It’s the Sugar, Stupid

A juicy steak on the left and a 6-inch Veggie Delight from Subway on the right

Which meal is more heart healthy, the steak or the sandwich? If you believe the American government, and the media, and the vast majority of medical professionals, then it’s no contest. The veggie sandwich is a better choice for heart health because it contains no cholesterol or fat. The steak, on the other hand, has been vilified for decades because we’ve been told that eating foods that contain fat (especially saturated fat) raises the level of cholesterol in your blood and high levels of LDL cholesterol in your blood increases your risk of heart disease.

Signed. Sealed. Delivered. Yes? Not so fast.

What if I told you there has been a vast conspiracy to condemn fat in order to bury the evidence that the real enemy of heart health is sugar? Would you tell me I am crazy and to lose the tin foil hat? Are you willing to risk your life on it?

Lately some of my friends and family have been telling me I sound like Oliver Stone barking about the Kennedy assassination when it comes to sugar. They’d like me to turn down the volume a bit and stop being such a fun suck. Sugar is a vice, but it’s not the root of all dietary evil they say. Shut up and eat a cookie for crying out loud!

Okay, I admit I’ve been ranting a bit too much lately. But if you’d read what I’ve been reading you’d be disturbed as well. And if you’d had a heart attack at a young age like me and have been in a life and death struggle to figure out how to keep it from happening again you might be more open to alternative theories.

The fact is, there is mounting evidence that sugar is the root cause of heart disease. Rather than treat you to a series of quotes from various authors, doctors, and scientific studies I’ll simply list some resources for you to explore on your own at the end of this post. But suffice it to say, I’ve seen enough evidence to convince me that fat has gotten a raw deal and sugar has been artificially and immorally propped up by the sugar industry itself as a simple vice that is fine in moderation. Hell, at first it was literally endorsed as a health food.

I’ve been on a personal journey to protect my heart for nearly a decade now, and at every turn I run into more evidence that sugar (and processed carbohydrates) is the cause of heart disease. Despite the fact that the government still points the finger at fat and cholesterol. It’s frustrating to see how slow this ship is turning. But I believe it is indeed turning and that in the very near future the health powers that be will be forced to issue a gigantic mea culpa and set us all on the path to healthier hearts.

Over the holidays I finally read The Case Against Sugar by Gary Taubes. You don’t have to read it to learn what he uncovered about the dastardly deeds of the sugar industry — you can Google it and read any number of reviews and interviews with Taubes like this one in the New York Times. Here’s a highlight:

Sugar is not only the root cause of today’s diabetes and obesity epidemics (had these been infectious diseases, the Centers for Disease Control and Prevention would have long ago declared an emergency), but also, according to Taubes, is probably related to heart disease, hypertension, many common cancers and Alzheimer’s.

Taubes is a journalist and a well educated one at that. He has degrees from Harvard, Stanford, and Columbia. He has won numerous awards for his work, including the Science in Society Journalism Award of the National Association of Science Writers. He is legit. But he’s not alone in this fight for dietary truth. My explorations have led me to some amazing journalists and health professionals who have all reached the same conclusions about sugar. Like Dr. Stephen Sinatra. Dr. Mark Hyman. Dr. Zoe Harcombe. And Nina Teicholz, science journalist and author of The Big Fat Surprise.

I have also been experimenting with my own body. The fewer carbs and added sugars I eat, the better my blood work turns out. I recently had a nuclear stress test and an echocardiogram as part of my cardiovascular follow-up care, and my cardiologist said my heart is pumping at full power and all the images indicate my heart is healthy. My most recent blood work reported total cholesterol at 118, triglycerides at 120 and LDL at 55. These numbers are enviable for anyone regardless of heart history.

I believe my heart attack was caused by a single blocked artery that became blocked from years of a high carb, high added sugar diet that caused my triglycerides to skyrocket. My trigs were so high at one point (north of 700) that it skewed by total cholesterol numbers to the point that they couldn’t be accurately measured. Ironically, I was not eating an unhealthy diet according to the U.S. government. In fact, I was eating the recommended diet of low fat, high carbs. Journalists like Taubes and Teicholz have uncovered how and why the U.S. dietary guidelines went so astray, but in a nutshell, the reason is sugar. Much like how the tobacco industry lied and manipulated the science and policy of cigarettes, the sugar industry did the same. The evidence is clear.

Sugar is toxic. It screws with your endocrine system, forcing your body to produce too much insulin, which in turn causes you to become insulin resistant. Insulin resistance causes increased production of fat in the bloodstream which causes both obesity and plaque in your arteries. That’s my nonscientific explanation, but if you want to understand it in more detail you can read more on your own.

So back to that question at the top of this post. Which is healthier for the heart, the steak or the sandwich? Well, the 6-inch Veggie Delight from Subway has 41 grams of carbs and the steak has none. Carbs are sugar. Sugar equals heart disease.

If you want to live a heart-healthy life, don’t listen to the government. Listen to science.

