CHAPTER 9

PUTTING IT ALL TOGETHER—A SIMPLE AND EASY BLUEPRINT FOR A HEALTHY HEART—AND LIFE!

IN THIS CHAPTER, we’re going to make specific suggestions about what you can do right now to prevent a first (or second) heart attack and keep your heart healthy for many decades.

We’re going to advise you about which tests you should ask your doctor for and why. We’ll recommend which foods you should incorporate into your diet, if you haven’t already.

And we’re also going to discuss the emotional and psychological risk factors for heart disease, which need to be taken just as seriously as the physical ones. We’ll give you specific tools to help lower these risk factors.

THE TESTS YOU SHOULD ASK YOUR DOCTOR FOR

We hope by now you’re convinced that total cholesterol is a meaningless number and should be the basis for absolutely nothing in your treatment plan. The old division into “good” (HDL) cholesterol and “bad” (LDL) cholesterol is out of date and provides only marginally better information than a “total” cholesterol reading. As we’ve said, both good and bad cholesterol have a number of different components (or subtypes) that behave quite differently, and the twenty-first-century version of a cholesterol test should always tell you exactly which subtypes you have. Anything less is not particularly useful and should never be the sole basis on which a treatment plan or a statin drug is recommended. That’s why the LDL particle size test is the first test we recommend.

1. Particle Size Test

Although LDL cholesterol is known as the “bad” cholesterol, the fact is that it comes in several shapes and sizes, as does HDL cholesterol, the so-called “good” kind. These different subtypes of cholesterol behave very differently. Seen under a microscope, some LDL particles are big, fluffy, and harmless. Some are small, dense, “angry,” and much more likely to become oxidized, slipping through the cells that line the walls of the arteries (the endothelium) and beginning the inflammatory cascade that leads to heart disease.

Tests are now available that measure LDL particle size, and that’s the information you really want to have. If you have a pattern A cholesterol profile, most of your LDL cholesterol is the big, fluffy kind, which is great; but if you have a pattern B profile, most of your LDL cholesterol is composed of the small, dense, atherogenic particles that cause inflammation and ultimately plaque. (Fortunately, you can change the distribution from small to buoyant by following the dietary and supplement recommendations in this book.)

One widely used test is called the NMR LipoProfile, and it analyzes the size of LDL particles by measuring their magnetic properties. Others—including the Lipoprint and the Berkeley (from the Berkeley HeartLab) use electrical fields to distinguish the size of the particles. Another test known as the VAP (Vertical Auto Profile) separates lipoprotein particles using a high-speed centrifuge.1 And still another is the LPP (or Lipoprotein Particle Profile). Any of these newer cholesterol tests can be offered by your doctor.

Taking a statin drug, or any other medication, based solely on the standard cholesterol test is a really bad idea. Ask your doctor for one of the newer particle tests. If he objects, make sure he has a darn good reason. It’s the only cholesterol test that matters.

2. C-Reactive Protein (CRP)

CRP is a marker for inflammation that is directly associated with overall heart and cardiovascular health. In multiple studies, CRP has been identified as a potent predictor of future cardiovascular health—and, in our opinion, one that is far more reliable than elevated cholesterol levels. Biological characteristics that are associated with high CRP levels include infections, high blood sugar, excess weight, and hypercoagulability of blood (sticky blood).

Fortunately, there is a simple test that your doctor can conduct to find out how much CRP is in your blood. Just make sure the high-sensitivity test (hs-CRP) is used. This test doesn’t take much time: Typically, blood is drawn from a vein located either on your forearm or on the inside of your elbow. The blood is then analyzed in several tests to determine the level of CRP present. (Dr. Sinatra’s recommendation for an optimal CRP level is less than 0.8 mg/dL.)

3. Fibrinogen

Fibrinogen is a protein that determines the stickiness of your blood by enabling your platelets to stick together. You need adequate fibrinogen levels to stop bleeding when you’ve been injured, but you also want to balance your fibrinogen levels to support optimal blood circulation and prevent unnecessary clotting. (In women younger than forty-five, Dr. Sinatra has seen far more heart attacks caused by improper blood clotting than by anything else.) Normal levels are between 200 and 400 mg/dL, and they may be elevated during any kind of inflammation.

Fibrinogen has been identified as an independent risk factor for cardiovascular disease and is associated with the traditional risk factors as well. In one study, fibrinogen levels were significantly higher among subjects with cardiovascular disease than among those without it.2

There are two ways to test for fibrinogen. The first is the Clauss method and the second is a newer test called the FiF (immunoprecipitation functional intact fibrinogen) test, which was developed by American Biogenetic Sciences.³ The FiF test is the better one because it shows a stronger association with cardiovascular disease than the Clauss method does.⁴ If the FiF test isn’t available, use the Clauss method—it still has a strong association with cardiovascular disease, even if it’s not quite as accurate as the newer test.

If you have a family history of heart concerns, you must check your serum fibrinogen level. Women who smoke, take oral contraceptives, or are postmenopausal usually have higher fibrinogen levels.

Worth noting: This test hasn’t caught on with many doctors because there are no direct treatments for elevated levels. But supplements such as nattokinase, discussed in chapter 7 on supplements, can work well to “thin” the blood and prevent unwanted clotting. Adding omega-3 fatty acids to your diet may also help.

4. Serum Ferritin

Ever wonder why so many vitamin manufacturers offer multiple vitamins “without iron”? Here’s why: Iron is one of those weird substances where if you don’t have enough you can have some real problems (e.g., iron-deficiency anemia), but if you have too much, look out! Iron is highly susceptible to oxidation. (Imagine someone leaving a barbell from your gym outside in the rain for a couple of days. It’s going to rust like crazy. That’s oxidation.)

Iron levels in the body are cumulative (stored in the muscles and other tissues), and unless iron is lost through menstruation or by donating blood, over the years toxic levels can build up in the system. Although this danger always exists for men, it becomes a real risk for women after menopause. Both of us are adamant that no one but premenopausal women should ever take vitamins with iron, or supplemental iron of any kind, unless prescribed by a doctor.

Iron overload—technically called hemochromatosis—can actually contribute to heart disease. Researchers measure iron in the blood by measuring a form of it called ferritin. A 1992 study by Finnish researchers examined the role of iron in coronary artery disease. After studying 1,900 Finnish men between the ages of forty-two and sixty for five years, the researchers found that men with excessive levels of ferritin had an elevated risk of heart attack, and that every 1 percent increase in ferritin translated into a 4 percent increase in heart attack risk.5

Those with high levels of ferritin were more than twice as likely to have heart attacks than those with lower levels. The authors of this study concluded that ferritin levels may be an even stronger risk factor for heart disease than high blood pressure or diabetes is.⁶ It’s certainly a more important risk factor than high cholesterol.

If your ferritin levels are high, consider donating blood every so often, or ask your doctor to consider a therapeutic phlebotomy. (Dr. Sinatra’s recommendation for an optimal serum ferritin level is less than 80 mg/L for women and less than 90 mg/L for men.)

Worth noting: One consideration regarding supplemental vitamin C is that it helps the body absorb iron better. If you have a problem with iron levels, keep your supplemental vitamin C to less than 100 mg a day.

