The Flaming Heart :: Health and Disease :: Heart/Cardiovascular

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The Flaming Heart
by author Stephen Sinatra, MD, FACC, FACN

We all know what inflammation is. We recognize it as the redness, heat, and swelling that accompany injuries or infections. Although we may not like how it feels, inflammation is actually a beneficial process. It means that our body’s immune system is mobilizing cells to combat invading germs, remove damaged cells, and seal off the affected area so that it may heal.

A Destructive Defence System

But inflammation isn’t always beneficial. Inflammation in the coronary arteries, which supply life-giving oxygen to the heart, is dangerous. Scientists are only now beginning to understand the role that inflammation plays in heart disease. For decades it was believed that heart disease was caused by deposits of cholesterol (plaque) along artery walls, causing the arteries to stiffen and narrow, leading to atherosclerosis (“hardening of the arteries”). When coronary arteries become clogged, blood is unable to reach the heart and the person suffers a heart attack. People were told that if they avoided cholesterol, they would not suffer from heart disease.

Today, scientists know that an array of lifestyle and environmental factors assault the delicate lining of the arteries. Cholesterol and inflammatory substances can enter the arterial wall, causing a plaque lesion within.

Sometimes, the nasty contents of the lesion can be contained by smooth muscle cells that form a dense “cap.” This is called “stable plaque.” Sometimes, however, inflammation causes the cap to be thin and unstable. This is called “vulnerable plaque.” And although stable plaque isn’t a good thing - it narrows the arteries - it isn’t as lethal as vulnerable plaque, which is always in danger of rupture. When a plaque lesion ruptures, it releases its deadly contents into the bloodstream, forming a clot. If the clot is localized within the coronary arteries, it can cause a heart attack.

So the most important battle today isn’t against cholesterol - in fact, 50 percent of people hospitalized for heart disease have normal cholesterol levels - it is against vulnerable plaque and inflammation in the arteries.

How can you tell if you have inflammation? Most people are familiar with blood tests that assess cholesterol levels. You probably have also heard of “bad” (LDL) and “good” (HDL) cholesterol. Newer blood tests look for C-reactive protein (CRP), homocysteine, ferritin, fibrinogen, Lp(a) lipoprotein, AA/EPA ratio, and oxidized LDL. These important markers provide clues as to the presence or absence of silent inflammation.

Lifestyle and Environmental Factors

A family history of early coronary heart disease and advancing age will place you at high risk for heart disease. Obviously, we can’t control these factors. But most risk factors are avoidable and are a result of our environment and lifestyle.

Environmental factors include exposure to radiation, industrial wastes, toxins (such as mercury and heavy metals), certain bacteria, and viral infections. Lifestyle factors include cigarette smoking, consumption of hydrogenated oils, sugars, chemicals, refined flour products, and emotional stress. Obesity and high insulin levels are prime contributors to inflammation.

Diet and Weight Loss

Many North Americans think they’re taking care of their heart by eating margarine and sautéing in canola oil. They’re wrong. Margarine and canola contain hydrogenated oils, and they contribute to inflammation. Consumers have also been told that carbohydrates such as bread and pasta should form the “base” of a food pyramid. Wrong again. Too many refined flour products in the diet add extra weight and raise the level of blood sugar in the body, causing insulin levels to soar.

A heart-healthy meal consists of a ratio that will keep insulin levels in a smart zone:

Carbohydrates - 40 to 45 percent
Protein - 25 to 30 percent
Fat - 25 to 30 percent

Carbohydrates - The best carbohydrates are “low-glycemic,” meaning they don’t cause the body’s blood sugar to rise excessively. Lentils, chickpeas, and broccoli are ideal low-glycemic carbs. Organic fruits like cherries, plums, and grapefruits are also good choices. The key is to keep your use of refined flour products and simple sugars to a minimum.

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Stephen Sinatra, MD, FACC, FACN, is a board-certified internist and cardiologist specializing in preventive cardiology. His most recent book is Lower Your Blood Pressure in Eight Weeks (Ballantine, 2003).

Source: alive #262, August 2004

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