Why I’m Doubling Down on Low Carb, Intermittent Fasting in 2019

I’m not much of a New Years resolution guy, but it’s hard not to think about the year ahead as the new year approaches. When it comes to my diet plans for 2019, I feel the need to echo the late George Herbert Walker Bush during the 1988 presidential campaign — stay the course.

All of my reading and research last year led to my full adoption of a low carbohydrate lifestyle, and nothing has changed that would lead me to rethink this approach. I’m not a doctor, but I’m fully confident that my cardiovascular health improved over the course of 2018. A year-end visit to my cardiologist confirmed my own analysis. In December I had an echocardiogram, a nuclear stress test, and a blood workup and all of these diagnostics returned very positive results.

The biggest danger for a heart attack survivor like me is to have a second cardiovascular event. In the first few years following my near fatal event, my heart performance was stable and improved a bit. My blood work was better, if not perfect, and all the other tests showed incremental improvement. Most importantly, my ejection fraction (my heart’s ability to pump blood out to my body) went up each year.

At the time of my heart attack, my ejection fraction (EF) was measured at around 30-35 percent. An EF of less than 40 percent may be evidence of heart failure or cardiomyopathy. For me, this was the scariest aspect of my event. It was also what has been driving me to make changes to my lifestyle.

Improving my EF has provided positive reinforcement for the things I’ve been doing to improve my cardiovascular health. I know that lifestyle led to my heart attack, and therefore lifestyle could keep me from having another one. This is why I’ve spent the past seven years exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right.

Honestly, the only aspect of the above lifestyle changes that have provided any complications for me over the years since my heart attack has been eating right. I truly believe the medical establishment either doesn’t know or doesn’t want to suggest how to eat appropriately for cardiovascular health (I think they don’t want to provide advice because it is not so clear cut and if they are wrong they may be worried about liability). All the proof you need that the medical establishment doesn’t know the best way to eat is to Google diet advice — you’ll go down a rabbit hole from which you may never surface.

After my heart attack, my first cardiologist told me to avoid sodium because high blood pressure can lead to heart failure and/or cardiomyopathy. In that first year I avoided sodium like it was poison. Do you have any idea how hard it is to limit sodium intake to less than 1,500 mg a day?

But sodium didn’t cause my heart attack, so I spent a lot of time researching the latest medical advice on diet. I was really frustrated with what I found. I read about the China Study and Dr. Caldwell Esselstyn and thought perhaps meat was the cause of heart disease. I became a pescatarian, eliminating all meat except for fish. Then research started to point to the Mediterranean Diet as the best overall diet and that seemed reasonable so I went down that path. My blood work was better, but still not where I needed it to be.

I watched every movie about diet from Forks Over Knives to Fed Up to Fat, Sick and Nearly Dead and all I got was more frustrated and confused. But as time went on, I started to notice a trend — there was more and more information out there about the dangers of carbs and sugar. I really honed in on this trend, reading everything I could get my hands on. At the same time, I started working with a new primary care doctor who also believed that carbs and sugar were the real culprits of diseases like diabetes, metabolic syndrome, and heart disease.

I jumped in to the low carb movement under doctor care and with regular blood work checkups to assess how I was doing. And for me, the results have been compelling. My blood work is enviable by any standard, and my weight is in a good range. Best of all, my EF has continued to rise and last month was measured at between 60-65 percent — the best it has been since before my heart attack and within the normal range.

As of today, I have above average blood work and a normal EF. That’s all I could have asked for seven years post heart attack. I may cheat here and there (I do enjoy a beer now and again), and my sugars are not as low as I’d like them (that’s where the intermittent fasting is hopefully going to help), but basically, I am in great cardiovascular health. And I’m enjoying how I eat, which is to say I get to eat a wide range of foods including meat, eggs, and a little whole grain bread.

So here I am in January 2019 with probably the best cardiovascular health I’ve had since I was a teen. I attribute this to exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right — that is to say, a low carb, low added sugar diet. I definitely need to exercise a bit more, but for the first time in a long time, I am confident I am eating healthy.

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. My employer, 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. The aforementioned AHA (and others like them) 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.