5. Lp(a)

Lp(a) is a type of cholesterol-carrying molecule that contains one LDL (low-density lipoprotein) molecule chemically bound to an attachment protein called apolipoprotein(a). In a healthy body, Lp(a) isn’t much of a problem. It circulates and carries out repair and restoration work on damaged blood vessels. The protein part of it promotes blood clotting. So far, so good.

The problem is, the more repair you need on your arteries, the more Lp(a) is utilized, and that’s when things get ugly. Lp(a) concentrates at the site of damage, binds with a couple of amino acids within the wall of a damaged blood vessel, dumps its LDL cargo, and starts to promote the deposition of oxidized LDL into the wall, leading to more inflammation and ultimately to plaque.

Also, Lp(a) promotes the formation of blood clots on top of the newly formed plaque, which narrows the blood vessels further. If the clots are large enough, they can block an artery. (Most heart attacks are due to either a large clot developing in vessels with moderate-to-severe narrowing or a plaque rupture that blocks the artery.)

Elevated Lp(a) is a very serious risk factor. A very high percentage of heart attacks happen to people with high Lp(a) levels. Dr. Sinatra thinks Lp(a) is one of the most devastating risk factors for heart disease and one of the hardest to treat.

One reason doctors aren’t running out to test for Lp(a) all the time is that there are no real pharmaceutical interventions that work to lower it. In addition, Lp(a) levels are largely genetically determined and not very modifiable by lifestyle choices. However, your Lp(a) level can give you a good idea of your real risk for heart disease, and a high level may serve as a wake-up call to inspire you to work harder to improve your heart health using the strategies, foods, supplements, and lifestyle changes suggested in this book. That said, Dr. Sinatra feels that Lp(a) can be lowered with a combination of 1 to 2 g of fish oil, 500 to 2,500 mg of niacin (not the slow-release kind), and 200 mg of lumbrokinase.

Worth noting: Statin drugs can sometimes raise Lp(a) levels! This is mentioned on the warning labels of statin drug ads in the Canadian edition of the New England Journal of Medicine, but such labeling is not required by the Food and Drug Administration, so you won’t see it in ads published in the United States.7

6. Homocysteine

Homocysteine is an amino acid by-product that causes your body to lay down sticky platelets in blood vessels. Having some homocysteine is normal, but an excess might affect your cardiovascular health. Evidence shows that homocysteine contributes to atherosclerosis, reduces the flexibility of blood vessels, and helps make platelets stickier, thus slowing blood flow. Net result: There’s a direct correlation between high homocysteine levels and an increased risk of heart disease and stroke.

Elevated homocysteine strongly predicts both a first and a recurring cardiovascular incident (including death).⁸ Too much homocysteine adversely affects the function of the endothelium, the all-important lining of the artery walls. It also increases oxidative damage and promotes inflammation and thrombosis—a regular evil trifecta for heart disease.⁹ One study looked at more than 3,000 patients with chronic heart disease and found that a subsequent coronary event was 2.5 times more likely in patients with elevated levels of homocysteine. What’s more, each 5 μmol/L of homocysteine predicted a 25 percent increase in risk!¹⁰

Fortunately, there’s an easy way to bring down homocysteine levels. All you have to do is give the body the three main nutrients it needs to metabolize homocysteine back into harmless compounds. The three nutrients are folic acid, vitamin B₁₂, and vitamin B₆. All it takes is about 400 to 800 mcg of folic acid, 400 to 1,000 mcg of B₁₂, and 5 to 20 mg of B₆. If you’ve had a heart attack or other cardiovascular event; if you have a family history of early heart disease; or if you have hypothyroidism, lupus, or kidney disease, consider asking your doctor to test your homocysteine levels. Finally, if you take drugs that tend to elevate homocysteine—theophylline (for asthma), methotrexate (for cancer or arthritis), or L-dopa (for Parkinson’s)—you should be tested. (Dr. Sinatra’s recommendation for an optimal homocysteine level is between 7 and 9 μmol/L.)

7. Interleukin-6

Interleukin-6 is important because it stimulates the liver to produce CRP. And we are learning that this inflammatory cytokine has a strong association with not only heart disease but also asthma. (Asthma is the result of airways swelling and constricting, so it makes sense that an inflammatory agent is behind the curtains here as well.) The Iowa 65+ Rural Health Study demonstrated that elevated levels of interleukin-6 and CRP were associated with an increased risk for both cardiovascular disease and general mortality in healthy older people.

Interleukin-6 may be an even better marker for inflammation than CRP is because these “precursor” levels rise earlier. If you’re concerned about inflammation and its effect on your heart, ask your doctor to do an interleukin-6 test. (Dr. Sinatra’s recommendation for an optimal interleukin-6 level is 0.0 to 12.0 pg/mL.)

8. Coronary Calcium Scan

Calcium is great—as long as it stays in the bones and teeth. One place you don’t want it is in the coronary arteries.

Coronary calcification is one of the major risk factors that predicts coronary heart disease and future heart attacks.11 The more calcium present, the greater the risk of suffering a heart attack. Men develop calcifications about ten to fifteen years earlier than women do. Calcification can be detected in the majority of asymptomatic men over fifty-five years of age and in women over sixty-five.

As far back as 1991, cardiologist Stephen Seely, M.D., published a paper in the International Journal of Cardiology titled “Is Calcium Excess in the Western Diet a Major Cause of Arterial Disease?” He pointed out that cholesterol only makes up 3 percent of arterial plaque while calcium makes up 50 percent!¹²

The Florida cardiologist Arthur Agatston, M.D., is best known for his wildly popular South Beach diet, but what many people don’t know is that he also developed a widely accepted test for coronary calcification known as the Agatston test. Individuals who score less than 10 on the Agatston test have minimal calcification; those with Agatston scores of 11 to 99 have moderate calcification; those with scores of 100 to 400 have increased calcification; and those with scores above 400 have extensive calcification.

It is well established that individuals with Agatston scores above 400 have an increased occurrence of coronary procedures (bypass, stent placement, and angioplasty) and events (myocardial infarction and cardiac death) within the two to five years following the test. Individuals with very high Agatston scores (over 1,000) have a 20 percent chance of suffering a heart attack or cardiac death within a year. Even among patients over the age of seventy who frequently have calcification, an Agatston Score above 400 was associated with a higher risk of death.¹³

The American Heart Association and the American College of Cardiology provide guidelines for coronary calcification testing, available online, www.ahajournals.org/misc/sci-stmts_topindex.shtml. These guidelines currently suggest—and we agree—that screening for calcification is of value for an individual who is considered to be at intermediate ten-year risk, which means that he or she has a 10 to 20 percent likelihood of experiencing a cardiac event within the next ten years.¹⁴

WHAT YOU NEED TO KNOW

Ask your doctor for the following tests, which are more important than the standard test for cholesterol:

• LDL particle size

• Hs-CRP

• Fibrinogen

• Serum ferritin (iron)

• Lp(a)

• Homocysteine

• Interleukin-6

• Coronary calcium scan

Eliminate these foods:

• Sugar

• Soda

• Processed carbs

• Trans fats

• Processed meats

• Excess vegetable oils

Eat more of these foods:

• Wild salmon

• Berries and cherries

• Grass-fed meat

• Vegetables

• Nuts

• Beans

• Dark chocolate

• Garlic and turmeric

• Pomegranate juice, green tea, and red wine

• Extra-virgin olive oil

Make these lifestyle changes to reduce stress:

• Meditate or practice deep breathing

• Express your emotions

• Play

• Cultivate intimacy and pleasure

• And most of all . . . enjoy your life!