Intermittent Fasting Off to Metabolic Slow Start

Three months ago, in an effort to reduce my fasting glucose levels and hemoglobin A1c which are slightly elevated, I added 16/8 intermittent fasting (IF) into my diet routine. The idea was that by not eating during a 16-hour window each day, I’d lower my insulin resistance and bring my sugars into a more normal range.

It’s worth noting that my sugars were not too high (109), but rather near the top of the normal range (less than 100) butting up against the pre-diabetic range (100 to 125). My A1c was 5.2, within the normal range, but not too far away from the prediabetic range of 5.7 or above. With my cholesterol and triglycerides in wonderful shape thanks to my low carb high-fat diet, the sugars were the only thing threatening my overall cardiovascular health.

Yesterday I got my most recent blood test results, and while my cholesterol/triglyceride levels were flat, my friggin’ fasting glucose and A1c went up to 112 and 5.6 respectively. Needless to say, this was not the result I was looking for when I started IF in early September. In fact, while my doctor suggested I do IF five times per week I have been doing it virtually every day for three months.

Rather than panic and give up, I thought a little more about how I’ve been eating (and drinking) over the past three months and the truth is while I have generally been on a low carb high-fat diet, I have cheated a ton. It started with a 12-day vacation to London and Paris, where I ate more than my share of chocolate croissants, macarons, and muffins and drank more than my share of beer. When we got back from Europe, I continued to snack here and there on sugary cookies and muffins and continued to have a few beers every week. I went on a boys’ trip to Wyoming where in two days I drank more than I do in a typical month, went to a beer festival with my son, and then between Thanksgiving and Christmas I’ve sneaked an unhealthy amount of sugar-laden foods and drank plenty of beer. I also hurt my lower back, which still hurts by the way, and as a result, I have not exercised much at all.

Mmmm Beer.

All this is to say, I probably counteracted the good from the IF with the bad from my lack of dietary willpower. I sent my primary care doc a note to ask for her advice, and she said to continue with IF because it really takes closer to a year to see significant results on the A1c and sugar front. She suggested I try doing IF only five days per week, but to try to extend it a couple of days a week from 16 hours off to 18-20. On the diet front she told me to eat a diet that I will stick with.

Rather than freak out, I have decided to rededicate myself to eating a low carb high fat diet, get serious about cutting out the “holiday” snacking, do IF Monday through Friday, and increase my walking to 5-6 days per week or a minimum of 150 minutes per week as recommended by the American Heart Association and others. Honestly, I felt better physically when I was sticking to the low carb high-fat diet more religiously. And the more beer I drink, the worse my GI system feels. If I didn’t love beer so much I’d give it up completely, but for now, I suppose I’ll limit my intake of the nectar of the gods and only imbibe on special occasions.

The experiment continues!

Dying From Heart Disease is Pretty Much Optional

Punk rock legend Pete Shelley died on Thursday from an apparent heart attack at age 63, and once again my reaction was anger. Every time someone famous has a heart attack, I get in a fight with my inner voice. How did he not know he was at risk? Why didn’t he take care of himself? When are people going to start paying attention?

I know this might seem a touch disingenuous given I had a surprise heart attack when I was 45, but what I’ve learned about heart disease in the past seven years is enough to make me want to scream from the rooftops — you don’t have to go out this way! Heart disease is optional!

I’m not mad at these people, rather I’m mad at the situation. Nearly 18 million people die each year from cardiovascular disease (according to the World Health Organization) and 85 percent of those deaths are from heart attacks and strokes. 

Heart attacks and strokes are 80 percent preventable!

Yes, that’s right. The vast majority of these deaths can be attributed to preventable factors like obesity, poor physical activity, heavy drinking, eating unhealthy foods and not keeping your blood pressure and cholesterol under control. The CDC also found that about six in ten preventable heart deaths occur in people younger than 65 years old.

So why do people keep dropping dead from heart attacks? Do we not know how to prevent heart disease? Do we not care about getting heart disease? Are we too busy to worry about it? WTF people.

See, I get mad. It’s my issue, I know. Every time a famous person under…say…75, has a heart attack I am reminded of my own mistakes and my own mortality. I immediately go back to stage two of the five stages of grief. I’m serious. I get angry, then I get depressed (which is stage three).

Coach Mike Ditka had another heart attack recently. Alan Thicke. Garry Shandling. Carrie Fisher. Bill Paxton. It doesn’t make a difference who it is. Each time it happens I take it personally.

I wonder why I’ve become so passionate about heart disease prevention. Plenty of people have a health issue and keep to themselves. You don’t see Mike Ditka tweeting about heart disease. I think maybe there’s something in my personality that makes me want to stand up on a milk crate on the corner and preach the gospel of heart health. Is that a personality flaw or strength? I guess it depends on how obnoxious I am about it!

So, if you’re going to get anything valuable out of this post I probably ought to tell you how to prevent a heart attack so you don’t become one of the 14.4 million people who die each year from a preventable disease.

It’s pretty simple actually. I can tell you how to NOT have a heart attack in six words: Eat healthy. Move more. Don’t smoke.

