After the Attack

A cardiac crisis can motivate needed lifestyle changes.


February 2014

By Linda Melone

Years of eating pizzas, steaks and hamburgers added up to excess pounds and yo-yo dieting for Ken Walker, 62, who “struggled mightily” with his weight. A mild heart attack when he was 54 required two stents (small mesh tubes) to open blockages in a cardiac artery. But it took a double bypass several years later to finally get Walker to commit to a healthy lifestyle. “I recognized that if I didn’t make a dram­atic change in my eating habits, another two and a half years later I might not be alive,” says Walker, a freelance writer and editor in Huntington, West Virginia.

Afterwards, Walker enrolled in the Dean Ornish Program at the hospital where he had his surgery, West Virginia University’s Robert C. Byrd Health Sciences Center. Developed by a pioneer in the field, the plan is generally recognized as the first program scientifically proven to reverse heart disease progression. It consists of a very-low-fat vegetarian diet, aerobic conditioning, stress-easing relaxation techniques and group support to help participants deal with emotional issues that can contribute to, or result from, heart disease.

“Switching to a vegetarian lifestyle made all the difference in the world,” says Walker. “It marked an amazing turnaround.” He lost more than 20 pounds after three decades of watching his weight steadily climb, and he’s kept off the weight for more than five years. He admits he occasionally “cheats” and eats chicken along with the vegetarian fare that’s part of the Ornish plan.
Follow a Heart-Healthy Diet

Stephen T. Sinatra, MD, FACC, author of The Sinatra Solution: Metabolic Cardiology (Basic Health), recommends the Mediterranean diet for heart attack patients. While most healthy diets rely on fruits, vegetables, fish and whole grains, “the crucial aspects of the Mediterranean diet are nuts and olive oil,” says Sinatra. “Both are very healthy because they contain healthy fats and they boost the good cholesterol (HDL) levels.” Kale, asparagus and brussels sprouts are Sinatra’s top three vegetable picks; he also favors avocado and coconut.

Plant-Based Heart Help

Eating more fresh produce is standard advice for people who have suffered a heart attack, and with good reason. Study after study has shown the benefits of a diet based primarily on plants.

Key plant components are now available in supplement form to help round out a heart-healthy diet. Among them are plant sterols (also known as phytosterols), found in oils, nuts and other natural sources. These substances—including beta-sitosterol, campesterol and stigmasterol—are, as their names indicate, plant versions of the cholesterol found in animals. Plant sterols interfere with the absorption of their animal-based cousins, lowering blood cholesterol levels. Plant sterols have shown additional benefits in laboratory animals fed high-fat diets, such as reducing intestinal inflammation and preventing arterial plaque development (Molecular Nutrition & Food Research online 1/9/14, Atherosclerosis 12/13).

Resveratrol is one of the best-known plant substances found to boost human health. Present in grapes, wine and herbs such as Polygonum cuspidatum, resveratrol promotes relaxation of blood vessels and helps make blood less sticky—both of which improve blood flow—as well as protecting arteries from injury and plaque formation. It may also help activate adiponectin, a hormone that plays a vital role in insulin regulation (Journal of Biological Chemistry 1/7/11).

Sinatra suggests eating minimal amounts of white flour, gluten and wheat. To reduce inflammation, he also says you should cut down on sugar consumption and to reduce your intake of omega-6 oils.
What’s more, Sinatra recommends cutting out all trans fats, which pack a double whammy by both lowering HDL and raising LDL (bad cholesterol). Foods containing trans fats include chips and other snack foods, fried items such as donuts and chicken nuggets, cookies, cakes, crackers, muffins, pie crust, pizza dough and frozen dinners, among others. Avoiding these artificial fats may become easier, though: The Food and Drug Administration has determined that trans fats known as partially hydrogenated oils are no longer “generally recognized as safe (GRAS),” setting the stage for the elimination of these oils from processed foods.

Researchers believe eating the right foods may be more important than weight loss in fending off heart attacks. Men at risk for heart disease who followed a heart-healthy diet reduced cholesterol levels regardless of whether they lost weight, according to a study presented at an American Heart Association meeting. Among 19 men ages 24 to 62, those who followed a Mediterranean-style diet over 25 weeks lowered their LDL by 9%.