EAT THIS, DUMP THAT

This section is divided into two parts—what to eat and what not to eat for optimal heart health. Fortunately, the list of what not to eat is fairly short, so let’s get that one out of the way first. We call it the “Dump It!” list and provide you with specific “fast action plans” to help you remove these nutritionally empty, heart-unfriendly foods from your diet. The second section is called “Eat This!” and reveals some of the healthiest foods on the planet.

Dump It: Sugar

As we’ve said throughout this book (see chapter 4), sugar is a far worse threat to your heart than fat ever was.

The 2010 Dietary Guidelines for Americans suggest that no more than 25 percent of your calories should come from added sugars, but we think that’s a ridiculously high amount. (The American Heart Association recommends no more than 5 percent.) Research by Kimber Stanhope, Ph.D., at the University of California, Davis, has shown that when people consume 25 percent of their calories from fructose or high-fructose corn syrup, several factors associated with an increased risk for heart disease—including triglycerides and a nasty little substance called apolipoprotein B—escalate.¹⁵ (Remember, it’s the fructose in sugar that’s the problem. High-fructose corn syrup is 55 percent fructose, and regular sugar is 50 percent fructose, so for all intents and purposes, they have the same bad effect on your heart and your health.)

Fast Action Plan: Cut out soda. Soda is probably the worst offender in this category, but not by much. Fruit juices are loaded with sugar and only marginally better than soda. “Energy drinks” aren’t any better. Most are loaded with sugar, and the sugar-free versions are loaded with chemicals. Many processed carbs (see below) are also full of sugar, and virtually all cakes, candies, pastries, doughnuts, and other sources of empty calories are also sugar heavyweights.

Dump It: Processed Carbohydrates

Processed carbs include almost any carbohydrate food that comes in a package: cereals, pasta, bread, minute rice, you name it. These foods are almost always high-glycemic, meaning they quickly and dramatically raise your blood sugar, which is exactly what you do not want. A 2010 study in the Archives of Internal Medicine demonstrated that women who ate the highest amount of carbohydrates had a significantly greater risk of coronary heart disease than those who ate the lowest amount, and that carbohydrates from high-glycemic carbs were particularly associated with significantly greater risk for heart disease.¹⁶ (This association was not confirmed for men in this particular study, but we suspect that future studies will discover that it’s true for both sexes.)

CORNFLAKES A GREAT BREAKFAST? THINK AGAIN!

If any of you out there still think cornflakes are a great, wholesome breakfast, read on.

A landmark research study conducted by Michael Shechter, M.D., of Tel Aviv University’s Sackler School of Medicine and the Heart Institute of Sheba Medical Center, with collaboration from the Endocrinology Institute, shows exactly how high-carbohydrate foods increase the risk for heart problems.17

Researchers looked at four groups of volunteers who were given different breakfasts. The first group was given a cornflake mush mixed with milk, not unlike the typical American breakfast. The second group was given a pure sugar mixture. The third group was given bran flakes. And the fourth group was given a placebo (water).

Over four weeks, Shechter applied a test that allows researchers to visualize how the arteries are functioning. It’s called brachial reactive testing, and it uses a cuff on the arm (similar to those used for measuring blood pressure) that can visualize arterial function in real time.

The results were dramatic. Before any of the patients ate, their arterial function was basically the same. After eating, all had reduced functioning except for the patients in the water-drinking placebo group. Enormous peaks indicating arterial stress were found in the high GI groups: the cornflakes and sugar groups.

“We knew high glycemic foods were bad for the heart. Now we have a mechanism that shows how,” Shechter wrote. “Foods like cornflakes, white bread, French fries, and sweetened soda all put undue stress on our arteries. We’ve explained for the first time how high-glycemic carbs can affect the progression of heart disease.”

During the consumption of foods high in sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the arteries. Endothelial health can be traced back to almost every disorder and disease in the body. According to Shechter, it is the “riskiest of the risk factors.”

Shechter recommended sticking to foods such as oatmeal, fruits and vegetables, and legumes and nuts, which all have a low glycemic index. Exercising every day for at least thirty minutes, he added, is an extra heart-smart action to take.

There’s no two ways about it—high-glycemic carbohydrates are inflammatory. As researchers from Harvard Medical School and the Harvard School of Public Health noted, quickly digested and absorbed carbs (i.e., those with a high glycemic load) are associated with an increased risk of heart disease.18

These same researchers examined the diets of 244 apparently healthy women to evaluate the association between glycemic load and blood levels of CRP (C-reactive protein, the systemic measure of inflammation discussed earlier in this chapter). They found “a strong and statistically significant positive association between dietary glycemic load and [blood levels of] CRP.”¹⁹ And that’s putting it mildly. Women whose diets were highest in glycemic load had almost twice the amount of CRP in their blood as women whose diets were lowest in glycemic load (3.7 for high–glycemic load ladies, 1.9 for low–glycemic load ladies). The difference in inflammation levels was even more pronounced for overweight women. Among women with a body mass index (BMI) greater than 25, those whose diets were lowest in glycemic load had an average CRP reading of 1.6, but those whose diets were highest in glycemic load had a CRP reading more than three times that amount (average measurement: 5.0 mg/L).²⁰

Full disclosure: We don’t much buy into the argument that “whole grains” eliminate all the problems associated with processed carbs, and here’s why: Number one, most commercial products that are made with whole grains don’t contain all that much of them. Number two, whole grains raise blood sugar almost as much as processed grains do. Number three, whole grains still contain gluten, which can be very inflammatory for people who are gluten-sensitive. That said, real whole grain products (Ezekiel 4:9 breads, for example) are way better than their processed counterparts. But be a careful consumer—just because a label says “wheat” instead of “white,” don’t assume it’s good for you.

Fast Action Plan: Reduce (or eliminate) consumption of processed carbohydrates. At the same time, increase non-processed carbohydrates such as vegetables and low-sugar fruits. Replace your bagel and orange juice with some eggs, veggies, and a slice of avocado. Have berries for dessert. When eating out, say “no” to the breadbasket.

Dump It: Trans Fats

According to findings presented at the annual meeting of the American Heart Association in 2006, women who ate the most trans fats were more than three times as likely to develop heart disease as women who ate the least.²¹ Harvard researcher Charlene Hu examined data from the long-running Nurses’ Health Study, which has followed 120,000 female nurses for more than thirty years. His research shows that for each 2 percent increase in trans fat calories consumed, the risk for coronary heart disease roughly doubles!²² Trans fats raise LDL cholesterol levels, which doesn’t mean very much by itself, but at high intakes they also reduce HDL levels, which definitely isn’t good.²³

The worst offenders include nondairy “creamers,” most margarines, cake mixes, ramen noodles, soup cups, virtually all packaged baked goods (e.g., Twinkies, chips, and crackers), doughnuts, many breakfast cereals, “energy” bars, cookies, and definitely fast food. (Just for example, a medium order of fries contains an incredible 14.5 g of trans fat, and a Kentucky Fried Chicken Original Recipe chicken dinner has 7 g. The ideal intake for humans is 0 g.)