Not smoking is the most obvious one. People who smoke are two to four times more likely to get heart disease. The risk is even greater for women who smoke and also take birth control pills. Seriously, don’t smoke.

Moving more is actually pretty easy as well. The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. What does moderate-intensity aerobic exercise look like? 

  • brisk walking (at least 2.5 miles per hour)
  • water aerobics
  • dancing (ballroom or social)
  • gardening
  • tennis
  • biking slower than 10 miles per hour

Seriously, all you have to do is walk for 30 minutes, five days a week. Nobody is suggesting you have to run a marathon or swim 50 laps a day.

Lastly, eat healthy. Well, this one may be a little more complicated. Note that I said complicated, not difficult. Most experts suggest you simply eat a diet that focuses on a variety of fruits and vegetables, whole grains, low-fat dairy, skinless poultry and fish, etc. 

There are some that argue a “Mediterranean Diet” is best. Some argue you should be fully plant-based. Others argue keto is the healthiest way to eat. Paleo? Pegan? You can spend the rest of your life trying to figure out the “best” way to eat and never figure it out. So pick one of the above because in truth, all of them are healthy enough for the average person to avoid heart disease in combination with moving more and not smoking.

I have written about this extensively, and I’m convinced from my own health and indicators that it’s working. I eat a low carb, very low sugar, high healthy fat diet. I’m also doing a little intermittent fasting and I’m doing great by any standard. 

Want to know how you’re doing? I recommend you sign up for Life’s Simple 7 and take the survey. It’s free and you can go back again and again as your numbers change. It’s not perfect, but it’s an easy way to see how you’re doing.

Yes, heart disease is voluntary. I wish I knew that prior to Oct. 11, 2011 and that someone had shared these tips with me. Then again, had I not had a heart attack maybe I wouldn’t be on the Interwebs sharing these tips with you.

Getting ‘Poked and Prodded’ is My New Normal

Tomorrow I head to my cardiologist’s office for another in a seemingly endless series of tests. I know my life changed on Oct. 15, 2011 when I had a heart attack and that things will never be the same, but I had no idea how often I’d be subjected to diagnostic tests. I feel like the proverbial guinea pig.

Since it has been seven years since my cardiac event, I only have to see my cardiologist a couple of times a year now. But between those exams, I am required to have a blood test regularly (keeping an eye on my cholesterol, triglycerides, blood sugars and more) and then regular stress tests and echocardiograms. Tomorrow I get the double whammy — a nuclear stress test and an echocardiogram.

A nuclear stress test is a type of stress test that uses radioactive dye and an imaging machine to create pictures showing the blood flow to your heart. This is more involved than a standard stress test in which the victim (er, patient) is simply hooked up to an electrocardiogram (ECG) and blood pressure cuff to measure your heart’s reaction to exercise. For the nuclear stress test, you are also hooked up to an IV for the dye injection.

During the same visit, I’ll be subjected to an echocardiogram which is basically an ultrasound of your heart (it’s just like the ultrasound a pregnant woman receives to check on the status of her baby except instead of finding out the sex of the baby you find out the strength of your heart). The echo is a simple test, but I’ll never get used to the cold goo.

To be more precise, an echocardiogram takes images of the size and shape of your heart and also show how well your heart’s chambers and valves are working. This is pretty critical for me since at the time of my heart attack I had permanent damage to my heart muscle and it’s important to keep track of any changes in the amount of blood my heart pumps (known as ejection fraction). A normal heart’s ejection fraction is somewhere between 50 and 70 percent, while anything below 40 means you are in heart failure. At the time of my heart attack my ejection fraction was between 30-40 depending on who you believe, but with medication, exercise and time it has bounced back to around 60 at last check. For me, my ejection fraction is how I keep score of how I’m doing and so far, I feel like I’m winning.

The stress test, on the other hand, basically tries to determine if any of the coronary arteries that supply blood to and from your heart and blocked. A typical stress test is not foolproof, but a nuclear stress test is a much better way to determine if you have any blockages. Frankly, neither test is perfect and to be sure the best way to check for blockages is to insert a camera into your arteries but that’s pretty invasive and only done if the stress test or other indicators (like actually having a heart attack) suggest you might have a blockage. Basically, if I “fail” the stress test they’re going to go in and check and if I have blockages they can blast them with a balloon (angioplasty) and/or insert coronary artery stents to prop open the narrowed pathway. I had three stents inserted at the time of my heart attack, but the angiogram showed no other significant blockages so…I have that going for me.

All this is to ensure I have not gotten any worse since my heart attack, and thankfully, so far, I have not. In fact, I’ve gotten better. Still, these tests have become part of my routine and will likely continue to be part of my routine until such time as medical science comes up with a better way to see if your heart and arteries are doing what they are supposed to do.

I know these tests are helping me live longer, but I still feel like I’m at the doctor or a testing center all the time. It’s a pain in the ass. I know I should feel fortunate that I live during a time when we have all these diagnostic tests, and on top of that I have darn good medical insurance to pay for all these tests. But it’s still a pain in the ass.