Christian Bale Reminds us That Heart Attacks Vary

I read an interesting article today about how actor Christian Bale effectively saved the life of Vice director Adam McKay. As part of the Oscar-winning actor’s preparation to play former Vice President Dick Cheney in the upcoming film Vice, Bale learned everything he could about heart attacks because the veep had more than his share. At one point during the filming of the movie, Bale explained to McKay that not all heart attacks present with pain across the chest or shooting pain down the left arm.

Not long afterward, McKay was at the gym when he felt queasy and had tingling in his arm. He initially didn’t think much about it, but then he remembered what Bale had said about heart attacks and he rushed to the hospital. He was, in fact, having a heart attack, and getting to the ER so quickly likely saved his life and certainly saved his heart from having too much damage.

Fred Sanford on TV’s Sanford and Son had a “heart attack” in nearly every episode.

This is a lesson I try to share as often as I can. Not all heart attacks present in the same way, and in fact heart attacks in women often present in very different ways. When we think of heart attacks, many of us have the image of Redd Foxx as junkyard owner Fred Sanford clutching his chest and looking to the sky declaring to his dead wife “I’m coming to meet you Elizabeth.” That’s how I envisioned it. At least, until I had one.

Heart attacks can present in many different ways. Here are just a few: Pain in the area between shoulder blades, arm, chest, jaw, left arm, or upper abdomen. Dizziness, fatigue, lightheadedness, clammy skin, cold sweat, or sweating. Heartburn, indigestion, nausea, or vomiting. Discomfort or tightness in the arm or neck. Anxiety, chest pressure, feeling of impending doom, palpitations, or shortness of breath. In women, symptoms often include jaw pain, back or shoulder pain, shortness of breath, or nausea/vomiting.

Many times there’s little drama involved in a heart attack. My heart attack presented with a radiating heat across my chest, a cold sweat, indigestion, and pain down both arms. I didn’t think I was having a heart attack, though looking back I should have. And because my symptoms only lasted for about 20 minutes, I figured whatever it was had ended and I was OK. Because of that, I didn’t seek treatment for two days and ultimately that caused permanent damage to my heart that otherwise could have been avoided. I could very easily have died while I avoided going to the hospital. My E.K.G. was so bad when I did go to my doctor two days later that she called 9-1-1 and I got a ride to the ER where 30 minutes later I was in the cath lab receiving three stents for a mostly blocked left anterior descending artery (LAD).

Heart attacks are also not always caused by blocked arteries, otherwise known as atherosclerosis. Heart attacks can also be caused by a spasm of a coronary artery, arrhythmias (abnormal heart rhythm), cardiomyopathy (enlarged heart), undetected heart defects, and even electrical shock. In other words, heart attacks are not monolithic in nature.

WebMD has a nice list of common heart attack symptoms, but even if you’re having one or more of these symptoms it can be confusing to know if you should get to the hospital. It’s easy for me to say this in hindsight, but when it comes to heart attack symptoms I suggest you don’t take any chances. What’s the worst case — you spend a few hours at the ER and go home feeling silly? It beats dying!

52 Things I’m Thankful for on My 52nd Birthday

52-highsOne thing about nearly dying is that it makes you appreciate life more. It may sound cliche, but there was a time not too long ago when I wasn’t sure I’d make it to 52. And even though it’s not a nice round number like 50 or 55, I still feel like celebrating simply waking up for another birthday. Happy 52nd birthday to me.

Even for those who did not have a near-death experience, the world sure seems to be coming apart at the seams. Things feel pretty dire. We have a lunatic in the White House. The world looks to Germany for moral authority. The climate is changing so rapidly that huge chunks of the polar caps are falling off and melting into the sea. The American wage gap is getting wider. Americans are getting wider. Kids keep getting gunned down at schools. The U.S. Men’s National Team didn’t make the World Cup!

Yet even still, perhaps because I have been consciously trying to pay less attention to politics and the news, I feel like I have a lot for which to be thankful (including knowing how not to end a sentence with a preposition).