THE “NO TRANS-FATS!” SCAM

When the government mandated that trans fats be listed on the nutrition facts label of food, big food lobbyists sprang into action. They somehow created a loophole that lets manufacturers use trans fats while legally claiming “no trans fats!” on their packaging. Here’s how:

Manufacturers can claim “no trans fats” as long as there is less than half a gram of the stuff per serving. Sounds reasonable, until you remember how clever and ruthless Big Food can be. By making “serving sizes” ridiculously small, and by keeping trans fats to just under half a gram per “serving,” they were able to technically comply with the rules. But the end result is that if each artificially small “serving” contains, say 0.4 g of trans fats, you could quite easily consume a gram or two of the stuff just by eating what most people would consider a “normal” serving size. Do that a few times a day and before you know it you’ve raised your heart disease risk by quite a few percentage points.

What to do? Simple. Ignore the “no trans fats!” legend on the front of the package and read the ingredients list instead. No matter what the label says, if the list of ingredients contains partially hydrogenated oil or hydrogenated oil, the product has trans fats. Period. (Typically, you’ll see partially hydrogenated soybean oil in the ingredients list, but it could be any type of oil at all. What you’re looking for are the keywords hydrogenated and partially hydrogenated.)

Worth knowing: There is one exception to the don’t-eat-trans-fats rule, and that’s something called conjugated linoleic acid, or CLA. CLA is a trans fat that’s not man-made; rather, it’s made naturally in the bodies of ruminants (cows). Factory-farmed meat doesn’t have any, but grass-fed meat—and products that come from pasture-raised animals—do. CLA has both anticancer and antiobesity properties. CLA is good for you, unlike hydrogenated or Partially hydrogenated oils—the very definition of man-made trans fats—which are definitely not good for you.

Fast Action Plan: Stop eating fast food. On all packaged foods from the supermarket, check the ingredients list for “partially hydrogenated” or “hydrogenated” oils. If either of those is listed, don’t eat it. Look in particular at margarines, cookies, cakes, pastries, doughnuts, and, as mentioned, fast food.

Dump It: Processed Meats

Processed meats contribute to both inflammation in general and heart disease specifically.

Harvard researchers investigated the effect of eating processed meat versus unprocessed meat. Processed meat was defined as any meat preserved by curing, salting, smoking, or with the addition of chemical preservatives, such as those found in salami, sausages, hot dogs, luncheon meats, and bacon. (Previous studies had rarely separated processed meat from unprocessed meat when investigating the relationship between disease and meat eating.) The researchers analyzed twenty studies that included a total of 1,218,380 people from ten countries on four continents (North America, Europe, Asia, and Australia). They found that each 1.8-ounce daily serving of processed meat (about one hot dog or a couple slices of deli meat) was associated with a 42 percent higher risk of developing heart disease. (In contrast, no relationship was found between heart disease and nonprocessed red meat.24)

Although the study didn’t identify which specific ingredients in processed meat could be responsible for the association, many health professionals believe that the high levels of sodium and nitrates might be responsible. “When we looked at average nutrients in unprocessed red and processed meats eaten in the United States, we found that they contained similar average amounts of saturated fat and cholesterol. In contrast, processed meats contained, on average, four times more sodium and 50 percent more nitrate preservatives,” said Renata Micha, a research fellow in the department of epidemiology at the Harvard School of Public Health and lead author of the study. “This suggests that differences in salt and preservatives, rather than fats, might explain the higher risk of heart disease and diabetes seen with processed meats, but not with unprocessed red meats.”²⁵

Fast Action Plan: Cut out processed (e.g., deli) meats.

Dump It: Excessive Omega-6 Fats

Vegetable oils (corn, canola, and soybean) are mostly made up of pro-inflammatory omega-6 fats, and you should reduce (not necessarily eliminate) your consumption of them while increasing your consumption of anti-inflammatory omega-3 fats.

This is the one recommendation that comes with an asterisk. Omega-6 fats, the ones that are most prevalent in vegetable oils, are not in and of themselves “bad.” But they are pro-inflammatory, and they need to be balanced by an equal (or near-equal) intake of anti-inflammatory omega-3s. (You can review this information in chapter 5, “The Truth about Fat.”) The optimal ratio of omega-6 to omega-3 in the human diet is no higher than 4 : 1, and many believe the ideal ratio is 1:1. In the average Westernized diet, the ratio is anywhere between 15 : 1 and 25 : 1, which creates a highly inflammatory state in the body. Because heart disease is primarily a disease of inflammation, such a state should be avoided as much as humanly possible.

And by the way, it’s not just the oils you use for cooking that tip the scales into inflammation land. Omega-6 fats are everywhere in the food supply—you can’t swing a rope without hitting a food product loaded with omega-6s. Nearly all processed foods contain them. They’re used almost exclusively in restaurants, for frying, sautéing, and baking, so virtually anything you order from the menu has got a ton of omega-6 fats.

So choose your omega-6 fats carefully and use them sparingly. (The best choices are cold-pressed, unrefined oils—sesame oil is a particularly good choice.) Use highly processed supermarket oils (such as corn oil) infrequently or not at all. When you sauté food, try substituting monounsaturated fats such as olive oil and macadamia nut oil for high omega-6 oils such as canola or soybean. And, above all, increase your intake of omega-3 fats to help balance your intake of omega-6s (see the “Eat This!” section below).

Fast Action Plan: Never use generic processed oils such as Wesson or Crisco. Cut down on corn oil, safflower oil, soybean oil, and canola oil (see Dr. Sinatra’s personal story on canola oil in chapter 5). Whenever possible, use olive oil, sesame oil, or macadamia oil. And pay attention to the “Eat This!” section in this chapter on omega-3s.

THE “EAT THIS!” LIST

Both of us are frequently interviewed about the best foods for health. Virtually every reporter either of us has ever spoken with winds up asking, “How much of this food do you need to eat to get its benefits?” It’s a reasonable question, but there’s almost never a perfect answer. We know of no study, for example, that has systematically tested the effects of eating five portions of blueberries a week as opposed to three, or compared eating two portions of salmon per week with eating it daily. Our recommendation is to put these foods in heavy rotation in your diet, enjoying them as frequently as you like.

Here are the foods you want to include in your diet on a regular basis.

Eat This: Wild Alaskan Salmon

Salmon is one of the best sources of anti-inflammatory omega-3s. But not all salmon is created equal. Wild Alaskan salmon is far superior to the farm-raised variety. (According to independent lab tests by the Environmental Working Group, seven out of ten farmed salmon purchased at grocery stores were contaminated with polychlorinated biphenyls [PCBs] at levels high enough to raise health concerns.) Wild salmon is far cleaner, and it has the added benefit of containing one of the most powerful antioxidants on the planet, astaxanthin. A 4-ounce serving also contains 462 mg of heart-healthy potassium, the same amount in a medium banana.26

Both of us have been buying our salmon from a wonderful company called Vital Choice for many years. Vital Choice is run by third-generation Alaskan fishermen who are scrupulous about using sustainable fishing and equally scrupulous about testing their fish thoroughly for contaminants and metals. They ship in dry ice, and they have the best fish we’ve ever tasted.

Fast Action Plan: Eat wild salmon twice a week.

