine can offer tremendous relief, but it's not doing anything to treat the underlying cause.

Your body wants to regain its health if you let it. But if you keep reinjuring yourself three times a day, you interrupt the healing process. Consider smoking and lung cancer risk: One of the most amazing things learned in medical school was that within about fifteen years of stopping smoking, your lung can​cer risk approaches that of a lifelong nonsmoker. ​
Your lungs can clear out all that tar buildup and, eventually, it's almost as if you never smoked at all.  Your body wants to be healthy. And every night of your smoking life, as you fall asleep, that healing process is restarted until you light up your first cigarette the next morning. Just as you can reinjure your lungs with every puff, you can reinjure your arteries with every bite. You can choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? You can choose to stop damaging yourself, get out of your own way, and let your body's natural healing process bring you back toward health.

The Endotoxins

​Unhealthy diets don't just affect the structure of your arteries, an unhealthy diet can also affect their functioning. Your arteries are not merely inert pipes through which blood flows. They are dynamic, living organs. We've known for nearly two decades that a single fast-food meal-sausage and Egg McMuffins were used in the original study - can stiffen your arteries within hours, cutting in half their ability to relax normally. ​
And just as this inflammatory state ​starts to calm down five or six hours later - lunchtime! You may once again whack your arteries with another load of harmful food, leaving many Americans stuck in a danger zone of chronic, low grade inflammation. Unhealthy meals don't just cause internal damage decades down the road but right here and now, within hours of going into your mouth.  Originally, researchers blamed the animal fat or animal protein, but attention has recently shifted to bacterial toxins known as "endotoxins." Certain foods, such as meats, appear to harbor bacteria that can trigger inflammation dead or alive, even when the food is fully cooked.

Endotoxins are not destroyed by cooking temperatures, stomach acid, or digestive enzymes, so after a meal of animal products, these endotoxins may end up in your intestines. They are then thought to be ferried by saturated fat across the gut wall into your bloodstream, where they can trigger the inflammatory reaction in your arteries. 

This may help explain the remarkable speed at which cardiac patients can experience relief when placed on a diet composed primarily of plant foods, including fruits, vegetables, whole grains, and beans. Dr. Ornish reported a 91 percent reduction in angina attacks within just a ​few weeks in patients placed on a plant-based diet both with or without exercise. This rapid resolution in chest pain occurred well before their bodies could have cleared the plaque from their arteries suggesting plant-based diets don't just help clean out arteries but also improve their day-to-day function.
In contrast, control-group patients who were instead told to follow the advice of their doctors had a 186 percent increase in angina attacks. It's no surprise their conditions worsened, given that they continued to eat the same diet that crippled their arteries in the first place.  We've know about the dramatic power of dietary changes for decades. For example, there was a paper entitled "Angina and Vegan Diet" published in the American Heart Journal back in 1977. Vegan diets are exclusively plant based, avoiding meat, dairy, and eggs. Doctors described cases like that of Mr. F. W. (initials are often used to protect patient confidentiality), a Sixty-five-year-old man with angina so severe he had to stop every nine or ten steps. He couldn't even make it to the mailbox. He was started on a vegan diet, and his pain improved within days. Within months, he was reportedly climbing mountains with no pain at all.

Consider Brazil Nuts

​Can a single serving or Brazil nuts bring down your cholesterol levels faster than statin drugs and keep them down even a month after that single meal?

Researchers from Brazil gave ten men and women a single meal containing between one and eight Brazil nuts. Amazingly, compared to the control group who ate no nuts at all, just a single serving of four Brazil nuts almost immediately improved cholesterol levels. LDL- the "bad"- cholesterol levels were a staggering twenty points lower just nine hours after eating the Braz1l nuts. Even drugs don't work nearly that fast.
The researchers went back and measured the study participants' cholesterol thirty days later. Even a month after ingesting a single serving of Brazil nuts, their cholesterol levels stayed down. Normally, when a study comes out in the medical literature showing some too-good-to-be-true result like this, doctors wait to see the results replicated before they change their clinical practice and begin recommending something new to their patients, particularly when the study is done on only ten subjects, and especially when the findings seem too incredible to believe. But when the intervention is cheap, easy, harmless, and healthy - we're talking just four Brazil nuts per month - the burden of proof is somewhat reversed. The reasonable default position is to do it until proven otherwise. ​More is not better, however. Brazil nuts are so high in the mineral selenium that eating four every day may actually bump you up against the tolerable daily limit for selenium. Nevertheless, this is not something you have to worry about if you're only eating four Brazil nuts a month. 

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