I’m not really going to tick off 52 things I’m thankful for as I turn 52 (not because I can’t come up with 52, but because I don’t think you’d read through a list that long). I am, however, going to hit some high notes.

  • First and foremost, my heart is strong and while it will never be fully recovered it is pumping within the normal range (ejection fraction at 55). My arteries are clear. I recovered completely from the little stroke I had last year with no permanent deficiencies. Aside from a few normal age-related aches and pains, I’m in pretty good health given my history.
  • I have a loving wife/best friend who treats me like a king despite my often whiny personality. In a few months, we’ll be celebrating our 25th wedding anniversary.
  • We have raised a remarkable son who at 20 is wise beyond his years. He may still be trying to find himself, but he’ll never be lost.
  • I live in a wonderful town in a perfect townhouse in a great neighborhood.
  • For the first time in my life, I can truly say I love my job. I had a great year raising money for the American Heart Association and I am honored to be able to do this work for a living. Strange way to find a calling, but I’ll take it.
  • Despite some ups and down this year, my mom, dad, and sister are doing well (as well as can be expected given they all live in Tucson now).
  • We’re doing well enough financially to afford to travel more and are starting to tick off our bucket list one by one.
  • I have great friends both online and in real life.
  • The heart attack support network I founded on Facebook has grown from a handful of survivors in Phoenix to nearly 3,500 across the globe.
  • I serve my community as a board member of a great nonprofit that unites, strengthens and advances the state’s nonprofit sector.
  • The Suns have the first pick in the NBA Draft tonight and will finally land the “big man” they’ve always needed. The Padres are not winning, but they are on the right track with a great young core and some special players almost ready for the big leagues. The Cardinals drafted a QB of the future. No team I’ve ever rooted for has ever won a world championship — but that will change in the next few years. Go Cardinals. Go Padres. Go Suns.
  • I have found a new passion in soccer and have become a rabid fan. Seriously, I wake up early every weekend during the season to watch Arsenal play.

All this is to say that I’m living a great life. It’s nothing like the life I imagined I’d be living in my 50s, but it’s great nonetheless. And despite world events, my own life is really good. And I’m grateful. And I need to remind myself to share that fact more often, and certainly not just on my birthday.

I’m a heart attack and stroke survivor and I’m grateful for everything I have in this world.

It’s Time to Quit the Lonely Heart’s Club

I was struck by a report yesterday in the Daily Mail about a new study that says lonely people are twice as likely to die from heart problems. You can read the report for yourself, but the study found, among other things, that:

  • Lack of social support may cause people to not take medication correctly
  • Loneliness increases people’s risk of anxiety and depression by three times
  • Approximately 42.6 million adults over 45 in the U.S. report being lonely
  • In the U.K., 3.9 million people say the television is their main source of company

Loneliness is a strong emotion and I’m not surprised it can cause health issues, but being lonely makes you twice as likely to die from heart problems? I guess you really can die of a broken heart.

“Loneliness is a strong predictor of premature death, worse mental health, and lower quality of life in patients with cardiovascular disease, and a much stronger predictor than living alone, in both men and women.” – Study author Anne Vinggaard Christensen, Copenhagen University

The caveat here is that the study looked at patients with existing cardiovascular disease, and I can tell you from experience that having a friend or partner to talk to when you have a health issue is critical. But this also speaks to finding a support network when you have a heart attack or frankly any health crisis.

Following my heart attack at age 45, I couldn’t find anyone to talk to that shared the same experience with me. There were support groups, but the most prominent one was full of patients much older than me. During cardiac rehab, I was the youngest patient by 20 years. I felt alone, which is what led me to start my own support group specifically for young heart attack survivors. The group started small, but today the Under 55 Heart Attack Survivors Group on Facebook has grown to more than 3,300 members from all over the world. The American Heart Association also has a support network.

Loneliness is a tricky thing. I can’t imagine how I’d have gotten through my health issues without the love and support of my wife and son and my extended family. I know survivors who don’t have a significant other and that fact alone can make things so much worse. There’s nobody to go with you to doctor appointments. Nobody to celebrate with when you reach a milestone. Nobody to lean on when things don’t go as planned. Being a heart attack survivor is something I deal with every day — I’m so fortunate I don’t have to deal with it alone.