Eat This: Berries

All berries are loaded with natural anti-inflammatory properties and natural antioxidants. They’re also very low in sugar. Blueberries contain a beneficial compound called pterostilbene, which helps prevent the deposit of plaque in the arteries and also helps prevent some of the damage caused by oxidized cholesterol.²⁷ Raspberries and strawberries contain another substance, ellagic acid, which offers similar protection against oxidized LDL.²⁸ And all berries—blueberries, raspberries, strawberries, and others—contain anthocyanins, plant compounds that help lower inflammation (see “Cherries” below).

Fast Action Plan: Eat berries three (or more) times a week.

Eat This: Cherries

Cherries and cherry juice have long been known to be effective against the pain of gout, and scientists believe that the compounds in cherries responsible for this are anthocyanins. Anthocyanins act like natural COX-2 inhibitors. “COX” stands for cyclooxygenase, which is produced in the body in two forms called COX-1 and COX-2. COX-2 is used for signaling pain and inflammation.

The popularity of arthritis drugs such as Vioxx and Celebrex was based on their unique ability to block the pain and inflammation messages of COX-2 while leaving the non-inflammatory COX-1 alone. Unfortunately, there were some really unpleasant side effects associated with Vioxx, and it was taken off the market. But anthocyanins produce a similar effect with none of the problems of such drugs. Cherries (along with raspberries) have the highest yields of pure anthocyanins. In one study, the COX inhibitory activity of anthocyanins from cherries was comparable to that of ibuprofen and naproxen. Researchers feel that in addition to helping with pain and inflammation, consuming anthocyanins on a regular basis may help lower heart attack and stroke risk.

Fast Action Plan: Eat cherries two (or more) times a week.

Eat This: Grass-Fed Beef

We’re not anti-meat guys, but we are very much against factory-farmed meat. The majority of the meat we consume, unfortunately, is feedlot-raised meat from factory farms. It’s loaded with antibiotics, steroids, and hormones; it’s very high in inflammatory omega-6 fats; and it contains virtually no anti-inflammatory omega-3s.

Grass-fed meat is a whole different “animal.” (Okay, bad pun, sorry, we couldn’t resist.) Raised on pasture, it contains less omega-6s plus a fair amount of omega-3s, resulting in a much better omega-6: omega-3 ratio. Grass-fed meat is almost always raised organically, and, in any case, it never has hormones, steroids, or antibiotics. If you eat meat, grass-fed is the only way to go.

Fast Action Plan: Eat only grass-fed meat when you eat meat.

Eat This: Vegetables (and Some Fruit)

No matter what kind of diet you’re on—from vegan to Atkins—you can probably benefit from eating more vegetables than you already do. The entire vegetable kingdom is loaded with natural anti-inflammatories, antioxidants, and other plant compounds, such as flavonoids, that are good for your heart.

In two long-running Harvard-based research projects, the Nurses’ Health Study and the Health Professionals Follow-up Study, the higher the average daily consumption of vegetables and fruits, the lower the chances of developing cardiovascular disease. Compared with those in the lowest category of fruit and vegetable intake (fewer than one and a half servings daily), those averaging eight or more servings per day were a whopping 30 percent less likely to have had a heart attack or stroke.29

Although all vegetables and fruits probably contributed to this stunning effect, the researchers felt that the most outstanding contributors were the green, leafy veggies (such as spinach and Swiss chard) and the cruciferous ones (broccoli, Brussels sprouts, kale, cabbage, and cauliflower). (In the fruit department, citrus fruits such as oranges, lemons, limes, and grapefruit were particularly protective.³⁰)

When researchers took the Harvard studies mentioned above and combined them with several other long-term studies both in Europe and the United States, they found a similar protective effect. Individuals who ate more than five servings a day of vegetables and fruits had a roughly 20 percent lower risk of coronary heart disease,³¹ and a similar reduction in the risk of stroke.³²

The reason we’re not as over-the-top enthusiastic about fruit is that despite its terrific benefits, it still contains sugar, which can be a problem for many folks. For the large number of people whose blood sugar rises when they merely look at a candy bar, unlimited fruit is a bad idea. Low-sugar fruits (such as apples, grapefruit, cherries, berries, and oranges) are fine in moderation. Vegetables, on the other hand, can be virtually unlimited.

Fast Action Plan: Eat 5 to 9 half cup servings of vegetables and fruit a day.

Eat This: Nuts

Although an apple a day may indeed keep the doctor away, the same can also be said of a handful of nuts. People who eat nuts regularly are less likely to have heart attacks or die from heart disease than those who don’t. Five large studies—the Adventist Health Study, the Iowa Women’s Health Study, the Nurses’ Health Study, the Physicians’ Health Study, and the CARE Study—have all found a consistent 30 to 50 percent lower risk of heart attacks or heart disease associated with eating nuts several times a week.³³

FIGHT HEART DISEASE WITH FOOD

In a fascinating and much-discussed article that appeared in the December 16, 2004, issue of the British Medical Journal, researchers put forth an idea called the polymeal.34 They examined all of the research on foods and health to see whether they could put together the ideal meal (the polymeal) that, if you ate it every day, would significantly reduce your risk for cardiovascular disease. They came up with a theoretical meal that, eaten daily, would reduce cardiovascular risk by a staggering 75 percent (there’s not a pill in the world that can do that!).

The ingredients of the polymeal?

Wine, fish, almonds, garlic, fruits, vegetables, and dark chocolate.

One of the many reasons for the protective effect of nuts may be an amino acid named arginine. Remember our earlier discussion about the endothelium, (the inner lining of the arterial walls)? Arginine has a role in protecting this inner lining, making the arterial walls more pliable and less susceptible to atherogenesis. Arginine is needed to make an important molecule called nitric oxide, which helps relax constricted blood vessels and ease blood flow.³⁵

In addition, nuts are a great source of numerous phytonutrients—bioactive chemicals found in plants. These compounds have powerful health benefits, not the least of which is their antioxidant activity, which is linked to the prevention of coronary heart disease. And if you’re worried about calories, consider this: In the Nurses’ Health Study out of Harvard, nut consumption was inversely related to weight gain.³⁶ Several large studies, including the Physicians’ Health Study (22,000 men) and the Adventist Health Study (more than 40,000 people), have demonstrated a link between nut eating and a reduction in heart disease.³⁷ Just keep portions reasonable—an ounce or so a day is great.

Fast Action Plan: Eat 1 ounce of nuts five times a week.

Eat This: Beans

Fact number one: Fiber is good. (High-fiber diets have been associated with lower rates of a host of diseases, including heart disease.) Fact number two: We don’t get enough of it. (Most health organizations recommend a daily intake of 25 to 38 g daily; the average American gets 11 g.) Fact number three: Beans are a fiber heavyweight.

Case closed.

One study found that one serving of beans on a daily basis lowered the risk of a heart attack by 38 percent.