Heart-healthy supplements include omega-3 fatty acids, such as the marine fats DHA and EPA. “Squid oil is high in DHA content, which makes plaque more resistant to rupture,” says Sinatra. He also recommends coenzyme Q10, magnesium and ribose.

Heal Your Inner Wounds

Unfortunately, not everyone gets a second chance after a heart attack. Paul Epstein, ND, who conducts a mind-body practice in Westport, Connecticut, and is the author of Happiness Through Meditation (Peter Pauper Press), found inspiration for his career in integrative medicine after his father died of a heart attack at the age of 39. “He suffered from post-traumatic stress disorder (PTSD) from serving in World War II,” says Epstein. “We now know that stress contributes to heart disease risk, along with an unhealthy diet and lack of exercise.”

A heart attack can be an opportunity to explore the meaning and message behind the attack and use that as an opportunity for deeper healing, says Epstein. “You want to think about what can I do to prevent another heart attack? It’s important to look at what contributed to the development of heart disease.”

Research supports Epstein’s approach. A study in the journal Circulation, for example, found links between childhood trauma and an increased risk of heart disease in adulthood. Adverse childhood experiences were also strongly associated with risk factors, including smoking, obesity, depression and physical inactivity.

“The body bears the burden,” says Epstein. “The stress of childhood trauma could be living in that person in the form of anger or trauma. Time conceals but it does not heal.”

This makes finding ways to cope with stress an essential part of preventive medicine. Stress reduction affects you on a genetic level, says Epstein. “Even if you’re predisposed to heart disease, lifestyle changes can change your gene expression and affect cellular resistance.” A study in Psychoneuroendo­crinology (2/14) found reduced levels of pro-inflammatory genes after participants practiced eight hours of mindfulness meditation. Inflammation plays a role in the development of cardiovascular disease, making mindfulness practices such as meditation particularly relevant in reducing risk of a second heart attack. “Mindfulness shows a positive effect on the immune system and blood pressure,” says Epstein.

Some people may even be genetically more sensitive to stress, according to study in PLoS ONE (12/18/13). Scientists at the Duke University School of Medicine reported a 38% increased risk of heart attack or death in patients with heart disease who carry this genetic trait. The findings suggest behavior modification could play a role in reducing death and disability from heart attacks.

Ask Empowering Questions

When Dede Bonner’s mother experienced a heart attack, Bonner realized she had no idea what to ask her mother’s physicians. As a result Bonner, a PhD, came up with The 10 Best Questions for Recovering from a Heart Attack (Simon & Schuster).

Bonner recommends asking your practitioner for specific information to ensure you or a loved one is getting the best possible care. “How you ask a question is also important,” says Bonner. “Many people are intimidated by doctors, and the doctors themselves are stressed out, overbooked and typically give cookie-cutter advice to everyone. So first ask, ‘How is my heart attack different from others?’” Make your inquiries open-ended instead of looking for a yes-or-no answer.

For women, it’s particularly important to ask about cardiac rehabilitation, says Bonner. “Women do not go through cardiac rehab as much as men, but statistics on survival are staggeringly better than for those who do not do rehab.”

Other questions include:
• Did I really have a heart attack? (Other conditions can cause the same symptoms.)
• What is the extent of the damage? (Know your ejection fraction, a measure of the heart’s pumping power.)
• What lifestyle changes can I do now to help myself?
• When should I come back and how often should I see you?
• What warning signs should I look for that might indicate a reccurrence? At what point should I call you?

In addition, Bonner recommends asking a “magic question,” a smart query people rarely think to ask such as, “What’s the latest thing you’ve learned about my current condition?” This ensures your practitioner is up on the latest techniques and information.

Your practitioner isn’t the only person you should engage in discussion. “Consider asking other members of the staff, especially if your doctor holds a position that limits his time,” suggests Bonner. “Some nurses may be more knowledgeable or articulate in talking to patients and can be better skilled at explaining.” You want to view your medical team almost as partners with you, she says. “If your doctor doesn’t like these questions you may want to search out a different doctor.”

Treat a cardiac incident as a wake-up call. Making the necessary lifestyle changes can help you stave off another trip to the emergency room and let you enjoy renewed well-being.

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