That said, I probably don’t do as good a job as I should simply getting out of the house to meet with friends. Men have a harder time making close friends than women, I think. There’s something very offputting about calling up a guy you don’t know that well and asking him to join you for a ballgame or a movie. Most men, and probably a lot of women, only have a handful of really close friends. I mean, lots of people checked in on me in the days and months following my heart attack, but after a while that petered out and now I often can’t find a guy to go to a concert with or have a drink with.

It’s definitely a two-way street though. If you want friends you have to be willing to take the first step. Excuses are easy to find. Maybe he or she has young kids and you don’t. Or maybe you live just a bit too far away for it to be convenient. Or maybe you like country music and she prefers hip hop. Or maybe I’m just overthinking it!

Recently I’ve tried to push myself on this front. In the past few months, I initiated lunch with a guy I didn’t know that well. I invited a newer friend to a concert I wanted to attend. I launched a monthly book club. I’m trying.

bocci
A 2017 New York Times piece says bocce ball is the secret to living a long life

I think a lot of the difficulty stems from our busy lives in general. But I’m now at a point where I don’t have a young child in the home and I have a job that doesn’t keep me up working at all hours of the night. I do think, though, that there’s something of a societal issue going on. One-quarter of the U.S. population lives alone. And we’re working more. And if we’ve got kids we’re running them around to karate and soccer and swim practice. There’s also been a decline in civic activity in general.

In 2000 author Robert Putnam wrote Bowling Alone: The Collapse and Revival of American Community. In the book, Putnam reported that “we’ve become increasingly disconnected from family, friends, neighbors, and our democratic structures.” By this, he means we’ve stopped joining clubs and social groups. In fact, in the 25 years prior to the book coming out, Americans had a 58% drop in attending clubs, a 43% drop in family dinners and a 35% drop in having friends over. I don’t know too many people my age who are involved in Kiwanis or the Jaycees, or who participate in sports leagues or bridge clubs.

I do think there’s a growing trend in these activities among millennials and generation Z. I have some young friends at work who are in a kickball league (how very millennial). And maybe some of you are doing things and I’m just not aware. I have at least one friend who goes lawn bowling (and yes, he’s under the age of 80). I have another friend who is very active in Rotary. But in general, I think the trends outlined by Putnam haven’t changed much since 2000.

All this is to say, there’s a cure for loneliness and all it requires is for us to step out from behind the computer and go outside. And lest you think loneliness is not a health concern, this study surely proves otherwise. And for me, I just have to think about that “buzz” I have when I come home from dinner with friends or a concert with a buddy. Those are endorphins and increasing them releases stress and is good for your heart.

I enjoy alone time as much as the next guy — maybe even a little more than the next guy. But I can also tell when I’ve been hanging out by myself too much. I actually get sad and mopey. I need to remind myself to make time to engage with others in the real world.

What do you do to ensure you spend quality time with other human beings? Are you good at being the one who initiates a dinner or a coffee meetup? I’m going to keep looking for new ways to get out there and now I can say I’m doing it for my heart.

Anyone up for bocce ball?

Don’t Be Fooled by Your Total Cholesterol Number

We all know that elevated cholesterol is an indicator of heart disease risk, but the truth is most of us have no idea what our cholesterol data tells us. Even if you’ve been a good steward of your heart health and have your cholesterol checked regularly, most doctors only tell you the basic results of your blood tests — and that doesn’t tell the whole picture.

You probably know your total cholesterol level, and perhaps you even know that the Centers for Disease Control and other medical experts suggest your total cholesterol should be less than 200 mg/dL. This common wisdom also suggests that your LDL (“bad” cholesterol) should be less than 100 mg/dL, your HDL (“good” cholesterol) should be 40 mg/dL or higher and your triglycerides should be less than 150 mg/dL.

Too often we look at our total cholesterol number and if it’s under 200 we figure we’re fine. Unfortunately, I can tell you hundreds of stories about seemingly “healthy” people who had cholesterol levels under 200 and still had a heart attack. Myself included.