Regarding heart disease, the big selling point of beans used to be that they lowered cholesterol.38 That’s definitely true, but, as you’ve learned, it’s not nearly as important as whether they actually lower heart disease. And they do. One study found that one serving of beans on a daily basis lowered the risk of a heart attack by an eyebrow-raising 38 percent!³⁹ Another study found that individuals eating beans and legumes at least four times a week had a 22 percent lower risk of heart disease than individuals consuming beans/legumes less than once a week.⁴⁰

Their high fiber content alone would make beans a top food for the heart, but beans offer a lot more than fiber. The U.S. Department of Agriculture ranking of foods by antioxidant capacity lists small red dried beans as having the highest antioxidant capacity per serving size of any food tested. In fact, of the four top-scoring foods, three were beans (red beans, red kidney beans, and pinto beans). Many bean varieties have a lot of folic acid (especially adzuki beans, lentils, black-eyed peas, and pinto beans). Folic acid is one of the key players in bringing down the inflammatory compound homocysteine, itself a risk factor for heart disease.

Fast Action Plan: Eat a serving of beans or lentils at least four times a week. (One serving is ¹/₂ cup to 1 cup cooked beans.)

Eat This: Dark Chocolate

Study after study is confirming that plant chemicals in cocoa-rich dark chocolate called flavanols can lower blood pressure and reduce inflammation. A 2011 study in the British Medical Journal found that high levels of chocolate consumption are associated with a one-third reduction in the risk of developing heart disease. The highest levels of chocolate consumption were associated with a 37 percent reduction in cardiovascular disease and a 29 percent reduction in stroke when compared to the lowest levels.⁴¹

Flavanol-rich cocoa lowers blood pressure.⁴² And the Zutphen Elderly Study of 470 elderly men found that those who ate the most cocoa had literally half the risk of dying from heart disease than men who ate the least.⁴³

Now the thing about chocolate is that all the good stuff is found in the cocoa that it’s made from, so you really want high-cocoa chocolate. We’re not talking about the candy bars you get at the 7-Eleven here; we’re talking about a cocoa-rich chocolate that contains all the flavanols that have been found to be so healthy. White chocolate and milk chocolate have hardly any flavanols to speak of, so it’s got to be dark. Many dark chocolate bars will now tell you their cocoa content in percentage form—look for at least 60 percent cocoa. (The higher the cocoa content, the less sweet the bar.)

You’ll also find that this kind of chocolate is easy to eat in small quantities—it’s not so sweet that it causes you to crave more and more of it, and it’s easy to be satisfied with just a square or two, which is all you need for the health benefits.

Fast Action Plan: Eat one to two squares of dark chocolate four to six days a week.

Eat This: Turmeric

Turmeric is the spice that makes curries yellow. It occupies a place of distinction in both Ayurvedic and Chinese medicine, largely because of its phenomenal anti-inflammatory properties. (It also has anticancer activity and is very helpful for the liver.) The active ingredients in turmeric are a group of plant compounds called curcuminoids (collectively known as curcumin). In addition to being anti-inflammatory, curcumin is a powerful antioxidant. Because oxidized LDL is a big player in the cascade that leads to inflammation and heart disease, turmeric’s antioxidant properties are a big benefit.

Fast Action Plan: Put turmeric at the front of your spice cabinet and use it often. It goes well on veggies, eggs, sautéed dishes, meats, fish, and poultry.

Eat This: Pomegranate Juice

Pomegranate juice is one of the few “trendy” health foods that actually lives up to its hype. Researchers at the Technion-Israel Institute of Technology in Haifa suggest that long-term consumption of pomegranate juice may help slow aging and protect against heart disease.

In a study published in the American Journal of Cardiology, forty-five patients with heart disease drank either 8 ounces of pomegranate juice or 8 ounces of a placebo drink for three months. The pomegranate juice drinkers had significantly less oxygen deficiency to the heart during exercise, suggesting that they had increased blood flow to the heart.

Pomegranate juice has the ability to inhibit the oxidation of LDL cholesterol.44 (Remember that LDL cholesterol is only a problem when it’s oxidized!) And an impressive number of studies have demonstrated a beneficial effect of pomegranate juice on cardiovascular health, including one that showed 30 percent reduced arterial plaque.⁴⁵ Pomegranate juice also enhances the activity of nitric oxide, a molecule essential for cardiovascular health.⁴⁶

One caution: Avoid “juice blends” and “juice cocktails,” because these have much less pomegranate juice in them and much more sugar. We like pure pomegranate juices such as Just Pomegranate, which are admittedly expensive but contain absolutely nothing but pure pomegranate juice. Another popular brand we like a lot is Pom Wonderful.

Fast Action Plan: Put pomegranate juice in “heavy rotation” on your menu: 4 to 8 ounces a day, or as often as you like.

Eat This: Red Wine

For years, it was believed that the reason the French could “get away” with eating high-fat foods—while still having remarkably lower rates of heart disease than Americans—was because of their regular consumption of red wine, which contains numerous compounds that protect the heart. Chief among these is resveratrol, a polyphenol (plant compound) that’s found in the skins of dark grapes and is highly concentrated in red wine. Resveratrol is a potent antioxidant that can prevent harmful elements in the body from attacking healthy cells. Red wine has been shown to be cardioprotective in quite a number of studies.47 And resveratrol isn’t the only reason. Other compounds in red wine such as flavonoids inhibit the oxidation of LDL cholesterol, which is pretty darn important because oxidized LDL cholesterol initiates and intensifies the inflammatory process.⁴⁸ Red wine also limits the tendency of compounds in the blood to clot and increases HDL cholesterol to boot.⁴⁹ Interestingly, in one study, moderate consumption of red wine was associated with lower levels of three markers we told you about earlier: CRP, fibrinogen, and interleukin-6.⁵⁰ It’s hard to think of a more heart-healthy drink.

Worth noting: The dark side of alcohol is well known, and we don’t have to recount it here. If you’re not a drinker, please don’t start because of the benefits of red wine. Not everyone can handle alcohol, and if you suspect you’re someone who doesn’t do well with it, for goodness’ sake, don’t drink it! (With all the talk about how the wine-drinking French have the lowest rates of heart disease in western Europe, it’s frequently forgotten that they also have the highest rates of liver cirrhosis!) The key to enjoying wine’s beneficial effects is moderate consumption, defined as about two glasses a day for men and about one a day for women, about three to four times a week. Also worth mentioning is that alcohol increases the risk for breast cancer in women who aren’t consuming enough folic acid, so make sure you’re getting at least 400 mg of folic acid a day through food or supplementation.

Fast Action Plan: If you are a drinker, have a glass of red wine with dinner. (If you’re not, don’t start!)

Eat This: Green Tea

Apart from water, tea is probably the most consumed beverage in the world, and it’s also one of the healthiest. That’s because it’s absolutely loaded with protective plant-based chemicals known as polyphenols. Green tea in particular has gotten a ton of attention in the media, largely for the anti-cancer action of one of its compounds, epigallocatechin gallate (EGCG).