So if these numbers don’t tell the whole picture, what’s a better indicator of your cholesterol-related health? Well, a study published in the American Heart Association journal Circulation found that those people with the highest triglyceride-to-HDL cholesterol ratios had a sixteen times greater risk of heart disease than those with the lowest ratios.LDL-cholesteral-particle-size-matters

Why? It turns out not all LDL cholesterol is the same, so just knowing your LDL number doesn’t tell you much. In fact, LDL particle size is a much better predictor of heart disease. Some LDLs are large and fluffy while other LDLs are small and sticky. The small sticky cholesterol plays a more critical role in determining your cardiovascular health and it turns out a higher triglyceride to HDL ratio is more indicative of small sticky LDL.

The triglyceride to HDL ratio also indirectly measures insulin resistance, and that is a predictor of diabetes — and diabetes is also a major risk factor for heart disease.

Ideally, you want no more than a 2:1 ratio of triglycerides to HDL cholesterol. So, if your triglycerides are 100 mg/dl, your HDL cholesterol should be 50 mg/dl. — Dr. Stephen Sinatra, cardiologist

It turns out a better strategy for lowering your risk for heart disease is to lower your triglycerides and/or raise your HDL. Ironically, the first line of defense for elevated cholesterol recommended by most cardiologists is a statin to lower your LDL. But statins don’t affect your triglycerides to HDL ratio.

It’s also possible to get a newer type of blood test that measures particle size. The Vertical Auto Profile (VAP) test or a similar test is available at most labs and can give you a sense of whether you are one of the unlucky ones who create small sticky (known as pattern B) cholesterol. Here’s a pretty good explanation of why VAP is better. The site suggests the standard cholesterol test fails to identify as many as 60% of people who are at risk for cardiovascular disease.

Cholesterol is much more complicated than a single number. Don’t let that total cholesterol number fool you into complacency. If you have other risk factors (like diabetes, high blood pressure, elevated blood sugar, family history of heart disease) you shouldn’t assume your total cholesterol number or even your LDL number means you’re safe. Check out your triglycerides to HDL ratio and ask your doctor for an advanced cholesterol test.

Oh, and as I’ve mentioned before, if you have these risk factors you might consider having a coronary artery scan as well.

 

Heart Attack Survivors Should Embrace Prescription Drug Therapy

colors colours health medicine

It’s amazing to me how many people I’ve met in my life who complain about prescription drugs. They treat headaches with meditation, muscle pain with acupuncture and guzzle herbal tea for everything from indigestion to toe fungus. In America, measles is making a comeback because uninformed parents refuse to inoculate their kids because some quack on the Internet referenced a flawed study in a phoney medical journal. Yes, some “alternative” treatments have therapeutic value. But you’ve had a heart attack — it’s time to put your big boy pants on and take your meds. Former heavyweight boxing champion Mike Tyson famously said “everyone has a plan until they get hit.” That’s how I feel about people who refuse to take the life-saving drugs available today. Think about how lucky we are to live in a time when researchers have developed extraordinary medicines to keep us alive. There’s a reason why your grandfather died after a heart attack when he was 45 — all he had to treat his diseased heart was aspirin and Alka-Seltzer.

If you are one of those lucky people that has gotten through life having barely having to take even a simple Tylenol for a headache, congratulations. But if you’ve had a heart attack, that part of your life is over. The sooner you get over the fact that you have to buy one of those pill cases with the days of the week on them to keep track of all your medications the better. Seriously, what’s the big deal? Take your medicine.

Current treatment methodologies for heart attack patients have drastically reduced the risk of death from 30% in the 1960s to approximately 3–4% today. Part of this is due to medical advancements like angioplasty and stents, and part of it is due to the discovery of new medications. Historically speaking, it wasn’t that long ago that first-line treatment for heart disease included bloodletting or mercury.

In truth, it’s a glorious time to be alive. Medical advancements in the 20th century have had a significant impact on the health of humans and one need only look at life expectancy to see just how significant we’re talking about. At the start of the 20th century, according to the World Health Organization the average global life expectancy was 31. 100 years later, it is 65.6 and in some countries it is as high as 80. The reason for this dramatic improvement is multifold, but some of the key reasons include the eradication of infectious diseases like smallpox, polio and leprosy and the decline in deaths from diseases like measles. In fact, in just the past century science introduced vaccines against the six most deadly childhood killers (polio, diphtheria, measles, mumps, rubella, and chickenpox). Advances in childbirth safety made a huge impact too. Other important advancements included the use of randomized clinical trials, vitamin supplements, insulin treatment for diabetics, chemotherapy, x-rays, and of course the introduction of antibiotics. In the heart diseases realm, the past 100 years have seen the introduction of bypass surgery, heart transplants, and pacemakers to name a few. And in terms of noninvasive treatment, we’ve seen the development of numerous drugs to treat all aspects of heart disease.

All this is to say, depending on your specific condition, today’s medical professionals have a huge arsenal from which to choose to treat your heart disease. And yes, with many medications there are side effects, but the side effects are far outweighed by the success of these drug treatments. To be sure, some of us will experience a side effect that is too severe to live with, but even then there are both mainstream and alternative treatments.

I am now nearly six years post heart attack, and my heart is doing great; in fact, I suspect it’s in better shape today than it was before my heart attack. I attribute this to following a good diet, exercising, and taking my meds. Yeah, I had to buy two pill boxes to keep track of everything I’m taking (one for the morning and one for the evening) but what’s the alternative? I’ll tell you what the alternative is — dying.

So It’s the Kind of Protein in Red Meat, not the Saturated Fat that Kills us?

steakI have been thinking about reintroducing red meat into my diet after a decade or so of avoiding the stuff. In the ongoing saga that is my diet, I feel like I’ve finally settled into some themes about how to eat healthy — I call how I eat a modified Mediterranean diet but it has also been called Pegan. Basically, I’m all in on eliminating all processed carbs like bread as well as all added sugars while increasing my intake of healthy fats from sources like avocado and nuts/seeds. As for meat, I’ve been sticking with fish, chicken and turkey. We have the meats!

The more I eat this way, the better I feel and the better my blood test results. My triglycerides are very low (under 100 at last check) and my LDL cholesterol is well below the 70 mark recommended for heart disease patients. The “experts” I’ve been following such as Dr. Mark HymanDr. Stephen Sinatra, and Gary Taubes to name a few all suggest sugar, not fat, is the demon that causes heart disease and frankly the data is compelling. The common theme among these low carb/high fat evangelists is that red meat (and the saturated fat that comes with it) is fine.

There are good scientific and health-minded reasons to eat high-quality, organic, grass-fed, sustainably raised meat as part of an overall healthy diet. — Dr. Mark Hyman

Yes, everyone agrees plants are better for you and that they should make up the largest part of your diet, but if saturated fat isn’t bad then grass-fed red meat should be back on the plate in modest portions.

Not so fast.

new study found that eating meat regularly is associated with a 60 percent increase in the risk of heart disease, while plant-based proteins have been found to benefit the organ.

But the study doesn’t point to saturated fat as the culprit, rather it suggests there’s something troubling about the protein in meat versus the protein in plants, nuts and seeds.

“Our results suggest that healthy choices can be advocated based on protein sources, specifically preferring diets low in meat intake and with a higher intake of plant proteins from nuts and seeds,” the authors said.

This research doesn’t vindicate the anti-meat people because the argument against meat has long been about saturated fat. If true, and protein is the issue, then they have been right all along but not for the reasons they believe.

The saturated fat debate is far from over. Both sides make compelling arguments based on real research. Personally, I’m not willing to risk it by introducing saturated fat to my diet when I haven’t been eating it for years. No butter, no red meat, no coconut oil.

But I was, as I mentioned above, considering adding back in a little grass-fed beef to mix things up. Hey, I haven’t had a good burger since the George W. Bush administration.

Thanks for nothing Loma Linda University School of Public Health, AgroParisTech, and the Institut National de la Recherche Agronomique!