But green tea also contributes to cardiovascular health. Although much has been written about its cholesterol-lowering effect, we find it much more interesting that green tea lowers fibrinogen, a substance in the body that can cause clots and strokes. In an article in the journal Circulation titled “Effects of Green Tea Intake on the Development of Coronary Artery Disease,” researchers from the department of medicine at Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan, concluded that “the more green tea patients consume, the less likely they are to have coronary artery disease.”⁵¹

Worth knowing: Just because green tea gets the lion’s share of attention from health writers doesn’t mean there’s not great stuff in other teas, such as black, oolong, white, and yerba matte. At Boston University’s School of Medicine, Joseph Vita, M.D., conducted a study in which sixty-six men either drank four cups of black tea a day or took a placebo. The researchers showed that drinking black tea can help reverse an abnormal functioning of blood vessels that can contribute to stroke or heart attack. Best of all, improvement in the functioning of the blood vessels was visible within two hours of drinking just one cup of black tea!52

“What we found was that if you take a group of people with heart disease who have abnormal blood vessel function to begin with and asked them to drink tea, their blood vessels improved,” said Vita.⁵³

Fast Action Plan: Remember, any form of tea contains caffeine, so drink in moderation. Make a big pitcher of green tea and keep it in the fridge. Drink it in the earlier part of the day, up to two glasses.

Eat This: Olive Oil

Olive oil is the primary fat used in the Mediterranean area and the one most associated with what’s been called the Mediterranean diet. (There is no single “Mediterranean diet,” but all variations of it contain high amounts of fish, fruits, vegetables, nuts, wine, and olive oil.) There are countless studies on the Mediterranean diet and heart health and virtually all of them show enormous benefits for the heart and the brain. These studies have left olive oil with an unimpeachable reputation as one of the healthiest fats for the heart.

Research in the Archives of Internal Medicine concluded that greater adherence to the traditional Mediterranean diet (including plenty of olive oil and other monounsaturated fats such as nuts and avocados) was associated with significant reduction in mortality among people who had been diagnosed with heart disease.⁵⁴ Another study in the same journal compared two groups of people with high blood pressure.⁵⁵ One group was given sunflower oil, a typical high omega-6 oil used in Western diets, and one group was given the good stuff: extra-virgin olive oil. The olive oil decreased the second group’s blood pressure by a significant amount; it also decreased their need for blood pressure meds by a whopping 48 percent. As the English might say, “Not too shabby.”

Like red wine and green tea, olive oil contains polyphenols that are anti-inflammatory and act as powerful antioxidants. (Researchers have isolated one in particular, oleocanthal, which acts similarly to ibuprofen.⁵⁶) Because so many of these polyphenols have significant health benefits, some people believe that the fat in olive oil may not be the only reason olive oil is so darn healthy. They think that the main health benefits of olive oil come from the fact that it is a delivery system for these powerful polyphenols. Either way, the stuff is great, and you should make it a part of your heart-healthy diet.

Worth knowing: All olive oil is not created equal. Unfortunately, commercial manufacturers, trying to ride the health hype on olive oil, have rushed to market all kinds of imitation and inferior products that say “olive oil” on them but are highly processed and refined and have questionable benefits. That’s why you want “extra-virgin” olive oil, which is the least processed, the most like what you’d get if you walked around barefoot in barrels of olives. It’s made without the use of heat, hot water, or solvents, and it is left unfiltered. (The first pressing produces the best stuff, known as “extra-virgin.”)

Once you begin machine harvesting and processing with very high heat, you start damaging the delicate compounds in olive oil responsible for all those great health benefits. The antioxidant and anti-inflammatory polyphenols are water soluble and can be washed away with factory processing. That’s one reason that factory-produced olive oil has a shorter shelf life—no antioxidants to protect it. Real olive oil—the extra-virgin kind, made with care and love and the absence of high heat and harsh chemicals—lasts for years.

Fast Action Plan: Switch to extra-virgin olive oil. Use it for salad dressing, low-heat stir-fries, and sautées.

Eat this: Garlic

Garlic is a global remedy. More than 1,200 (and counting) pharmacological studies have been done on garlic, and the findings are pretty impressive. In addition to lowering lipids and preventing blood coagulation, it has antihypertensive, antioxidant, antimicrobial, and antiviral properties. Garlic has been shown to lower triglyceride levels. It can also reduce plaque, making it a powerful agent for cardiovascular health.

In one study, subjects receiving 900 mg of garlic powder for four years in a randomized, double-blinded, placebo-controlled study had a regression in their plaque volume of 2.6 percent; meanwhile, a matched group of subjects given a placebo (an inert substance) saw their plaque increase over the same time period by 15.6 percent!57

One of the active ingredients in garlic—allicin—also has significant antiplatelet activity. That means it helps prevent platelets in the blood from sticking together. To understand just how important that is, consider that many heart attacks and strokes are caused by spontaneous clots in the blood vessels. The anticoagulant effect of garlic is an important health benefit.

Worth knowing: The preparation of garlic is critical for it to release its health-providing benefits. If for any reason you had the impulse to swallow a garlic clove whole, not much would happen. The garlic clove has to be crushed or chopped—the more finely the better—for the compounds in it to mix together to create allicin, the active ingredient responsible for the health benefits. Allicin starts degrading immediately after it’s produced, so the fresher it is when you use it, the better. (Microwaving destroys it completely.) Garlic experts advise crushing a little raw garlic and combining it with cooked food. If you add it to food you’re sautéing, do it toward the end so the allicin is freshest.

Fast Action Plan: Start cooking with garlic.

THE “HIDDEN RISK FACTORS” FOR HEART DISEASE

Everyone reading this book needs to know this: You can prevent and even heal heart disease through diet, exercise, and/or nutritional supplements.

But if you’re interested in doing that—and we’re pretty sure you are, or you wouldn’t be reading this—diet, exercise, and supplements are only a part of the picture. The many hidden emotional and psychological risk factors that are hardly ever addressed by conventional medicine are equally important—and sometimes even more so. They include suppressed anger, rage, the loss of love (what Dr. Sinatra calls “heartbreak”), and the emotional isolation that results from lack of intimacy with other people; we’ve touched on some of this in the previous chapter on stress.

Opening your heart to your feelings and learning how to express them in a healthy way will do far more for your heart and your overall health than you might imagine. Here are some specific ways you can accomplish this.

Breathe Deeply

When people are subjected to chronic stress, they oftentimes become tense and rigid. They take shallow breaths. Improper breathing can, over the course of time, result in actual physical changes in the body, such as a more rigid upper body, including the chest and shoulders. High chest breathing tends to be rapid and shallow and is frequently associated with emotional upset, physical tension, or ordinary mental stress. Slow, rhythmic, deep abdominal breathing, however, is physiologically more suited to the body and has the added benefit of allowing a greater intake of oxygen.

Proper breathing has been the subject of many stress-management programs. It’s the first place you start when you learn to meditate, and it’s a principle focus of yoga. In Gestalt psychotherapy, deep breathing is used as a vehicle to loosen up the energy of the chest and to free emotions.

A more prolonged form of deep breathing is meditation, which has an impressive amount of research showing that it lowers blood pressure effectively. Cardiologist Herbert Benson, M.D., has been doing pioneering research on meditation and deep breathing for decades. An associate professor of medicine at Harvard Medical School and founder of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, he coined the term “the Relaxation Response” to refer to a physical state of deep rest that changes the physical and emotional responses to stress. And it’s all based on deep breathing and calming the mind.

Benson was able to show time and again that the relaxation response decreases the heart rate, lowers blood pressure, slows the rate of breathing, and relaxes the muscles. It also increases levels of nitric oxide—a molecule that’s important for circulation and improved blood flow. Tai chi, meditation, yoga, and mindfulness are all able to elicit the relaxation response.