The Best Post Heart Attack Diet and How it Can Also Prevent a First Heart Attack

I can say with no uncertainty that the fastest way to get into an argument with a bunch of heart attack survivors is to discuss diet. Seriously, you’re better off discussing politics or religion. I think the reason for this is quite simple — nobody really knows the best way to eat to prevent heart disease, the number one cause of death in the world.

Well, that’s not entirely true. I don’t think anyone would argue that a truly healthy diet is mostly focused on fruits (providing you are not diabetic) and vegetables. And while we can argue about the merits of measuring glycemic load vs glycemic index, or whether juicing fruit removes too many of its healthy properties, fruit is healthy for most people and it is part of a balanced diet.

But that’s where the agreement ends and zealotry begins. For every diet “expert” on the Internet that claims fat will kill you there are an equal number who tell you fat is our friend. Should we eat meat? Just white meat? Just fish? And what about carbs? Simple or complex? Gluten or gluten-free? And just what the hell is a FODMAP?

For each style of eating there’s a diet out there that helps you meet these typically strict requirements. U.S. News and World Report recently published its 2018 ranking of diets, and they looked at no less than 40 popular diets. Some you’ve likely heard about, like the Mediterranean Diet, Weight Watchers, and the Zone Diet. Others sound flat out made up, such as the Nutritarian Diet, the Volumetrics Diet, and the Flexitarian Diet. And of course there are the “hot new trend” diets like the Whole30 Diet, the Engine 2 Diet, and the suddenly everywhere Keto Diet.

But back to my fellow heart attack survivors. I run a support group for heart attack survivors on Facebook and whenever diet comes up the same thing happens — everyone chimes in that their diet is best and if you don’t eat this way you’ll die. And they usually point to legitimate studies to support their view. And that’s the real problem. Many of these diets will improve your overall health, but in some cases the diets themselves contradict each other.

For example, one popular diet among the heart attack crowd is the Esselstyn Diet, which purports to prevent and reverse heart disease. Holy crap, shouldn’t we all be on this diet? Dr. Esselstyn argues that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects. On his diet, you’ll also need to eliminate nuts/nut butters and saturated fat, but you can increase whole grains. Hot dog buns yes, hot dogs no? And beware of the vegan police!

Then there’s the Keto diet, which argues you can have all the meat you want, plenty of high fat dairy, nuts and other fats but stay away from grains, fruits and sugar. Lamb chops yes, apples no?

Which diet is right? Can they both be right? Well, that’s a tough question. Both diets will undoubtedly lead to weight loss, but I’m interested in heart disease prevention. Which is it, bread or no bread? Fat or no fat? Apples or no apples? Trying to figure this out is enough to cause a heart attack!

For what it’s worth, U.S. News and World Report ranked the Keto Diet 35th out of 40 for best heart-healthy diet and dead last in overall diets, for the most part because it’s hard to follow and the data is not in yet on this relatively new diet (although it sounds an awful lot like the old Atkins Diet to me).

U.S. News selected the DASH Diet tops overall and for heart health. This diet focuses on lowering blood pressure, emphasizes fruits, veggies, whole grains, lean protein and low-fat dairy, and suggests you avoid foods high in saturated fat such as fatty meats, full-fat dairy foods and tropical oils, and sugar-sweetened beverages and sweets. Hmmm. This sounds familiar — eat your fruits and veggies and lay off the fat and sugar. A little lean protein and dairy is okay.

Here’s my take — as long as the jury is still out scientifically on “fad” diets like Keto or ultra-specific diets like Essylstyn and its little brother the Engine 2 Diet, I’m going to stick to the basics. I try to eat a Mediterranean Diet, which has been proven to lower the risk for heart disease. It’s also easy to stick to and gives you flexibility. And it aligns nicely with the mantra espoused by writer and journalist Michael Pollan, who famously wrote about his seven word diet: eat food, not too much, mostly plants.

Am I eating in the best way possible for my heart? I don’t know and I don’t think the medical community knows. But my post heart attack health speaks for itself. I had a recent angiogram that showed very little plaque buildup in my arteries and my blood work would make a healthy person jealous. Cholesterol is under 100. Triglycerides at 85.