According to the Benson-Henry Institute, between 60 and 90 percent of all doctor visits are for complaints related to, or affected by, stress. “Scores of diseases and conditions are either caused or made worse by stress,” Benson has said. “These include anxiety, mild or moderate depression, anger, hostility, hot flashes of menopause, infertility, PMS, high blood pressure, and heart attacks. Every one can be caused by stress or exacerbated by it. And to the extent that that’s the case, the relaxation response is helpful.” 58

HOW TO DO “THE RELAXATION RESPONSE”

Allow ten to twenty minutes to try this simple technique:

• Sit quietly in a comfortable position.

• Close your eyes.

• Deeply relax all your muscles beginning at your feet and progressing up to your face. Keep them relaxed.

• Breathe through your nose. Become aware of your breathing. As you breathe out, say the word one silently to yourself. For example, breathe in . . . out, (one), in . . . out (one), etc. Breathe easily and naturally.

• Continue for ten to twenty minutes.

• You may open your eyes to check the time, but don’t use an alarm. When you finish, sit quietly for several minutes at first with your eyes closed and later with your eyes open. Don’t stand for a few minutes.

“Don’t worry about whether you are successful in achieving a deep level of relaxation. Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them by not dwelling upon them and return to repeating one.”

—From The Relaxation Response by Herbert Benson, M.D., used with permission

NOTE: Try not to do this within a couple hours of eating. According to Benson, the digestive process seems to interfere with eliciting the relaxation response.

See the sidebar on how you can do the relaxation response.

How Crying and Laughing Can Help

Next to love, crying is perhaps the most healing activity for the heart. It frees the heart of muscular tension and rigidity. Sobbing enhances oxygen delivery. Man is the only primate able to weep for emotional reasons. Weeping is nature’s way of releaseing the pain of heartbreak and preventing death. Any expression of feeling will help to heal your heart. Despite what we’re taught, it’s not weak to show your feelings. In fact, it’s far healthier than “stuffing” your feelings and seething silently.

Laughing is a way of experienceing strong feelings, just as crying is. (In fact, strenuous laughter often turns into tears.) When you laugh fully, breathing increases, freeing up the rigidity in the chest, diaphragm, and even deep down in the psoas muscles. As a spontaneous release of energy, laughter has the potential to be extremely therapeutic.

Laughing Your Way to Health

Over the course of his lifetime, Norman Cousins, the legendary journalist and editor of the Saturday Evening Post, suffered from a number of serious medical conditions, including heart disease and ankylosing spondylitis, a disease characterized by chronic inflammation along the axial skeleton. At one point, doctors gave him little hope of surviving. He ignored their doomsaying and developed his own program for recovery that involved love, hope, faith, and, courtesy of the Marx Brothers films he loved to watch, an awful lot of laughter.

Although he eventually died of heart failure at age seventy-five, Cousins lived far longer than his doctors predicted, a full thirty-six years after first being diagnosed with heart disease. (Cousins also did research on the biochemistry of human emotions at the School of Medicine at the University of California, Los Angeles, and wrote two important books on emotion, healing, and illness—Anatomy of an Illness and The Healing Heart.)

Sex: The Advantages of Intimacy

Have you ever wondered why some elderly people look much younger than their stated age while some younger people look so much older? This observation was studied by a Russian gerontologist who examined 15,000 individuals over the age of eighty in provinces of the former Soviet Union. He found several common denominators or markers for longevity. People who lived the longest reported working outdoors, high levels of physical activity, and a diet high in vegetables, fruits, and fresh whole grains. But several of the common denominators involved relationships, intimacy, and sexuality.

Many of these individuals continued to have an active sex life well into their eighties and nineties. And why not? Aging couples who are committed to one another’s pleasure can adapt sexually to the aging process. On an emotional level, sexuality provides a sense of security, connectedness, and emotional intimacy. When sexuality is an expression of love, the energies of the partners can fuse in harmony like two tuning forks vibrating with the same frequency. Feelings of warmth, connectedness, and emotional intimacy can help open our hearts.

EXPRESSING EMOTIONS (ESPECIALLY FOR MEN!)

Showing and expressing feelings can be a huge challenge for some people, particularly men. But getting in touch with your feelings doesn’t have to be embarrassing at all. You don’t have to get up in front of some encounter group and spill your guts to strangers. All it may take is a pencil and paper.

A writing exercise developed by social psychologist James Pennebaker has been tested in dozens of studies in which subjects were assigned to write about either mundane activities, such as running errands, or personal traumas. The technique is pure simplicity. You write your deepest thoughts and emotions about any event, situation, person, or even trauma for about fifteen minutes on four consecutive nights. Pennebaker has found that people who do this simple, private exercise show improvements in immune system functioning, are less likely to visit doctors, get better grades in school, and miss fewer days of work.59

The Power of Touch and Massage

Touch therapy or massage appears to be associated with a decreased heart rate, decreased blood pressure, and increased endorphin release, resulting in an increased sense of relaxation and heightened well-being. In humans, massage can be considered a tranquilizer with absolutely no side effects!

Remember the parasympathetic (slowing down) and the sympathetic (speeding up) nervous systems? Massage activates the parasympathetic system and provides a nice, healing balance to the typical sympathetic overdrive experienced by type-A, coronary-prone individuals.

Play

Play is one of the most healing things you can do for your heart health and your emotional well-being. And most adults have no idea how to do it. Sure, we talk about “playing” tennis or golf, but sports are different—though enjoyable, they’re not healing because they involve performance, competition, and the need to win! (Just ask Dr. Jonny how he feels after losing a tennis match!)

Play is totally different. True play is spontaneous and has no agenda, rules, or regulations, or even a desired outcome. When we play, we are totally free. That is, we do things solely for joy and pleasure. When we play, we become totally absorbed in what we are doing; we are taken out of our heads (and down into our bodies). Time stops for us.

Think of how completely absorbed five- or six-year-olds become when they’re painting a picture. Within minutes, nothing else matters to them but the colors, the feel of the brush on the paper, the way the paint drips and blobs and runs, the way the colors mix, and how closely they can match the picture with the image in their minds. Being carried away by their imaginations and getting their inspirations down on paper is, for a short time, the single most important thing in the world to them. Everything else falls away—worries, fears, wants, needs, hunger—and is replaced by a sense of total involvement, excitement, satisfaction, and gratification.

If you can play even partially this way, it can completely cut you free from stress and worry and help heal your mind and heart. Because of this nearly miraculous benefit of play, we encourage you to play like children. If, like most adults, you’ve forgotten how, observe children and see what they do.

Remember, play has no outcome, no goal. You need to play for play’s sake alone, and, when you play, try to bring out the little child inside you. Once you connect with your inner child—believe us, we all have one—it will bring you to another level of healing.

Final Words

Foods can fuel your heart, supplements can support it, and exercise can strengthen it. But never neglect the “hidden” emotional and psychological risk factors that contribute to the development of heart disease as surely as smoking, a high-sugar diet, stress, high blood pressure, and lack of exercise do.

Building and maintaining strong emotional connections with other people is one of the best stress-management strategies on the planet. It’s also one of the best ways to keep your heart healthy and your soul nourished. Next to exercise, it’s the closest thing we have to a panacea. It also makes life a lot more rich, a lot more fun, and a lot more gratifying.

Enjoy the journey.