I eat a diet rich in fruits and veggies, lean poultry, fish, healthy fats (think avocado and olive oil) and small amounts of whole grains. I avoid added sugar as much as possible. Wonder Bread no, Ezekiel Bread yes. It seems to be working for me. Is this a Mediterranean Diet, or the DASH Diet, or the Michael Pollan Diet, or the “Pegan” Diet?

Yes.

You Are What You Eat

fatsickandnearlydeadLong before I suffered a heart attack I had been thinking a lot about food and its relationship to health. I had good reason to learn more about food as my cholesterol, triglycerides and blood sugar were elevated due to a combination of genetics, inconsistent activity levels and an undying love of pizza. So I started doing research on how to naturally lower these signs of impending crisis and each time the path led back to the same place — food.

Flash forward to last night and here I am again watching a documentary about food and health, this time at a special screening of Fat, Sick and Nearly Dead at a local restaurant called Pomegranate Cafe. And just like all the others, the premise involves eating fruits and veggies. Hmm. Maybe it’s true that 50 million Elvis fans can’t be wrong.

Here are just some of the films I’ve seen and books I’ve read over the past few years that preach the gospel of healthy eating:

I’m sure you can find tons more, but these are some of the popular ones. The thing is, so much research (both scientific and anecdotal) points to the plain fact that food can make us sick and conversely food can heal. You don’t have to believe it, or even care, but that doesn’t make it not true. What would it take for you to change the way you eat?

What of you had a heart attack? Would you change the way you eat, or would you continue the unhealthy lifestyle that made you susceptible to heart disease in the first place? It’s not an easy answer. In the months since my heart attack I have run into all types of survivors — those who don’t change because they either don’t care about living or they think it’s too hard to those, like me, who are willing to make a radical change in hopes of not only living longer but being healthy enough to enjoy that longevity. For me it’s a no brainer, but I understand the other side.

Changing my diet was really hard at first, and not just because I missed regularly having a couple of slices at NYPD Pizza. The hardest part has been eating at restaurants. I’ll tell you what’s not hard — eliminating most animal products. I have been mostly vegetarian for years (I continue to enjoy seafood) and truthfully I don’t miss the meat. Yes, every once in a while I dream about a Double Double, but it passes and those cravings happen less and less. I’m even thinking being vegan or raw wouldn’t be too hard since I’m almost there already. Limiting fat and cholesterol is simple, especially if you eat mostly vegetarian anyway.

Unfortunately for me, my heart was damaged by my heart attack and if I want to take care of it — permanently — I need to severely limit sodium. This has been the hardest thing for me, and not because I crave the taste. It’s hard because sodium is everywhere and often in places you least expect it. I won’t go into detail on why sodium is so bad for heart patients, but suffice it to say sodium makes you retain water and retaining water makes your heart pump harder. When your heart pumps harder, it will naturally enlarge and that would exacerbate my damage and inevitably lead to heart failure. How much sodium are we supposed to eat? The recommended daily allowance for a healthy person is 2500 mg. For someone like me, I need to stay under 1500 mg. I am currently eating between 1000-1500 mg per day. To give you an idea of what that means, a single teaspoon of table salt? There is around 2500 mg in a teaspoon of salt. A typical slice of pizza? 700 mg. How about a “healthy” meal at a “healthy” restaurant? A small Greek salad at Pita Jungle has 940 mg of sodium.

So you can see eating at restaurants is a challenge for me. But it’s worth the hassle given my condition. If you don’t have a heart condition, changing your diet is a breeze. But even keeping to the RDA is tough for a healthy person. A single portion of lasagna classico at Olive Garden contains 2830 mg of sodium. Holy salt lick Batman!

Why wouldn’t you change your diet? It’s so easy and the evidence is so clear. I know, you love a good steak. Enjoy, but why not consider making small steps in the right direction? Michael Pollen says it best. When asked how to dig through all the hype and misinformation he says, simply:

Eat food. Not too much. Mostly plants. 

In case you’re confused, by suggesting we “eat food” he’s basically saying to eliminate anything processed, chemical, manufactured, toxic, etc. Broccoli is food.  Methylchloroisothiazolinone is not.